Myths about anesthesia: to whom it is contraindicated and how often it can be used

Our expert is an anesthesiologist at Branch No. 6 of the Central Military Clinical Hospital No. 3 named after. A. A. Vishnevsky Russian Ministry of Defense Alexander Rabukhin .

Despite the fact that today most people consider themselves to be very “advanced” in matters of medicine, the very word “anesthesia” often has a sharply negative connotation for them. Even those who, in principle, are not afraid of surgery, are usually afraid of anesthesia. But what about: after all, according to a common philistine myth, with general anesthesia, supposedly you may not fall asleep completely, or there is a chance of unexpectedly waking up right during the operation. And many are afraid that they may not wake up at all from medicated sleep. In addition, the opinion that “anesthesia takes away several years of life” is still alive. It is hardly worth taking seriously all these various rumors and prejudices that have no relation to modern reality. Moreover, it is necessary to especially emphasize - specifically to the modern one, because these fears still have some basis. But, fortunately, it is connected with a rather distant history.

Fast Facts About General Anesthesia

Here are some key points about general anesthesia. More detailed and supporting information can be found in the main article.

• The anesthesiologist usually administers a general anesthetic before surgery
• There are some risks associated with the use of general anesthetics, but they are relatively safe when used correctly
• Very rarely, a patient may experience unintentional awakening during surgery
• Side effects of general anesthesia may include dizziness and nausea
• The mechanisms by which anesthesia works are still only partially understood.

General anesthetics cause reversible loss of consciousness and analgesia necessary for surgery . The mechanism of action of anesthetics is not fully understood. There are several theories about this.

General anesthesia is essentially a medically induced coma, not sleep. Anesthetic drugs make the patient indifferent and turn off consciousness .

They are usually administered intravenously or by inhalation . Under anesthesia, the patient does not feel pain and may also experience amnesia.

The drugs will be administered by an anesthesiologist, who will also monitor the patient's vital signs during the procedure.

In this article, we'll look at a number of topics, including the possible side effects of general anesthesia, the risks involved, and some theories about how they work.

Anesthesia methods

Depending on the goals and nature of the problem, the doctor chooses the method of pain relief. In medicine there are two main methods:

Anesthesia

It is most often used in surgery, and in dentistry much less often, in case of urgent need. It affects the entire body of the patient, inducing a state of sleep. At this time, all muscles relax and consciousness turns off. You can administer painkillers intravenously or inhale vapors through a mask. Deep anesthesia is used during complex operations when a person does not have enough strength to cope with pain or it is necessary to completely eliminate body movement. During sleep, the doctor monitors the patient's condition to avoid emergency situations.

Recovery from anesthesia is the body’s return to normal functioning after a long “freeze.” For all people, this process proceeds differently, some experience signs of nausea or a feeling of lethargy, while others wake up well-slept and rested.

General anesthesia in dentistry during pregnancy is applicable only in emergency cases when there is no other alternative.

Local anesthesia

Unlike anesthesia, it occurs locally, affecting only certain areas of the body. Can be used for children and pregnant women, without fear of unwanted consequences. In dental practice, this method is most often used, so we will talk about it in more detail.

Story

General anesthetics have been widely used in surgery since 1842, when Crawford Long prescribed diethyl ether to a patient and performed the first painless operation.

On October 16, 1846, American dentist and surgeon Thomas Morton first administered ether anesthesia to a patient to remove a submandibular tumor.

In Russia, the first operation under anesthesia was performed on February 7, 1847 by Pirogov’s friend at the professorial institute, Fyodor Inozemtsev.

Pirogov himself performed the operation using anesthesia a week later. Over the course of a year, 690 operations were performed under anesthesia in 13 cities of Russia, 300 of which were performed by Pirogov!

Soon he took part in military operations in the Caucasus. Here, for the first time in the history of medicine, he began to operate on the wounded with ether anesthesia. In total, the great surgeon performed about 10,000 operations under ether anesthesia.

How is the period after?

In the first minutes after waking up, the patient may experience some discomfort, however, the unpleasant sensations quickly fade away and after an hour and a half, patients are in their usual state of mind. Sometimes, after waking up, patients may experience nausea and vomiting. That is why it is recommended to take a short pause between waking up and the first intake of water and food. Fortunately, if the above-described discomforts occur, they are quite fleeting.

Post Views: 1,120

Side effects

Nausea is a common side effect of general anesthesia.

