Lee Corbin writes:

> It's interesting that during an operation, while the patient is well and
> truly unconscious, the same physiological response to a painful stimulus is > seen as in an awake person: when the surgeon makes the first incision, heart
> rate and blood pressure immediately rise. If you give the patient more
> opioid analgesic (like morphine or fentanyl), this response is attenuated - > again, just as in an awake patient with pain who is given opiods. Another
> strategy is to use local anaesthetic in conjunction with the general
> anaesthetic, so that the part of the body the surgeon is working on is numb.
> It sounds silly: why would you want to make it numb when the patient is
> unconscious? The reason is, as you [Pete Carlton] suggest, because of the
> associated physiological response to painful stimuli which is present
> even when there is (presumably!) no conscious experience of pain.

I'm glad that even the appearance of pain in an unconscious patient
is disturbing to physicians. That's very good. For the body to be
experiencing pain---and presumably sending pain signals to the brain
---too closely resembles pain being experienced but with no memory
trace being left.

The main reason for giving opiods when the vital signs are affected as if the patient is in pain is not because we believe the anaesthetised patient is actually in pain, but because it imposes a physiological stress which could cause the patient physical harm.

It may also reassure you that in the worst possible case - the patient is actually awake, but paralysed - the pain experienced is nowhere near what you would imagine a fully awake person with no drugs on board would experience. I once met a young girl, about 10, who had apparently been awake during the first part of a cardiac operation, when her chest was being cut open with an electric saw. What does it feel like when your chest is being cut open with an electric saw? It is "an itchy, scratchy sort of feeling." Thank God for fentanyl!

P.S. How about this?  You get to create a person from whole cloth
down in your torture chamber, and give him the most wonderful
conceivable experiences. He or she manages to pack in more benefit,
thrills, joy, exuberance, zest for life, satisfaction, and contentment
than any hundred normal people all put together.

There is just one catch: since you like killing people, you have
him painlessly put to sleep when he's 20.

Is this pastime you so enjoy down in your torture chamber a good
or bad thing?  Is it right to do this?

It's a very bad thing. As I have said before, the prospect of death is in itself bad, even in the absence of pain. It is why I would not be happy with the idea of dying even though a relatively recent backup of my mind has been made. The backup would have to be current up to a fraction of a second, such as would be the case if one or more copies of my mind were being run in parallel. If I died then, I would lose no experiences, so it wouldn't really be dying.

--Stathis Papaioannou

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