Oh That Propofol

The first part of our routine cataract surgeries at the VA involves giving a retrobulbar injection of local anesthetic. As expected, not too many people are very fond of witnessing a long needle coming towards their eye. Really, they wouldn't even need to look at it, but I'm sure it doesn't feel good either.

At any rate, the way we deal with this is to put the patient to sleep for a few short minutes while we do it. One of the best IV medications for the job is propofol - a fast acting, though short-lived injectible. The effects on the patient are nothing short of often comical. You can imagine trying to talk to someone right as they're falling asleep - s/he won't fully comprehend the question, nor even the answery s/he is trying to give. Of course, this is how we know the near full effect is achieved - we ask them questions. When the answers become garbled, quite frequently coupled with big, fat yawns, it's time to inject.

To make the experience more humorous for us (okay, not really, it's for the patient to look at), there's a large paper butterfly taped to the ceiling above the patient's head. So not uncommonly, their final words may be:

"Gargle mmsnuff sshbipner. . .buttterrrfflyyyy. . . ." Nothing like starting eye surgery with a giggle.