There are a number of potential side effects of anesthesia.

Some people may experience none, others several. None of the side effects are particularly long-lasting and usually occur immediately after anesthesia.

Side effects of general anesthesia include:

• temporary confusion and memory loss, although this is more common in older people
• dizziness
• difficulty urinating
• bruising or soreness from the IV
• nausea and vomiting
• trembling and chills
• sore throat due to breathing tube

Operating principles

Anesthesia is carried out immediately before the start of treatment. The anesthetic comes in both liquid and gel form. The doctor injects into the soft tissues that are located near the diseased tooth. After some time, the tongue, gums and cheeks become numb and “freeze”. At this moment, the anesthetic acts as a blocker of nerve impulses that send a pain signal to the brain. The patient calmly endures dental procedures without experiencing stress.

The duration and effectiveness of dental anesthesia depends on the quality of the materials used and the location of the injection. The closer to the problem area the injection was administered, the more intense its effect. Each organism is individual, therefore the drug will be excreted at different rates.

Different types of drugs function in their own ways. For example, gel-like ones applied to the gums or surface of the cheek last only a couple of minutes. If they are installed in the upper part of the jaw, the effect will last for 2-3 hours. To treat the lower group of teeth, a deeper injection is required, so the result lasts up to 4 hours. After the solution is absorbed, the numbness disappears and sensitivity returns to the patient.

Risks

In general, general anesthesia is safe. Even very sick patients can be safely anesthetized. The surgical procedure itself involves much greater risk.

Modern general anesthesia is an incredibly safe procedure.

However, older adults and those undergoing lengthy procedures are most at risk for complications . These findings may include postoperative confusion , heart attack, pneumonia, and stroke.

Some specific conditions increase the risk for a patient undergoing general anesthesia, for example:

• obstructive sleep apnea, a condition in which people stop breathing while sleeping
• seizures
• existing heart, kidney or lung disease
• high blood pressure
• alcoholism
• smoking
• previous negative reactions to anesthesia
• medications that may increase bleeding - aspirin, warfarin , for example
• drug allergy
• diabetes
• obesity or overweight

Indications and contraindications for the use of local anesthesia

Any dental intervention that causes pain must be accompanied by “freezing” of the required area of ​​the oral cavity. There is a list of diseases for the treatment of which it is necessary to administer anesthetic drugs:

• Complex caries;
• Removal of a tooth or its roots;
• Periodontitis;
• Inflammatory processes in the dental system;
• During prosthetics.

Before drawing up a treatment plan and choosing medications, the doctor must interview the patient and find out from him the presence of contraindications in order to exclude the possibility of complications.

• Allergy to drugs used;
• Heart diseases;
• Diabetes;
• Problems with the endocrine system.

Unintentional intraoperative awakening

This refers to rare cases where patients report remaining conscious during surgery, long after the anesthetic should have taken effect . Some patients are aware of the procedure itself, and some may even feel pain.

Unintentional intraoperative awakening is incredibly rare, affecting approximately 1 in every 19,000 patients under general anesthesia.

Because of the muscle relaxants used at the same time as anesthesia, patients are unable to let their surgeon or anesthesiologist know that they still know what is happening.

Unintentional intraoperative awakening is more likely during emergency surgery.

Patients who experience unintentional intraoperative awakening may suffer from long-term psychological problems. Most often, awareness is short-lived and only sounds, and occurs before or at the very end of the procedure.

According to a recent large-scale study of this phenomenon, patients experienced involuntary twitching , stabbing pain, pain, paralysis and suffocation, among other sensations.

Because unintentional intraoperative awakening is rare, it is unclear exactly why it occurs.

Types of anesthesia

There are several methods in medicine; they differ in duration, effectiveness and location.

Conductor.

The most common type of local anesthesia in dentistry. Using a special needle, the drug is injected near the nerve trunk, blocking pain impulses that go to the brain. The injection is given in doses not exceeding a volume of 5 ml. To ensure a guaranteed result, the injection is placed at an angle of 90 degrees.

“Freezing” applies only to a certain group of teeth, in the place where the treatment will take place. After about 15 minutes, the medicine begins to work and the doctor can begin work.

The injection site can be additionally lubricated with lidocaine. If during the procedure the patient continues to feel discomfort, another dose may be administered.

