What Happens When You're Under Anesthesia?

Summary

Short Wave – "What Happens When You're Under Anesthesia?"

Date: October 15, 2025
Host: Emily Kwong (NPR)
Guest: Dr. Alopi Patel (Anesthesiologist)

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Episode Overview

This episode of Short Wave dives into the science—and art—of anesthesia. Host Emily Kwong interviews Dr. Alopi Patel, an anesthesiologist known for her compassionate “verbal anesthesia,” to demystify what happens to a patient’s mind and body when they’re “put under,” trace the history of anesthesia from its controversial beginnings, and discuss the immense responsibility anesthesiologists shoulder as trusted guides during surgery. The episode balances approachable analogies, personal stories, and nerves-soothing wisdom for anyone anxious about going under anesthesia.

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Key Discussion Points & Insights

Preoperative Patient Care and "Verbal Anesthesia"

• Personal Touch in the O.R.:
  • Dr. Patel describes how she creates a comforting atmosphere for patients before they go under, using guided imagery, favorite music, and humor.
    • “Okay, so while you're sleeping, we're going to go on vacation. Where do you want to go? Tahiti. Ooh, I like Tahiti.” (Dr. Patel, 00:46)
  • This approach puts patients at ease and is dubbed “verbal anesthesia.”
    • “It's a type of anesthesia you can't really put in an IV. It's being able to comfort a patient and help them anticipate what to expect next.” (Dr. Patel, 02:15)

What Is Anesthesia and How Does It Work?

• Types of Anesthesia (02:22–03:13):
  • General: Loss of consciousness, often involving a breathing device.
  • Sedation: Patient can breathe independently.
  • Regional: Numbs a limb or body section.
  • Local: Numbs a small, specific area.
  • Anesthesia is described like a recipe, mixing medications such as propofol, lidocaine, and opioids, tailored to each patient and procedure.
    • “Most recipes, you need the same ingredients...but the amount you’re making depends on how many people you're making it for.” (Dr. Patel, 02:52)
• Necessity for Modern Surgery: Enables complex surgeries—brain, cardiac, abdominal—by keeping patients unconscious and pain-free.

Brief History of Anesthesia

• Origins (04:54–06:39):
  • Began mid-1800s with chloroform, ether, and nitrous oxide.
  • First demonstration: William Morton at Massachusetts General Hospital (1846), now celebrated as World Anesthesia Day.
  • Societal resistance: For childbirth, pain relief was stigmatized until Queen Victoria famously used chloroform.
    • “She essentially legitimized it—that you can have childbirth with a pain-relieving substance.” (Dr. Patel, 06:39)

Anesthesia’s Effects on the Body and Brain

• Physical Impacts (07:08–08:02):
  • Alters heart rate, blood pressure; targets brain and heart for protection.
  • Metabolized by kidneys, liver, or exhaled via lungs (inhaled anesthetics).
• Nervous System Effects (08:02–09:10):
  • Activates “airplane mode” for the brain:
    • “When you're awake, your brain waves are going fast... when you get anesthesia, the brain waves come down—slower and more relaxed.” (Dr. Patel, 08:37)
  • Suppresses sensation of pain and creates a controlled “coma” state where incisions can be made without the patient feeling or remembering it.
• Analogy between Anesthesia and Local Numbing:
  • Local anesthetics: Block communication (pain signals) entirely.
  • General anesthesia: Suppresses sensation overall, doesn’t fully cut off messages but dampens their impact.

Key Properties: Memory Loss, Not Sleep

• No Memory Formation (10:22–10:43):
  • “Most of the time you won’t remember anything... If we do everything just right, most patients will not remember anything from their anesthetic.” (Dr. Patel, 10:26, 10:43)
• Difference from Sleep (10:45–11:19):
  • No REM cycles, no true restorative sleep; more a state of unconsciousness, not dreaming.

