Sean Mackey, M.D., Ph.D.

Yeah, yeah.

Yeah, yeah.

Yes. I believe firmly it is, and I'm a recovering anesthesiologist. I haven't done it now in... Oh gosh, 20 years. But when I did it, and when you were operating on a patient, the patient is unconscious. They are not experiencing pain. You need a conscious brain for the experience of pain.

Yes. I believe firmly it is, and I'm a recovering anesthesiologist. I haven't done it now in... Oh gosh, 20 years. But when I did it, and when you were operating on a patient, the patient is unconscious. They are not experiencing pain. You need a conscious brain for the experience of pain.

Now what people incorrectly made the leap of is thinking, well, they're not experiencing pain, so everything's okay. That would be a logical fallacy because all those signals are still coming from the body. still hitting the spinal cord and having their impact there, all those injury signals, because let's face it, when you do surgery, it's really nothing more than a controlled injury.

Now what people incorrectly made the leap of is thinking, well, they're not experiencing pain, so everything's okay. That would be a logical fallacy because all those signals are still coming from the body. still hitting the spinal cord and having their impact there, all those injury signals, because let's face it, when you do surgery, it's really nothing more than a controlled injury.

We still are trying to unlock the whole consciousness aspect of things, but we're inching our way there. But it wasn't enough to give that.

We still are trying to unlock the whole consciousness aspect of things, but we're inching our way there. But it wasn't enough to give that.

Exactly. Muscle relaxation.

Exactly. Muscle relaxation.

Part of the challenge was, and now I'm starting to step outside of my wheelhouse, even though I was a member of the anesthesia tribe for a long time, is the levels of volatile gas anesthetic that you need to necessarily obliterate reflexes and full nociceptive impulses would be so high that it would depress one's blood pressure. And so you augment that with an opioid. Understood.

Part of the challenge was, and now I'm starting to step outside of my wheelhouse, even though I was a member of the anesthesia tribe for a long time, is the levels of volatile gas anesthetic that you need to necessarily obliterate reflexes and full nociceptive impulses would be so high that it would depress one's blood pressure. And so you augment that with an opioid. Understood.

like fentanyl, like morphine, like whatever, and you combine those together, and that's why what the anesthesiologists do is quite magical.

like fentanyl, like morphine, like whatever, and you combine those together, and that's why what the anesthesiologists do is quite magical.

They're working synergistically, and they're working at different mechanisms. Got it. And during that process, the patient is not feeling pain, If they're unconscious, because you do need a conscious, working, aware brain to feel pain, but all of the electrical impulses coming in from the body that are slamming into the spinal cord and the brain are open full bore.

They're working synergistically, and they're working at different mechanisms. Got it. And during that process, the patient is not feeling pain, If they're unconscious, because you do need a conscious, working, aware brain to feel pain, but all of the electrical impulses coming in from the body that are slamming into the spinal cord and the brain are open full bore.

They're impinging on all those brain systems responsible for stress responses.

They're impinging on all those brain systems responsible for stress responses.

Yes. And in response to nociception. independent of perception of pain. Right. And you notice that I'm trying to be precise in my language here, because since they're unconscious, there's no pain, but there's plenty of nociception.

Yes. And in response to nociception. independent of perception of pain. Right. And you notice that I'm trying to be precise in my language here, because since they're unconscious, there's no pain, but there's plenty of nociception.