Name: 50 歲男子手術疑因麻醉不當身亡：麻醉藥到底如何作用，又為何危險？(How Does Anesthesia Work?)
Uploaded: 2021-06-23T02:17:32.000Z
Duration: 3 min 24 s

If you've ever landed on the surgeon's slab, you're probably really grateful that you won't remember or feel the operation.

如果你曾經躺上過手術台，你大概很慶幸自己不會記得或感覺到手術的過程。

Anesthesia is there to get you through it.

而這就是麻醉存在的原因，幫助你順利度過手術。

But what exactly happens when you go under?

但問題來了：當你進入麻醉狀態時，究竟發生了什麼？

Tens of thousands of people undergo anesthesia every day in the United States.

在美國，每天有成千上萬的人接受麻醉。

But here's the not so pleasant thought: surgery predates anesthetic drugs by thousands of years.

但有一個不太愉快的事實是：外科手術出現的時間，遠遠早於麻醉藥物。

Before the mid-1800s, surgeons turned to alcohol, narcotics, and even smacking their patients upside in the head to induce unconsciousness.

在 19 世紀中期之前，外科醫生只能靠酒精、麻醉劑，甚至直接把病人敲暈來讓他們失去意識。

That is not awesome bedside manner, so surgeries were often done when patients were totally awake.

這樣的「床邊禮儀」顯然不太好，所以很多手術都是在病人完全清醒的情況下進行的。

Some historians believe that before the advent of anesthetics, about half of patients in surgery died of shock.

一些歷史學者認為，在麻醉出現之前，大約有一半的病人會因為休克而死於手術。

That's why, in 1846, the first public demonstration of a surgery performed with general anesthesia took the medical world by storm.

因此，1846 年，首次公開的全身麻醉手術示範震撼了醫學界。

Doctors at Massachusetts General Hospital in Boston administered the first-ever anesthetic: diethyl ether.

在波士頓的麻州總醫院，醫生們首次使用了一種名為「乙醚」的麻醉劑。

In fact, the theater where the surgery took place received this totally awesome name: the Ether Dome.

手術舉行的場所因此得到了個很酷的名字：「乙醚圓形劇場」（Ether Dome）。

The landmark event was heralded in the press as the "end of pain."

這場劃時代的事件被媒體稱為「疼痛的終結」。

But anesthetics don't just address pain; they also temporarily paralyze the body and induce amnesia.

不過，麻醉的作用不只是止痛；它還能暫時讓身體癱瘓，並引發失憶。

Fortunately for you, that means you have no memories of the procedure.

對病人來說，幸運的是，這意味著你對手術過程毫無記憶。

Today, doctors usually give their patients combinations of different drugs to ensure a balance of these effects throughout a procedure.

如今，醫生通常會給病人多種藥物的組合，以確保在手術過程中達到平衡效果。

These include inhaled substances like sevoflurane and nitrous oxide, as well as intravenous drugs like propofol and ketamine.

這些藥物包括吸入性麻醉劑（像七氟醚、氧化亞氮），以及靜脈注射藥物（如丙泊酚、氯胺酮）。

Scientists know that anesthesia works, but they haven't worked out all the details of how it works, or even more broadly, how consciousness itself works.

科學家知道麻醉確實有效，但對於它的完整作用機制，以及更廣泛的「意識如何運作」，至今仍未完全解答。

The current thinking goes that these drugs work to create the perfect operating conditions by influencing neurotransmitters:

目前的理論認為，這些藥物會影響神經傳導物質，從而創造最佳的手術條件。

those are the chemical messengers that transmit signals between nerve cells.

神經傳導物質是神經細胞之間傳遞信號的化學物質。

Specifically, many anesthetics are thought to cut off access to receptors of a neurotransmitter called gamma-Aminobutyric acid—or GABA.

具體來說，很多麻醉劑被認為會阻斷一種名為 γ-胺基丁酸（GABA）的神經傳導物質受體。

GABA is involved in sending signals for responsiveness from the cerebral cortex, that's the part of the brain responsible for our emotions and higher-level thinking.

GABA 參與了大腦皮層的反應信號，而皮層正是掌管情感和高階思維的部分。

When this path is blocked by anesthetics, the connections for arousal signals are lost and its sleepytime.

當麻醉阻斷了這條路徑，喚醒信號無法傳遞，大腦就會進入「睡眠模式」。

But as you might imagine, bringing the brain down to such a low level of activity can be a little dangerous.

不過，把大腦活動降得太低也有危險。

Too much and the drugs could slow down activity not only in the consciousness-controlling cortex but in the brainstem itself,

劑量過高，藥物可能不僅抑制大腦皮層，甚至連腦幹也受影響，

which could stop a patient's heart and cause serious brain damage or even death.

導致病人心臟停止、腦損傷，甚至死亡。

But too little drug and the patient could wake up.

劑量不足，病人則可能在手術中醒來。

Avoiding all that is where anesthesiologists and nurse anesthetists come in.

而這正是麻醉醫師和麻醉護理師的工作所在。

These medical professionals monitor a patient's breathing, heart rate, and other vital signs to make sure they're delivering just the right amounts of anesthetic drugs in real time.

這些專業人員會實時監控病人的呼吸、心跳和其他生命徵象，確保輸送的麻醉劑量「剛剛好」。

That way you won't feel a thing as a skilled surgeon removes your funny bone for four hundred dollars.

如此一來，當外科醫師收你四百美元把「搞笑骨」（肱骨內上髁）切掉時，你完全不會有感覺。

Although, maybe next time you'll want to spring for doctors who don't use children as assistants or, you know, drip cigarette ash on your face.

雖然，下次你可能會想多花點錢，找些不會用小孩當助手，或邊做手術邊抖煙灰到你臉上的醫生。