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What Anesthesia Can Teach Us About Consciousness

More than a decade ago, a 43-year-old woman went to a surgeon for a hysterectomy. She was put under, and everything seemed to be going according to plan, until, for a horrible interval, her anesthesia stopped working. She couldn’t open her eyes or move her fingers. She tried to breathe, but even that most basic reflex didn’t seem to work; a tube was lodged in her throat. She was awake and aware on the operating table, but frozen and unable to tell anyone what was happening.
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Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge. Postoperative pain is the most common reason for delay in discharge and unplanned hospital admission after ambulatory surgery. 1–3 Because postoperative pain is to a large extent an inflammatory phenomenon, administration of systemic local anesthetics, which have inflammatory modulatory properties, 4 could significantly reduce pain and therefore allow more rapid discharge. 5 Lidocaine has an excellent safety record when administered by low-dose infusion. 5–7 However, whereas decreased hospital stay after inpatient surgery has been demonstrated, the effect of intraoperative and early postoperative lidocaine infusion on duration of stay after ambulatory surgery is not known. Although it see...

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