Do you remember your first anesthetic? My first anesthetic was one that I received for an inguinal hernia. It was late summer, in 1971. My family had been in Mainz, Germany, where my father had been teaching anesthesiology at Gutenberg University. He was also studying the trauma ambulance system there, but that is another story.
While in Germany, I was in the sixth grade. Sometime during that year, I developed an indirect inguinal hernia. It was always easily reducible, so we waited until we were back home in the U.S. to have it repaired. The surgery took place in that summer between sixth and seventh grades.
The reason I bring up this procedure, and its anesthetic, is that it was the beginning of the practice of outpatient surgery back then. For many years, we in the medical field have allowed patients the comfort of spending the night before their day surgical procedure at home, in a familiar environment. We have trusted that they have followed the NPO requirement and have provided them with safe anesthesia. Back in 1971, 11-year-old patients, and their parents, even if one was an anesthesiologist, could not be trusted to maintain appropriate NPO status the night before a surgical procedure. Thus, I spent the night prior to my inguinal hernia repair in the hospital, sharing a room with another boy who was also going to have surgery the next day.
Now back to my recollection of that event. The surgeon who took care of me lived right across the street from us. His daughter was my sister’s best friend. A well-known, highly skilled anesthesiologist provided my anesthesia. He lived right around the corner from my childhood home. His son was my best friend. Anyway, I recall lying on the operating room table, breathing through a facemask. After a few breaths, none of which I remember as being unpleasant, I was beginning to process reality differently. Those doctors and nurses in the room who stood over me looked bizarre. In my peripheral vision, their bodies were as thin as pencils. Yet directly above me, their heads were enormous caricatures, bigger than a Halloween pumpkin. The next thing I knew, I had awakened in the recovery room. The sound of a baby crying in the bed next to me had stirred me from the last vestiges of anesthesia.
It was not too long before I was returned to my room. Then began the typical day surgery demands. I could not leave until I was able to tolerate oral fluids. So the nurse brought me a lemon-lime soda. I’m sure I would have preferred Dr Pepper, but it likely wasn’t available in the hospital. Once I had the fluid down, the next expectation was soon to be realized – I had a full bladder and needed to empty it.
I pressed the call button and asked for some assistance to the bathroom. You see, my incision was now quite painful, and for several minutes I had already been trying to get out of the bed and walk to the bathroom. The nurse would neither bring me pain medication nor assist me to the bathroom. I don’t recall her exact words, but she likely thought that she was being encouraging. I certainly hope that when she spoke that way it wasn’t because she did not want to be bothered. So I eased myself out of the bed, and because it was too painful for me to stand up and walk, I crawled on my hands and knees into the bathroom. It is needless to say that that position was not a good start to figuring out how to ascend the toilet.
After emptying my bladder I was discharged home (or at least to my grandmother’s home, where we were staying for the time being). I figured if they weren’t going to give me any pain medicine, I might as well be home. At least I would have Dr Pepper there.
And so concluded my first experience with outpatient anesthesia. Some of what I experienced still happens these days, though having been through it myself, now three more times, it is my desire to have patients leave the hospital with a lower pain score than I had back in 1971. Our induction agents have improved, and when appropriate, we are providing anxiolysis before taking a patient into the operating room. Maintenance anesthetics provide a clearer-thinking patient sooner after emergence than back then. And we have a multitude of options for perioperative analgesia. Thus, even though the mechanics of an inguinal hernia repair are roughly the same as they were 42 years ago, we have the ability to provide a better anesthetic and a better total perioperative experience.
What has changed is the fact that we are now providing general anesthesia in other, truly ambulatory locations, such as dental offices, ophthalmological suites, etc. Some of those off-site areas don’t even have a wheechair available. And it has been the development of better, safer anesthetics and monitoring that has made it possible for us to practice in this manner.
Even so, we must never let down our guard. We must continue to advocate for the safety of our patients. We must be proponents for our guidelines, so that every patient who receives a general anesthetic, whether in a hospital, outpatient surgery center, endoscopy suite or physician’s office, receives the benefit of the sum of our past experience.