Any major surgical intervention is performed using anesthesia. In addition to complications from the operation itself, anesthesia often causes harm to the patient’s body. It is impossible to perform an operation without anesthesia; this entails the mandatory use of anesthetics for local and general anesthesia. The consequences after their use are often unpredictable and depend on the patient’s gender, general condition and age.
Sequence of general anesthesia (stages)
Preoperative measures are performed in strict order.
- To exclude the negative effects of general anesthesia on the heart and circulatory system, the patient is carefully examined.
- If no serious reactions of the body to the drugs used are detected, the anesthesiologist performs premedication with the administration of sedatives (they relieve the patient’s symptoms of anxiety).
- The anesthesiologist's assistant (anesthetist) inserts a cannula needle into the vein - it can be left untouched for several days. Using such a needle, medications, a blood substitute, or the blood itself are introduced into the vein of the person being operated on by drip.
- On a computer monitor, the surgeon's assistant monitors the work of the patient's heart and blood pressure.
- The patient is injected with a pre-operative number of painkillers to deactivate consciousness and drugs that relax the muscles.
The doctor-anesthesiologist maintains the presence of anesthesia in the body of the person being operated on during the entire surgical procedure. He relates this to the safe effect of pain relief on the patient.
General anesthesia is carried out at least 6 hours after the patient eats and drinks.
Clinical Application
An anesthesiologist works with drugs that affect the central nervous system, and the concept of anesthesia includes manipulations aimed at introducing a person into an unconscious state. General anesthesia is necessary for surgery and other procedures that require desensitization.
Medication-induced sleep makes it possible to perform complex operations that require prolonged pain relief. Large-scale disorders in which many organs are involved (mainly injuries after road accidents, falls from heights and natural disasters) are treated surgically only when consciousness is turned off.
Medication-induced sleep will not cause harm if the drugs are selected correctly and the dosage does not exceed the norm. The doctor is obliged to monitor the patient’s condition at all stages of the operation, as well as after recovery from anesthesia.
What are the contraindications for general anesthesia?
There are no 100% general prohibitions on anesthesia; its use is determined by life indications.
A competent anesthesiologist has a variety of painkillers in his arsenal. And they will find a worthy replacement. The doctor also has the option of rescheduling the date of surgery.
CONTRAINDICATIONS
- hormone-dependent abnormalities;
- endocrinological diseases in the acute stage;
- abnormal heart rate;
- less than 6 months after a heart attack (stroke) that occurred previously in the person being operated on;
- the patient has chronic bronchial asthma or its aggravated severe period;
- cardiovascular or diseases of internal organs to the degree of decompensation;
- alcohol (drug) exposure;
- allergic reactions, rare, but causing anaphylactic shock;
- food not digested by the stomach.
Surgery is postponed if the child or adult on the day of surgery has:
- infectious disease, especially developing in the respiratory system;
- manifestations of rickets, severe malnutrition (malnutrition);
- purulent wounds on the skin surface.
The child will not be operated on even after a planned vaccination - time is needed for recovery.
If a patient’s malignancy progresses or the patient requires immediate surgery to save his life, doctors take into account contraindications and carefully adjust the composition and concentration of anesthesia.
The importance of the end of general anesthesia
The patient's recovery from general anesthesia usually occurs simply. Consciousness gradually returns to the patient when the doctor stops administering the anesthetic drugs.
After a short time, the operated patient wakes up and breathes on his own. He spends the required time in the intensive care ward, where a nurse monitors his condition.
The anesthesiologist also carries out control, periodically monitoring the restoration of the patient’s body functions.
Post-anesthesia sleep most often lasts 1-2 hours. Sometimes it takes up to 6 hours to wake up.
What are the possible complications after general anesthesia?
Anesthesia ensures patient safety during surgery. But liberation from anesthesia is characterized by consequences, the occurrence of which anesthesiologists do not exclude.
Among the anesthesia aftereffects on the condition of the operated patient are those that negatively affect the impaired activity of the cardiovascular system.
Happens:
- decrease/increase in pressure;
- pulmonary edema;
- pulmonary embolism;
- heart rate failure;
- breathing disorder.
After the end of the anesthesia, the operated patient may experience a fleeting headache, drowsiness, and impaired thermoregulation, both in the form of hypothermia and overheating of the body.
