Patient satisfaction, however, tends to be high. Ms. Voynow did not need a preoperative physical exam, blood work, an I.V. drip or even an attending anesthesiologist. As nurses wheeled her on a gurney out of the O.R., she looked pleasantly surprised. “I’ve had root canals that were worse,” she said.Scarcely a half-hour after the surgery, she drove herself home, using her right hand, which had just been operated on. By contrast, if she had been given general anesthesia, she would most likely have needed several hours to recover, possibly had side effects like dizziness and nausea, and required someone to drive her. An anesthesiologist would have been necessary throughout the operation. And billed accordingly.“If I want sedation, I’ll have a beer,” said David S. Howes, who has had several awake procedures (and who is himself a doctor, an emergency physician in Chicago). During his awake colonoscopy, he discussed fly-fishing with the gastroenterologist. He had two total knee replacements with only regional nerve blocks.