The Emotional and Ethical Weight of Anesthesiology

• Responsibility and Human Connection (11:19–12:02):
  • Dr. Patel stresses the privilege and responsibility of guiding patients through such vulnerable moments.
    • “It is such a privilege to be with patients at that time. I think it is one of the most vulnerable times for most patients.” (Dr. Patel, 11:30)

Memorable Story from the O.R. (12:15–13:37)

• Dr. Patel recounts a high-risk case involving a nervous patient with blood clots.
  • She connected by staying with the patient, playing her favorite music (Yanni), and offering comfort throughout the fast-paced surgery.
  • “It is such a big part of the patient experience to be there as a human next to that person and not just a face peering down... That human aspect...is why I love this field.” (Dr. Patel, 13:29)

Advice for Anxious Patients (13:44–14:36)

• Be Honest: Always tell your anesthesiologist the truth about food, medications, recreational drug use, etc., for safety—not judgment.
  • “We want to know, when did you eat last?... Be honest with your anesthesiologist is the most important.” (Dr. Patel, 13:44)
• Anesthesia is Safer Than Ever: Advances in monitoring and physician training make it extremely safe today.

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Notable Quotes & Memorable Moments

• On Verbal Anesthesia and Comfort (02:15):
  “It's a type of anesthesia you can't really put in an IV. It's being able to comfort a patient and help them anticipate what to expect next.” — Dr. Alopi Patel
• On History and Queen Victoria (06:39):
  “She essentially legitimized it—that you can have childbirth with a pain-relieving substance.” — Dr. Alopi Patel
• On Anesthesia’s Mental State (08:37):
  “When you get anesthesia... the brain waves come down, they're slower and they're more relaxed—it just kind of creates this zen sort of mode for the brain or like an airplane mode.” — Dr. Alopi Patel
• On the Patient Experience (13:29):
  “It's such a big part of the patient experience to be there as a human next to that person and not just a face peering down... That human aspect of anesthesiology is why I love this field.” — Dr. Alopi Patel

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Timestamps by Segment

| Timestamp | Segment | |-----------|-----------------------------------------------------| | 00:24 | Entering the O.R., Dr. Patel’s comforting approach | | 02:22 | Types of anesthesia explained | | 04:54 | Brief historical origins of anesthesia | | 06:04 | Childbirth and Queen Victoria’s influence | | 07:08 | What anesthesia does in the body | | 08:02 | Anesthesia’s effect on the nervous system | | 10:22 | Why you don’t form memories under anesthesia | | 10:45 | How anesthesia differs from sleep | | 11:19 | The emotional responsibility of anesthesiology | | 12:15 | Dr. Patel’s memorable patient story | | 13:44 | Advice for anxious patients: Be honest! |

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Tone and Style

The episode is warm, conversational, and reassuring, blending scientific clarity with a human touch. Both Dr. Patel and Emily Kwong use analogies (cooking, pinball machines, airplane mode) and humor (dreaming about guava margaritas) to make complex information accessible and relatable—without downplaying the seriousness or responsibility the field requires.

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Summary

This insightful and compassionate episode gives listeners a front-row seat to what really happens under anesthesia—biologically and emotionally. Dr. Patel demystifies the process with relatable analogies and moving stories, affirming that anesthesia’s safety rests on both advanced science and the deep empathy of practitioners. For anyone facing an upcoming procedure, the message is clear: trust, honesty, and human connection are just as important as the medicines themselves.

Transcript

[NPR Announcer]

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[Dr. Alopi Patel]

Hi, my name is Dr. Patel, and I'm the anesthesiologist. And we're going to go into the operating room now. So the room might be a little cold. There might be a few people here, and I also have a few people.

[Emily Kwong]

This is what you'd hear in surgery if Dr. Alopi Patel was your anesthesiologist. When she puts patients under, she tries to explain everything as it happens so patients know what to expect.

[Dr. Alopi Patel]

Okay, so while you're sleeping, we're going to go on vacation. Where do you want to go? Tahiti. Ooh, I like Tahiti. So we're gonna go to Tahiti. We're gonna go to Bora Bora in Tahiti. And we're sitting on the beach.

