Very often, anesthesia scares people even more than the operation itself. The unknown, possible unpleasant sensations when falling asleep and waking up, and numerous conversations about the harmful effects of anesthesia are scary. Especially if all this concerns your child. What is modern anesthesia? And how safe is it for the child’s body?
In most cases, all we know about anesthesia is that the operation under its influence is painless. But in life it may happen that this knowledge is not enough, for example, if the issue of surgery for your child is decided. What do you need to know about anesthesia?
Anesthesia , or general anesthesia , is a time-limited drug effect on the body, in which the patient is in an unconscious state when painkillers are administered to him, with the subsequent restoration of consciousness, without pain in the area of the operation. Anesthesia may include administering artificial respiration to the patient, ensuring muscle relaxation, placing IVs to maintain a constant internal environment of the body with the help of infusion solutions, control and compensation of blood loss, antibiotic prophylaxis, prevention of postoperative nausea and vomiting, and so on. All actions are aimed at ensuring that the patient undergoes surgery and “wake up” after the operation without experiencing a state of discomfort.
Types of anesthesia: what kind of anesthesia is given to children?
Depending on the method of administration, anesthesia can be inhalational, intravenous and intramuscular. The choice of anesthesia method lies with the anesthesiologist and depends on the patient’s condition, on the type of surgical intervention, on the qualifications of the anesthesiologist and surgeon, etc., because different general anesthesia may be prescribed for the same operation. The anesthesiologist can mix different types of anesthesia, achieving the ideal combination for a given patient.
Anesthesia is conventionally divided into “small” and “large”; it all depends on the quantity and combination of drugs from different groups.
“Small” anesthesia includes inhalation (hardware-mask) anesthesia and intramuscular anesthesia. With machine-mask anesthesia, the child receives an anesthetic drug in the form of an inhalation mixture while breathing independently. Painkillers introduced into the body by inhalation are called inhalational anesthetics (Ftorotan, Isoflurane, Sevoflurane). This type of general anesthesia is used for low-traumatic, short-term operations and manipulations, as well as for various types of studies when a short-term switching off of the child’s consciousness is necessary. Currently, inhalation anesthesia is most often combined with local (regional) anesthesia, since it is not effective enough as mononarcosis. Intramuscular anesthesia is now practically not used and is becoming a thing of the past, since the anesthesiologist absolutely cannot control the effect on the patient’s body of this type of anesthesia. In addition, the drug, which is mainly used for intramuscular anesthesia - Ketamine - according to the latest data, is not so harmless for the patient: it turns off long-term memory for a long period (almost six months), interfering with the full development of the child.
“Major” anesthesia is a multicomponent pharmacological effect on the body. Includes the use of medicinal groups such as narcotic analgesics (not to be confused with drugs), muscle relaxants (drugs that temporarily relax skeletal muscles), sleeping pills, local anesthetics, a complex of infusion solutions and, if necessary, blood products. Medicines are administered both intravenously and by inhalation through the lungs. The patient undergoes artificial pulmonary ventilation (ALV) during the operation.
How many procedures are needed?
The duration of the course depends on the individual characteristics of the patient, the type and degree of disorders and is prescribed by the doctor. The first basic procedure matters. The choice of operating mode of the laser system also depends on it.
Almost instant results. Yes, it is visible to the doctor and felt by the patient even after the first procedure. The effect continues to increase for 2 days. Therefore, the use of certain drops is not recommended, excluding nighttime disturbances in nasal breathing in a horizontal position.
Are there any contraindications to anesthesia in children?
There are no contraindications to anesthesia, except for the refusal of the patient or his relatives to undergo anesthesia.
However, many surgical interventions can be performed without anesthesia, under local anesthesia (pain relief). But when we talk about the patient’s comfortable condition during surgery, when it is important to avoid psycho-emotional and physical stress, anesthesia is necessary, that is, the knowledge and skills of an anesthesiologist are needed. And it is not at all necessary that anesthesia in children is used only during operations. Anesthesia may be required for a variety of diagnostic and therapeutic procedures, where it is necessary to remove anxiety, turn off consciousness, to enable the child not to remember unpleasant sensations, the absence of parents, a long forced position, a dentist with shiny instruments and a drill. Wherever a child needs peace of mind, an anesthesiologist is needed - a doctor whose task is to protect the patient from the stress of surgery. Before a planned operation, it is important to take into account the following point: if a child has a concomitant pathology, then it is desirable that the disease is not exacerbated. If a child has been ill with an acute respiratory viral infection (ARVI), then the recovery period is at least two weeks, and it is advisable not to carry out planned operations during this period of time, since the risk of postoperative complications significantly increases and breathing problems may arise during the operation, because a respiratory infection primarily affects the respiratory tract.