Infiltration

It differs from the conductor only in the angle of the needle and the place of application. The drug is injected directly into the root apex area. This type is most effective for teeth and upper jaw. With infiltration anesthesia, you can “freeze” both a small area and a large surface of the oral cavity along with soft tissues.

Applique

This method is performed without a syringe. The dentist applies the necessary product directly to the diseased tooth and the soft tissues surrounding it using a cotton swab or fingers. Some doctors spray anesthetics using a special spray.

It is mainly used during simple and quick operations, since its effect is short-term and does not protect against severe pain. The result is stored for a maximum of 20 minutes. It is often used as the first stage before the injection “freezing” method.

Intraosseous

The dentist resorts to this technique much less often when other types of anesthesia have proven ineffective. An analgesic that is injected directly into the hard tissues between the teeth. The difficulty lies in the technique; to get to the bone, the doctor cuts the gum and drills a hole in it with a bur. This is the most effective method for quickly and permanently freezing the required area.

Intraligamentary

Its peculiarity is the high speed of injection, so numbness occurs almost immediately, but lasts only 20-30 minutes. The advantage of intraligamentary anesthesia in dentistry is that it acts directly on the tooth without touching the cheeks, lips and tongue. That is why the recovery process is much easier.

Types

There are three main types of anesthesia . General anesthesia is just one of them.

Local anesthesia is another option. It is done before minor surgeries such as toenail removal. This reduces pain in small, focused areas of the body, but the person receiving treatment remains conscious.

Regional anesthesia is another type. It numbs the entire part of the body - the lower half, for example, during childbirth. There are two main forms of regional anesthesia: spinal anesthesia and epidural anesthesia.

Spinal anesthesia is used for operations on the lower extremities and abdomen. The anesthetic is injected through a special very thin needle into the intervertebral space of the lumbar region . Epidural anesthesia is used for long-term pain relief. Can be used for operations on the chest, abdomen, and lower extremities. During an epidural, a thin plastic catheter is inserted through which a local anesthetic is injected. Pain relief can last as long as needed.

Anesthesia in dentistry

And one more question that interests many: is it worth agreeing to general anesthesia when installing dental implants? In fact, in this case there is no choice. After all, if we are talking about installing 1-2 implants, you can really get by with local anesthesia, but when a dentist does half of the jaw at a time, then working without anesthesia will turn into real torture for both the doctor and the patient. Considering these facts and the safety of modern anesthesiology, most patients agree with the doctor’s proposal and prefer to wake up with a finished result.

Local vs General

There are a number of reasons why general anesthesia may be chosen over local anesthesia.

This choice depends on age, health and personal preference.

The main reasons for choosing general anesthesia are:

• The procedure will likely take a long time.
• There is a possibility of significant blood loss.
• This may affect breathing, for example during breast surgery.
• The procedure will make the patient feel uncomfortable.
• It is difficult for the patient to maintain a forced position during surgery.

The purpose of general anesthesia is to induce:

• pain relief or elimination of the natural response to pain
• amnesia or memory loss
• immobility or elimination of motor reflexes
• dream
• relaxation of skeletal muscles

However, the use of general anesthesia poses a higher risk of complications than local anesthesia. If the surgery is minor, then the patient is offered local anesthesia, especially if he has a condition such as sleep apnea or other risk factors.

Not everyone can handle it

In recent years, it has become fashionable to treat teeth under anesthesia. A huge number of large and small medical centers have opened that actively advertise such treatment, but they are often completely unsuited to providing safe anesthesia. Meanwhile, dentistry is the only area where general anesthesia can often be associated with significant risks. Even in the USA and Europe, where the level of medicine is significantly higher than in Russia, doctors try to avoid anesthesia during dental procedures. The fact is that in this case, the anesthesiologist does not have access to the respiratory tract, is not able to control their protective reflexes, and cannot always prevent fluid (blood, pus) from flowing into the trachea - and such situations are life-threatening.

Unfortunately, in our country, the willingness to pay often becomes the main indication - so to speak, “any whim for your money.” Dental treatment under anesthesia is exactly the case when you shouldn’t be capricious without good reason; the price can be prohibitively high. And if there is a real need for this, you must definitely contact specialized centers that have an operating unit with the necessary equipment, it is possible to provide emergency care, and in an emergency, place the patient in intensive care or at least in a post-anesthesia observation ward.