[Emily Kwong]

She'll put on your favorite music and continue this guided vacation imagery meant to put you, as the patient, into a relaxed state.

[Dr. Alopi Patel]

We're sitting on the beach, putting our toes in the sand. And are we. Do you want a margarita? A mojito? What are we drinking today?

[Emily Kwong]

Yeah, margarita.

[Dr. Alopi Patel]

Salt or no salt?

[Emily Kwong]

Margarita on the rocks.

[Dr. Alopi Patel]

Salt?

[Emily Kwong]

Yeah.

[Dr. Alopi Patel]

What type of flavor are we doing?

[Emily Kwong]

Alopi then begins a process called induction, using medication to induce a state of unconsciousness.

[Dr. Alopi Patel]

I'm gonna put this mask on your face. It's gonna be a little tight. Pretend this is fresh oxygen from Tahiti. We just imported it. Right? So taking deep breaths in and out. And I'm gonna start giving you some medication in your vein. And as I'm giving that iv, you're gonna feel me rubbing on the other hand. And that rubbing is gonna make you feel better. And slowly, you'll start feeling warmer and warmer. Pretend you're putting your toes in the sand, sipping those margaritas, and soon you'll be off to sleep.

[Emily Kwong]

Mostly because of the cocktail of anesthetics delivered through IV or inhaled as gases. But Alopi says there is tremendous power, too, in her words. She calls this part of her job verbal anesthesia.

[Dr. Alopi Patel]

And it's a type of anesthesia you can't really put in an iv. It's being able to comfort a patient and help them anticipate what to expect next.

[Emily Kwong]

Anesthesia literally means without sensation or feeling. But different types of anesthesia can do different things. General anesthesia involves losing consciousness. You often have a breathing device during those procedures. Sedation is anesthesia, where you can breathe on your own. And regional anesthesia is when one part of the body gets numb, like a leg or an arm, while local anesthesia is just numbing in one specific area. And all of that can be done with different medications. Alopi describes the operating room as her kitchen.

[Dr. Alopi Patel]

Most recipes, you need the same ingredients. If you're making something like banana muffins, right. But the amount you're making depends on how many people you're making it for. Do you want something more salty or sugary? Whatever.

[Emily Kwong]

But instead of flour or sugar, Alopi is using different anesthetics like propofol, lidocaine, and different opioids. Anesthetics like these make all kinds of.

[Dr. Alopi Patel]

Surgery possible, brain surgery, back surgery, heart surgery. You would not be able to do any of these surgeries, abdominal surgeries, without having leaving the patient completely asleep and paralyzed or their muscles relaxed for the procedure.

[Emily Kwong]

Today on the show, we go into the operating room and under the sway of anesthesia, how this once controversial procedure became a cornerstone of modern medicine. I'm Emily Kwong, and you're listening to Short Wave, the Science podcast from NPR.

[NPR Announcer]

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[Dr. Alopi Patel]

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[Emily Kwong]

Okay, Alopi, let's talk about anesthesia's history. When did people start using it and what kind of chemicals were most popular Back in the day?

[Dr. Alopi Patel]

Yes, the traditional sort of history of anesthesia kind of starts around the mid-1800s. So the most popular form of anesthesia that was studied at that time was chloroform. So ether was another one. And nitrous oxide. They're all various sort of inhaled anesthetics that can. That can knock out a patient. The first successful demonstration of anesthesia was in 1846, and this was done by William Morton. William Morton was actually a dentist who was experimenting with different types of anesthesia. And ether was the one that he successfully demonstrated. The day that he successfully demonstrated anesthesia was October 16, 1846, in the ether dome in Massachusetts General Hospital in Boston. And that is now called World Anesthesia Day.

[Emily Kwong]

How was anesthesia used or not used for people giving birth back in the day? And how has that history evolved?