Before the operation, the anesthesiologist will definitely talk with you about abstract topics: where the child was born, how he was born, whether vaccinations were given and when, how he grew up, how he developed, what illnesses he had, whether there are any allergies, examine the child, get acquainted with the medical history, and carefully study everything tests. He will tell you what will happen to your child before the operation, during the operation and in the immediate postoperative period.
Some terminology
Premedication is the psycho-emotional and medicinal preparation of the patient for the upcoming operation, begins several days before surgery and ends immediately before the operation.
The main goal of premedication is to relieve fear, reduce the risk of allergic reactions, prepare the body for upcoming stress, and calm the child. Medicines can be administered orally in the form of syrup, as a nasal spray, intramuscularly, intravenously, and also in the form of microenemas. Vein catheterization is the placement of a catheter in a peripheral or central vein to repeatedly administer intravenous medications during surgery. This manipulation is performed before surgery.
Artificial pulmonary ventilation (ALV) is a method of delivering oxygen to the lungs and then to all tissues of the body using an artificial ventilation device. During surgery, they temporarily relax the skeletal muscles, which is necessary for intubation. Intubation is the insertion of an incubation tube into the lumen of the trachea for artificial ventilation of the lungs during surgery. This manipulation by the anesthesiologist is aimed at ensuring the delivery of oxygen to the lungs and protecting the patient's airways.
Infusion therapy is the intravenous administration of sterile solutions to maintain a constant water-electrolyte balance in the body, the volume of circulating blood through the vessels, to reduce the consequences of surgical blood loss.
Transfusion therapy is the intravenous administration of drugs made from the patient’s blood or donor’s blood (packed red blood cells, fresh frozen plasma, etc.) to compensate for irreplaceable blood loss. Transfusion therapy is an operation for the forced introduction of foreign matter into the body; it is used according to strict health conditions.
Regional (local) anesthesia is a method of numbing a specific area of the body by applying a solution of local anesthetic (painkiller) to large nerve trunks. One of the options for regional anesthesia is epidural anesthesia, when a local anesthetic solution is injected into the paravertebral space. This is one of the most technically difficult manipulations in anesthesiology. The simplest and most well-known local anesthetics are Novocaine and Lidocaine, and the modern, safe and longest-acting one is Ropivacaine.
Anesthesia during surgery: no pain
Anesthesia (Greek ἀναισθησία - without feeling)
- a decrease in the sensitivity of the body or part of it, up to the complete cessation of perception of information about the environment and one’s own condition.
First steps
I will not go into detail about the history of anesthesia, since its roots go back to ancient times. Doctors solved the problem of pain relief in different ways, ranging from dental sticks, alcohol, drinking narcotic extracts from poppy plants, hitting the head with a club, and ending with intravenous, inhalation local anesthesia.
However, the era of anesthesia began not so long ago
, October 16, 1846, when Morton officially (although there had been successful anesthesia with nitrous oxide, ether and other drugs before that) gave ether anesthesia to the patient.
Since this year, people in many countries have breathed a sigh of relief - even death under ether anesthesia was blessed. And there were so many deaths. They were a fairly ordinary, albeit tragic event.
For many years, anesthesia consisted of one component - ether.
, and that seemed enough. But while studying the response of a deeply sleeping organism to surgical aggression, we came to the conclusion that something was missing in anesthesia. Either sleep led to respiratory arrest, or the pulse rattled so much that the heart seemed about to explode (from insufficient pain relief). And it was not convenient for surgeons to cut a patient if he crawled like a worm on the operating table.
Ether turned out to be far from an ideal anesthetic: it was difficult to control; patients woke up several hours after a major operation with a headache, nausea, and vomiting. It quickly depressed breathing and the cardiovascular system. The staff, being in the operating room and inhaling ether vapor for hours, also did not feel the best, developing chronic diseases.
Reaching the required level of pain relief for surgery, the doctor often crossed the line, which led to intoxication (respiratory depression, cardiac dysfunction). It was necessary to isolate a separate drug that would only relieve pain and another that would give sleep. And then, using them together, it would be possible to reduce the total doses of drugs, significantly reducing their toxicity.
Chemical progress
What did they come up with in the end? How does modern anesthesia differ from single-ester anesthesia?
