Do you know how that usually applies to people with addiction problems who elect not to receive anesthesia? Do they generally receive everything except the pain killers?

Yup!

Luckily, opioids can be swapped for other medications that are less effective, like high dose NSAIDs. There's also local anesthetics for some stuff.

General anesthetics is definitely one of the weirder parts of medicine. It seems to have developed mostly by trial and error over hundreds of years, but it has obvious huge benefits. Imagine any kind of internal surgery being attempted without it!

I would much rather not!

> you're given an amnestic to help reduce immediate anxiety and avoid remembering going into the OR and getting prepped - which people don't generally enjoy.

In that case, they don’t seem to work that well for me. Or maybe they do it differently here.

I always remember going into the OR and being prepped.

My anxiety for my last surgery was huge up until the moment I passed up. The best I got was the anaesthesist telling me it was normal for someone in my circumstances (I’d not had anxiety the last few times, so was very confused as to why I had so much this time, I was freaking for some reason)

To be fair, the use of midazolam is ultimately up to your healthcare professionals. It's not required and may be skipped if they think it would be harmful (age or respiratory / nervous system health) or is unnecessary (no anxiety). It's almost always given as an IV drip 10-ish minutes before wheeling you around to the OR, which is how you'd recognize if you got it. It's just a very common practice to give it by default for most people under 65-ish.

You may also require either a higher baseline dose than expected, and an onset of acute anxiety can actually affect dosing too. Both totally normal!

Either way, it's best to speak with your doctor leading up to surgery if that experience was upsetting. There's lots that can be done for dosage, supplemental medication, etc. Your comfort is important!