What Happens When the Body Goes Under: General Anesthesia, Medical Racism, and the Pain Communities Were Never Allowed to Name

General anesthesia is one of the most remarkable tools in modern medicine — a temporary, controlled journey into unconsciousness that makes complex surgery possible. But the story of who receives adequate anesthesia and pain management, and who does not, is a story shaped by race. Understanding how anesthesia works is inseparable, for Black and Brown communities, from understanding who this medicine was built to serve.

How General Anesthesia Actually Works

General anesthesia is not simply “being put to sleep.” It is a precisely managed state involving four simultaneous effects: unconsciousness (the patient cannot be roused), analgesia (pain signals are blocked), amnesia (no memory of the procedure forms), and muscle relaxation (the body does not respond to surgical stimulation). Achieving all four requires a carefully calibrated combination of medications.

The process typically begins with an induction agent — most commonly propofol — administered intravenously. Propofol works within seconds, acting on GABA receptors in the brain to inhibit neural activity and produce unconsciousness. It is followed by inhaled anesthetic gases such as sevoflurane or desflurane, which maintain the anesthetic state throughout the procedure by broadly suppressing central nervous system activity.

Opioids are often added to manage pain signals during surgery. Neuromuscular blocking agents (sometimes called paralytics) prevent reflex movement. The anesthesiologist monitors the patient’s vital signs — heart rate, blood pressure, oxygen saturation, carbon dioxide levels — continuously throughout, adjusting dosages in real time. When the procedure ends, the anesthetic gases are discontinued and reversal agents may be given to restore muscle function. The patient gradually regains consciousness as the drugs clear from the system.

Scientists still do not fully understand the precise mechanism by which anesthesia produces unconsciousness. What is known is that it disrupts thalamocortical communication — the pathway by which the brain integrates sensory information into conscious experience. That this remains incompletely understood speaks to how much we still do not know about consciousness itself.

The Bias Built Into the Medicine

Here is what the science also shows: Black patients in the United States receive less pain medication than white patients with equivalent conditions — consistently, across decades of research. A 2016 study published in PNAS found that half of medical students and residents held false beliefs about biological racial differences — including the belief that Black people have higher pain tolerance or thicker skin. These beliefs, rooted in 19th-century pseudoscience used to justify slavery and surgical experimentation on enslaved people without anesthesia, persist in clinical practice today.

Dr. J. Marion Sims, celebrated in medical history as the “father of gynecology,” developed his surgical techniques by operating on enslaved Black women — without anesthesia — under the premise that they did not feel pain as white patients did. This was not fringe thinking. It was embedded in the medical curriculum for generations. Its legacy is measurable: Black patients are systematically undertreated for pain in emergency rooms, post-surgical care, and chronic pain management.

This is not incidental. It is the architecture. And communities that have long distrusted the medical system — for reasons rooted in exactly this history — are not irrational. They are historically informed.

African Traditions and the Wisdom of Altered States

Long before propofol, African healing traditions worked with altered states of consciousness as part of their therapeutic practice. Nganga healers in Central African traditions, Babalawo practitioners of Yoruba Ifá, and ritual specialists across the continent understood that accessing states beyond ordinary waking consciousness was sometimes necessary for healing. Plants with sedative, analgesic, and psychoactive properties — among them kola nut, iboga, and various cannabis preparations — were used with careful protocol, ceremony, and communal oversight.

These were not primitive approximations of anesthesia. They were sophisticated systems that recognized what modern anesthesiology is beginning to acknowledge: that consciousness is not a binary on/off switch, that the relationship between the body and awareness is complex, and that healing sometimes requires deliberately altering that relationship under skilled guidance within a relational container of trust and care.

The difference is that African healing traditions kept the community present. The patient was held — spiritually, relationally, communally — through the altered state. Modern anesthesia, for all its pharmacological precision, has not always extended that same care to Black and Brown bodies.

What Informed Consent Actually Requires

If you or someone you love is facing a procedure requiring general anesthesia, informed consent is your right and your power. Ask your anesthesiologist directly about their pain management protocol. Ask how dosages are determined. Ask whether your weight, age, and health history will be individually calibrated — because they must be. Bring an advocate if you can.

Know that you are entitled to have your pain taken seriously before, during, and after surgery. The history of medical racism does not obligate you to accept less than full care. It obligates the system to do better — and it obligates all of us to insist on it.

— MM

References: Hoffman, K.M. et al. (2016). Racial bias in pain assessment and treatment recommendations. PNAS. Meghani, S.H. et al. (2012). Time to take stock: A meta-analysis and systematic review of analgesic treatment disparities for pain in the United States. Pain Medicine. Washington, H.A. (2006). Medical Apartheid. Doubleday.

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