[Dr. Alopi Patel]

So Queen Victoria actually had many children. For almost all of her children, she did not have any anesthesia. There was stigma back in the day about women having pain relief during labor and delivery because it was expected for a woman to suffer during childbirth, because it was God's intention, right? For the pain to be unsufferable, to be able to have a child. And it wasn't until Queen Victoria herself asked to have chloroform for her eighth baby or something, she was like, give.

[Emily Kwong]

Me some of that good stuff. I am the queen.

[Dr. Alopi Patel]

And she essentially legitimized it that you can have childbirth with a pain relieving substance. And since then, we've come so far in obstetric anesthesia in terms of spinal anesthetic, epidural anesthesia for pain relief.

[Emily Kwong]

Wow. Okay, so let's accompany you now through this process, starting from when a patient is being induced and the anesthetic starts entering their system. What is anesthesia doing to the body?

[Dr. Alopi Patel]

So depending on the types of anesthetics, it can affect their heart rate, it can affect their blood pressure, it can affect different types of blood flow.

[Emily Kwong]

Right.

[Dr. Alopi Patel]

So when the blood pressure goes down, it can affect the blood flow to the brain, to the heart. We care about all the organs, but really the brain and the heart are the two most important organs that we really think about, because we don't want, you know, too little oxygen to be in the brain or the heart. So once the anesthesia enters the system, it's essentially just going in the bloodstream, traveling all across the body, and then being metabolized. It could be metabolized by the kidneys, the liver, and then inhaled anesthetics are metabolized through the lungs, and then you breathe them out.

[Emily Kwong]

Okay. What is anesthesia doing to your nervous system?

[Dr. Alopi Patel]

So anesthesia in general creates this very relaxing effect, right? So it creates a slowing down of your nervous system. So you have your Parasympathetic nervous system and your sympathetic nervous system, your sympathetic is your fight or flight. Right. So your, your go go going. Anesthesia essentially relaxes the body so it can help decrease the heart rate, it can help decrease the blood pressure and create a relaxation in the brain as well. So when you're awake, your, your brain waves are, are going fast, right? So they're just kind of go, go, going at a higher speed.

[Emily Kwong]

It's like a pinball machine over there.

[Dr. Alopi Patel]

Yes. So the waves are just going. When you get anesthesia, IV or inhaled anesthesia, the brain waves come down, they're slower and they're more relaxed and it just kind of creates the Zen sort of mode for the brain or like an airplane mode. Right. Where things are just kind of low energy and able to be relaxed. And during that, that induced coma or controlled coma, significant surgical incisions or surgical stimulus can be done without the brain and the body feeling. It's.

[Emily Kwong]

So the messages like, are they just not getting through? Is it kind of like your, your body's like pain, pain, pain, but then the receptors are like eh, we're just gonna ignore that message? Like what's happening kind of.

[Dr. Alopi Patel]

Yeah, it doesn't cut off communication necessarily. That would be something like a local anesthetic. Right. So a local anesthetic does cut off communication where it just doesn't allow that pain signaling to go through. But a anesthetic, like an IV anesthetic or an inhaled anesthetic just kind of relaxes it. So you, you don't really have that stimulation as much and it creates this low energy mode, essentially that airplane mode where you just don't feel it as much. If there's significant enough pain, you can definitely feel it, but you won't recall it. And that's another important aspect of anesthesia. Right. So there's anesthesia, which is that not feeling sensation, analgesia which is not feeling pain, muscle relaxation and then memory loss. Right. So when you have anesthesia, your body is not feeling certain things. When you have the pain medications, you're creating that pain free state, muscle relaxation, which is muscle relaxants. And then memory recall. You're not going to recall anything either.

[Emily Kwong]

I didn't know you can't form memories under anesthesia.

[Dr. Alopi Patel]

Yeah, most of the time you won't remember anything. So we call that recall in anesthesia. So if we, if we do that recipe just right in the kitchen of the, of the operating room, basically, if we do everything just right, most patients will not remember anything from their anesthetic yeah.

[Emily Kwong]

How is anesthesia different from sleep?