Thirty years later, they found a drug that acts directly on nerve endings. The plant that became the progenitor of modern local anesthetics was... the coca bush. Yes, yes, cocaine is the first local anesthetic! A wonderful drug with good anesthetic properties: it was an excellent pain reliever, used in ophthalmology, dentistry, surgery - even psychiatrists found a place for it! But it was ruined by a side effect - it turned out to be toxic to the central nervous system, which drug addicts actively use today.
The history of anesthesiology has followed two parallel paths. Some doctors believed that local anesthesia was self-sufficient, while others persistently sought pain relief with complete loss of consciousness. This is how local and general anesthesiology appeared. However, still others have realized that by combining both types of anesthesia, the toxicity of both local and general anesthetics can be significantly reduced.
At the same time, chemists found more and more safe drugs, such as novocaine, lidocaine (local anesthetics), chloroform, ethylene, acetylene, and finally, controlled and relatively safe fluorotane (general anesthetics)
. Drugs for intravenous anesthesia appeared, which included narcotic drugs with a pronounced analgesic effect (morphine, promedol, omnopon, fentanyl).
Challenges of modern anesthesiology
1. Provide pain relief.
This is certain! Anesthesia must interrupt any pain impulse: no matter at what stage (at the level of nerve endings, at the level of the nerve trunk, at the level of the spinal cord or brain). It should interrupt any response of the body to surgical trauma. There should be no memory of pain.
2. Guarantee safety.
Now, when a person dies during a planned operation while under anesthesia, this is an emergency situation that leads to criminal liability for the doctor. Unfortunately, this still happens, although extremely rarely.
Anesthesia has become multicomponent; the doses of anesthetics required for high-quality anesthesia have decreased due to the separation of flies from cabbage soup.
Anesthetics now provide sleep, narcotics provide pain relief, and relaxants provide muscle relaxation.
Modern anesthetics, having less toxicity and allergenicity, are much more manageable.
Drugs have become more powerful, shorter-lived (and therefore also more manageable), less toxic (less effect on breathing and the cardiovascular system).
Relaxers. The requirements are to ensure sufficient surgical access not only through the incision (the surgical wound gets smaller and smaller every year), but also through muscle relaxation, that is, complete muscle relaxation (a contracting patient sharply reduces the surgical field).
Everyone knows the poison curare, the one used by the Indians in America. He became the progenitor of modern relaxers. It completely turns off a person’s muscle function, including respiratory activity. In connection with this, there was a need to maintain breathing, and then devices for artificial ventilation of the lungs were invented.
3. Be comfortable.
Gone are the days when a patient wakes up after a planned hernia repair and feels like he’s had a terrible hangover, writhing in pain with a shrunken tongue stuck to it, marveling at the floating walls and horned neighbors, and periodically vomiting bile.
Now, thanks to modern anesthetics, the patient wakes up almost immediately after the last stitch, he does not feel sick, there is no excruciating pain and hallucinations.
But here a lot depends on the hospital’s equipment with drugs, equipment, and the skill of the anesthesiologist. Well, and the surgical capabilities of the surgeon. It is the art of the surgeon that makes it possible to reduce the incision, carry out all manipulations technically carefully, significantly reducing tissue trauma. This reduces the total dose of potent drugs and improves the quality of the postoperative period.
Regarding waking up during surgery
. I won’t lie, there is such a possibility. Relaxers mask inadequate anesthesia by preventing the patient from twitching, and if you do not pay attention to other indicators (pulse, blood pressure, cold sweat, dilated pupils from pain and horror), you can provide the patient with a trip to hell that he will never forget. But again, there will be no very acute pain due to the action of narcotic analgesics or local anesthesia. Of course, such cases are very, very rare, and each case is an emergency that clearly does not enhance our work.
I remember a story from an old anesthesiologist (I don’t know whether it’s true or not). This happened back in the eighties. Life-sentence prisoners have become accustomed to being admitted to the hospital with foreign bodies in the gastrointestinal tract. They swallowed nails, needles and other crap. They were operated on, fed hospital food - white sheets, beautiful sisters, free drugs. One, two, three... the doctors got fed up. And then anesthesia for such patients began to be carried out in a special way: a weak anesthetic, short-term relaxants were introduced, connected to the machine, long-acting relaxants were again introduced, the blood pressure was controlled with drugs, a weak anesthetic again at the end of the operation and weaning from the ventilator. That is, in fact, the entire operation took place in full consciousness. One, the second swallower - and that’s it, there were no more requests.
Types of anesthesia
Local anesthesia is anesthesia that acts on a strictly defined area of the body, without affecting the patient’s consciousness. I will not describe the infiltrative one, since this is what surgeons do. This is simply the injection of a local anesthetic into the incision area, such as minor interventions - opening an abscess and suturing cuts. I want to explain what epidural, spinal and conduction anesthesia are.