Some patients experience laryngo- and bronchospasm, vocal cord closure, and tongue retraction. It also happens when, during the post-anesthesia period, an accumulation of carbon dioxide and mucus is felt in the body.
Symptoms of allergies, hiccups, acute adrenal insufficiency are also related to anesthesia at the end of the operation.
A child undergoing surgery or a pregnant woman may experience vomiting and nausea. For a person suffering from epilepsy, there is a risk of progression of convulsive syndrome.
Spinal anesthesia in a small dose will have an anticonvulsant effect for such a patient.
Propofol and ketamine
The widely used anesthetic propofol (a sleeping pill) not only causes unconsciousness, but also amnesia.
In 2011, the authors of a study published in the European Journal of Anesthesiology suggested that rather than suddenly switching consciousness, the drug actually blocks cellular activity in the brain.
Along with propofol, anesthesiologists often give patients anesthetics with an analgesic effect. The drug ketamine is mainly used for this.
In small doses, this drug increases brain activity, but in large doses it has the opposite effect. Ketamine does not render patients unconscious. Rather, it suppresses sensation, judgment and coordination for 24 hours.
Ketamine blocks receptors that are critical for learning, memory and motor performance.
Possible consequences for pregnant women
Throughout life, the female body goes through sexual development, pregnancy, menstruation, and hormonal changes.
During pregnancy, it is better for a woman to exclude surgical intervention so as not to harm the planned child. Due to its toxic effects, anesthesia is unsafe for the expectant mother and the expected baby.
The threat of general anesthesia in the first 2 three months of pregnancy is explained by the formation and development of the fundamental organs and systems of the fetus.
And in the middle of the 3rd trimester, the uterine muscles are in a tense state, and this is dangerous when using anesthetics due to miscarriage or bleeding.
A woman in labor who gives birth to a baby by caesarean section under general anesthesia does not always, but at the end of the surgical intervention, experience brain fog, convulsions, nausea and dizziness.
The answer to the question of when pregnancy is permissible after general anesthesia is associated with the stage of formation of a healthy ovarian follicle. It occurs after 120 days, a little later and it is recommended to plan conception.
To avoid the negative consequences of general anesthesia on an infant, doctors advise denying the baby breast milk for at least 2 weeks.
This period covers the mother's hospital stay when she is unable to feed the child on schedule. To the resulting break, 10 days are added, during which toxic substances will be eliminated from the mother’s body.
Alternative during caesarean section? Epidural anesthesia.
As a result, the harm of anesthetics will not affect the baby’s health, since by that time they will not be in breast milk.
Question answer
The entire team of doctors who are present at the operation is ready for all situations, including an increase in the effect of anesthesia or anesthesia. During the intervention itself, the patient's condition is closely monitored by an anesthesiologist, and he is assisted by an anesthetist.
You need to understand that an adult will be able to behave adequately during the intervention, because you need to be motionless when the surgeon is working. And this is difficult to provide in the case of a child. Children are afraid, worried, cry, throw hysterics. It is unlikely that a small child will be able to lie quietly without twitching.
No doctor can give an exact answer. This is influenced by various nuances, including the complexity of the operation, age, etc. Some people recover in a matter of minutes, while other patients will need a couple of hours.
Preparation for the procedure
It is wiser to prepare your baby for the upcoming anesthesia just 2-5 days in advance . To do this, he is prescribed sleeping pills and sedatives that affect metabolic processes.
About half an hour before anesthesia, the baby can be given atropine, pipolfen or promedol - drugs that enhance the effect of the main anesthetic drugs and help avoid their negative effects.
Before performing the manipulation, the baby is given an enema and the contents of the bladder are removed. 4 hours before the operation, the intake of food and water is completely excluded, since during the intervention vomiting may begin, in which the vomit can penetrate the organs of the respiratory system and cause respiratory arrest. In some cases, gastric lavage is done.
The procedure is performed using a mask or a special tube that is placed in the trachea . Together with oxygen, anesthetic medicine is supplied from the device. In addition, anesthetics are administered intravenously to alleviate the condition of the little patient.
What are the differences between anesthesia techniques?
Patients undergoing surgery are interested in the difference between general anesthesia and local and epidural anesthesia.
The answer lies in putting the person being operated into a medicated sleep, if the anesthesia is general. The patient has no painful sensation throughout the entire body.