[Dr. Alopi Patel]

So that's a great question. Sleep has its own sort of neurochemistry and physiology, and there are REM waves associated with it. You can have dreaming associated with sleep, but anesthesia, you can sleep for five minutes and feel like you got the most restful sleep, but you didn't actually go into REM sleep. It's more of, like this state of unconsciousness. And you might feel relaxed, but it is different than true sleep. You're not having the same brainwave changes and you're not necessarily having the same dreams that you would under natural sleep state.

[Emily Kwong]

That must feel like at once very powerful, but also a big responsibility that you are, like, guiding people through something that is so. They're so vulnerable in those moments.

[Dr. Alopi Patel]

Absolutely. And it is such a privilege to be with patients at that time. I think it is one of the most vulnerable times for most patients. Right. To feel like, okay, I am not going to have sensation or power or autonomy over my own body. And you're giving it to the hands of the anesthesiologist at that time. And it's a powerful place to be in, but also a very important position to really be able to empower and identify the concerns that your patient has.

[Emily Kwong]

Wow. Can you tell me a story about a time you were monitoring a patient under anesthesia that just stays with you, that taught you a lot or stayed with you for whatever reason? Do you have a story like that?

[Dr. Alopi Patel]

Absolutely. I have one story that I can think of that really resonated with me about this is why I wanted to do anesthesiology and be an anesthesiologist. There's this very high risk patient that needs surgery ASAP for hematoma, which is a blood clot, but she also has a massive blood clot in her lungs. So that's a very tricky situation to be in. The patient was already very nervous, and I was able to connect with the patient. I said, hey, you have a blood clot. We have a couple options. I'm going to talk to the surgeon as soon as they get here, and we're going to see how we can do this. And I spoke to the patient the entire time. We put on her favorite music, which was. It was Janni. I had never heard of him. It was like a Greek musician.

[Emily Kwong]

I know Yanni.

[Dr. Alopi Patel]

And it was my first time listening, but very spirited. Very. Yeah. And, you know, we just listened to music and I held her hand and I sat with her. And the surgeon did his stuff as fast as he could to evacuate the hematoma. We stabilized, put on pressure dressing, all of that stuff and the patient was so grateful. It is such a big part of the patient experience to be there as a human next to that person and not just a face peering down like that. Human aspect of anesthesiology is why I love this field.

[Emily Kwong]

What would you say to someone who maybe has an upcoming procedure where anesthesia will be involved and, and let's say this person's nervous. What would you say to them?

[Dr. Alopi Patel]

Absolutely. So always be honest with your anesthesiologist is what I would say. Your anesthesiologist and your grandmother have one thing in common, which is we want to know, when did you eat last? Because we want to make sure that, you know, you have a, you can have a safe anesthetic on an empty stomach, as we say. But really be honest with your anesthesiologist is the most important.

[Emily Kwong]

Don't lie.

[Dr. Alopi Patel]

Do not lie. Whether it's whether you used cocaine or marijuana or we do not judge. We are there to protect you and to help you. And also it's super safe. Anesthesia has evolved so much over the last 30 years, especially since the, since the invention of certain monitors for like heart rate and oxygen. Anesthesiologists are trained physicians with thousands of hours of care and we're here to help you and walk you through the process.

[Emily Kwong]

Alopi Patel, thank you so much for talking to me and I hope if I ever have to go under, you.

[Dr. Alopi Patel]

Are my anesthesiologist, it would be my honor.

[Emily Kwong]

We go to Hawaii, girl We would get away. We'd get away.

[Dr. Alopi Patel]

Guava margaritas.

[Emily Kwong]

This episode was produced by Rachel Carlson and edited by Burleigh McCoy. Tyler Jones checked the facts. Jimmy Keeley was the audio engineer, Beth Donovan is our senior director and Colin Campbell is our senior Vice President President of podcasting strategy. I'm Emily Kwong. Thank you for listening to Short Wave, the science podcast from npr.

[Dr. Alopi Patel]

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