In all other cases, there are no contraindications to general anesthesia. On the contrary, some medical procedures and examinations are much more convenient and safer to do under anesthesia. For example, colonoscopy (examination of the intestines) throughout the civilized world is a necessary procedure for medical examination in people over 50 years of age, and it is necessarily performed under anesthesia. And the point is not only that without anesthesia it can be painful and psychologically uncomfortable. Another point is that if a patient has a bad heart or hypertension, then enduring pain is quite dangerous for him, and this can more often lead to complications than properly administered anesthesia.

Of course, the higher the qualifications of the anesthesiologist, the lower the risk of side effects from the use of anesthesia. And there is only one way out: when preparing for an operation or examination under general anesthesia, you need to choose a medical institution as carefully as possible, go not to where it is “cheaper and closer to home,” but to those specialists who inspire trust. It is better to rely not on intrusive advertising, but on objective information, on the experience of relatives and friends. You should not at all strive to ensure that your anesthesiologist is a candidate or doctor of science; it is much more important that he has extensive experience and extensive practice.

Preoperative assessment

Before undergoing general anesthesia, patients should undergo a preoperative assessment to determine the most appropriate medications, their amount and combination.

Some of the factors that should be examined in the preoperative assessment include:

• body mass index (BMI)
• disease history
• age
• medications taken
• time before anesthesia
• alcohol or drug use
• use of pharmaceuticals
• examination of the oral cavity, teeth and respiratory tract
• cervical spine mobility study

It is important that you answer these questions accurately. For example, if a history of alcohol or drug use is not mentioned, insufficient anesthesia may be given, which could lead to dangerously high blood pressure or unintentional intraoperative awakening.

Anesthesia for children

Painless pediatric dentistry is a hot topic today. All parents know what a trip to the dentist means for a child. If this brings few pleasant emotions to an adult, then what can we say about children. The first scheduled visit is always scheduled for the age of 6-7 years - this is the time when baby teeth are replaced with permanent ones.

The psyche of children is not yet fully formed; one wrong word or action can provoke the development of unpleasant memories. Therefore, it is important to instill confidence in the child, to mentally prepare him for the procedure: explain why he is going there and what the doctor will do. The use of anesthetic agents in pediatric dentistry is an integral part of comfortable treatment.

The most suitable injection methods for babies are infiltration, conduction and application. The place where the drug is administered is “frozen” in advance and only then does the doctor give an injection. The child’s body is not yet fully formed, so in pediatric anesthesia, special medications are used that make it possible to carry out the procedure safely.

Stages

The Gödel classification, developed by Arthur Ernest Gödel in 1937, describes four stages of anesthesia. Modern anesthetics and updated methods of drug have improved the speed of onset of anesthesia , overall safety and recovery, but the four stages remain essentially the same:

General anesthesia is similar to a comatose state and different from sleep.

Stage 1 or induction . This phase occurs between the administration of the drug and loss of consciousness. The patient moves from analgesia without amnesia to analgesia with amnesia.

Stage 2, or arousal stage . The period after loss of consciousness, characterized by agitated and delirious activity. Breathing and heart rate become erratic, and nausea, dilated pupils, and holding your breath may occur.

Due to irregular breathing and the risk of vomiting, there is a danger of suffocation. Modern fast-acting drugs are aimed at limiting the time spent on the 2nd stage of anesthesia.

Stage 3 or surgical anesthesia : muscles relax, vomiting stops, breathing is suppressed. Eye movements slow and then stop. The patient is ready for surgery

Stage 4, or overdose : if too much anesthetic has been administered, then depression of the brain stem occurs . This leads to respiratory and cardiovascular collapse.

The anesthesiologist's priority is to get the patient to stage 3 anesthesia as quickly as possible and keep him there throughout the operation.

Trial and error

Although general anesthesia (anesthesia) has been used in medicine since the mid-19th century, for many decades this field was purely practical, that is, based on trial and error. Anesthesiology as a science began to take shape only in the middle of the 20th century. Just half a century ago, in the USSR, anesthesiologists were not trained professionally. In those distant times, the administration of anesthesia was most often entrusted to surgeons - as a rule, those losers who were of little use in the operating room. But if a person was not able to learn to hold a scalpel well in his hands, then it was difficult to expect ideal work from him in other areas of medicine. Therefore, indeed, various complications during anesthesia (even death) were quite common in those days. And the quality of the drugs for general anesthesia and equipment used in the distant past, frankly speaking, left much to be desired.