The term “local anesthesia” does not exist in medicine, since “local sleep” does not exist in principle. There is local anesthesia, it eliminates pain sensitivity in a limited area of the body.
The anesthesiologist together with the surgeon chooses which technique is suitable for a particular patient.
To a large extent, in addition to the complexity of the surgical intervention, the duration of the event is also taken into account.
Invasion of the chest organs with a scalpel is impossible without general anesthesia, since local anesthesia will not affect the patient effectively. Opening the abscess is permissible with the use of local analgesia.
In surgical procedures in the abdomen, pelvis, arms and legs, epidural and spinal anesthesia are used today. They are preferable because they act as an alternative to anesthesia due to the rare occurrence of complications.
Commonly referred to as “epidurals” and “spinals,” they differ in their work in a specific area of the body and the technique of administering anesthetics.
The epidural space is used when a thick needle inserts drugs that pass along the nerve fibers of any part of the spine. The spinal area for injection with a thin needle is limited to the area between the 2nd and 3rd vertebrae. Methods and depth of penetration of anesthetics differ.
Knowing well the differences between epidural and spinal, general and local anesthesia, the doctor will competently select the optimal option for pain relief for the operation.
Effect of anesthetics on children
Children under general anesthesia are at greater risk of developing neurological problems and changes in brain structure. After surgery, a child may have problems understanding language and have a lower IQ than peers.
Children may also experience decreased density of gray matter in the back of the brain, especially in the occipital lobe and cerebellum, which coordinates and regulates muscle activity. The following medications may have this effect on the developing brain: sevoflurane, isoflurane, and halothane.
A 2012 study found that children who had surgery before age 3 were behind academically and had problems learning language and thinking until age 10. However, they did not show any differences with their peers in behavior, visual tracking, attention, fine and gross motor skills.
Overall, these studies prove the need to look for other drugs to effectively anesthetize a child.
Harm of general anesthesia to the body of the person being operated on
There is an opinion that such anesthesia takes 5 years of life. But is it?
Here's what every person needs to know:
- Heart and surgical anesthesia. In order not to cause an increase in the patient’s existing ischemia (tachycardia, atrial fibrillation, cardiac asthma), the doctor undergoes a diagnosis before the intervention. The doctor will select the right anesthetic agent.
- Brain and human memory and general anesthesia. At the end of the operation, there is likely to be a slight mental disorder with decreased memory and impaired learning. But something like this is passing. More harmful is asthenic syndrome, manifested by a disorder of the nervous system, disturbed sleep, increased fatigue, abrupt changes in mood, alternating lethargy and excessive liveliness.
- Vision and general anesthesia. The vision problems that arise are temporary. They are associated with the effects of anesthetics on the nervous system.
The effect of general anesthesia on the body is subject to many circumstances. To eliminate negative consequences, the anesthesiologist monitors the effect of anesthetics on the patient during the operation.
Side effects
After emerging from an unconscious state and recovering from general anesthesia, the consequences of which for the body vary, the patient may experience unexpected symptoms:
- nausea;
- vomit;
- difficulty going to the toilet.
These and other side effects, according to experts, occur on the first day after surgical procedures, disappearing over time.
General anesthesia, the consequences of which for the body are most often unpredictable, has both positive and negative sides. If the rules stated above are followed, the impact of deficiencies on the patient’s body is minimal, but despite this, it is advisable to consult a specialist before choosing one.
Expert opinion
- Cosmetologist
- Surgeon
Irina Dorofeeva
practicing cosmetologist
Many people are afraid of one name - general anesthesia. No need to worry though. The main thing is to go to an experienced doctor. A good doctor will take into account all contraindications and the patient’s condition. Such anesthesia makes it possible to perform complex operations that are important for a person’s life.
Aisha Baron
plastic surgeon
Quite often, anesthesiologists use endotracheal anesthesia (this is a type of general anesthesia).
In this case, there will definitely not be a situation where the tongue sinks. Also, the respiratory tract is completely isolated from the digestive system, which is another plus. The anesthesiologist, as a competent specialist, will not allow the occurrence of undesirable consequences for the patient caused by an incorrectly chosen anesthesia.
If the person being operated on has no predisposition to negative reactions, the surgical intervention proceeds without complications. The anesthesia is subsequently removed without residual effects.