The meaning of conduction anesthesia
in blocking impulses along nerve trunks. It's like turning off a water tap. If you turn it off in an apartment, then there will be no water only in this apartment; if you turn it off in the basement, then there will be no water in one entrance; if you turn off the common tap, then the whole house will be dehydrated. It’s the same in humans: if you block at the level of the hand, then impulses will stop coming from the fingers and palms; if at the level of the neck, then nerve impulses will stop coming from the whole hand.
Spinal and epidural anesthesia
are performed on the spine when anesthesia of the chest, abdomen, perineum, and lower extremities is planned.
Spinal - this is when a thin needle, after preliminary anesthesia, is used between the lumbar vertebrae to penetrate into the spinal canal, below the level of the spinal cord, a clear liquid is obtained, and a local anesthetic is injected. The lower chest, stomach, crotch of the legs go numb. The quality of anesthesia and relaxation is excellent, but the effect is limited in time. This anesthesia is used for cesarean sections, removal of hemorrhoids, amputation of lower extremities, hernia repair, and various trauma surgeries, that is, where the interventions are not too long.
For prolonged anesthesia, epidural anesthesia is performed. They also inject with a needle, but of a different caliber, the procedure is painless, only the level of the injection can vary depending on the task and location of the surgical intervention. Let’s say that during an operation on the perineum, they will inject into the lumbar spine; if the operation is performed on the stomach, then the injection will be performed in the thoracic spine. In a certain way they enter the canal located next to the spinal cord. A special catheter is installed, and pain relief can be carried out not only during surgery, but also in the postoperative period. Used as pain relief during childbirth and cancer.
However, it is not without complications, sometimes life-threatening. An allergy to a local anesthetic can lead to anaphylactic shock, accidental injection of a local anesthetic into the bloodstream can lead to cardiac arrest, and a high spinal block can lead to respiratory arrest and a drop in blood pressure. Such complications arise from gross violations of anesthesia techniques. Again, all of these complications can be prevented by preventative measures in which anesthesiologists are trained.
General anesthesia
gives no less problems, but can also lead to a sad outcome: breathing problems, anaphylactic shock to drugs, cardiac depression.
Local or general?
Which one would you choose? Of course, the vast majority will choose the general one. Beauty - fell asleep, woke up. I don’t remember anything, I didn’t see anything... But which anesthesia is safer? There is no definite answer and there will not be; it all depends on the patient’s condition.
If the patient is a compensated young man, then any methods of pain relief can be applied to him. But if such a young man is admitted with knife bleeding into the abdominal cavity, then it is definitely necessary to carry out general anesthesia and use only drugs that do not depress blood circulation, such as ketamine. Although ketamine is practically not used in elective surgery due to its hallucinating properties.
If a guy turns out to be severely obese, then he will most likely have breathing problems and, most likely, they will use either local anesthesia or general anesthesia, but with connection to an artificial respiration apparatus.
Elderly people with problems of the cardiovascular system need a special approach: they can also use both types of anesthesia, but the drugs will have to be titrated, and the total dose of anesthetics will be reduced.
For patients with breathing problems, many recommend the use of local (spinal, epidural) methods of pain relief, and if general anesthesia, then with mandatory prosthesis of the external respiration function (ventilator).
Lower limb amputations can be performed effectively and safely under local anesthesia. Again, if the patient is weakened, then we perform general anesthesia and transfer the patient to mechanical ventilation, since the patient may not be able to tolerate a decrease in blood pressure during spinal anesthesia (which almost always happens).
Yes, you can refuse this or that type of anesthesia, this is your right. However, before giving a categorical refusal, ask the doctor to justify the proposed type of anesthesia, ask why it is better than other methods.
A normal doctor will calmly justify his choice, explain in detail the anesthesia technique, and possible changes during the operation. Listen and ask questions, try to find a common language with the doctor. This doesn't mean you need to "talk for your life", but be sincere, answer questions truthfully, and don't be shy about admitting your fears and doubts.
Vladimir Shpinev
Photo thinkstockphotos.com
How to prepare a child for anesthesia
The most important thing is the emotional sphere. It is not always necessary to tell your child about the upcoming operation. The exception is when the disease interferes with the child and he consciously wants to get rid of it.
The most unpleasant thing for parents is the hunger pause, i.e. six hours before anesthesia, you cannot feed the child; four hours before, you cannot even give him water, and by water we mean a clear, non-carbonated liquid without odor or taste. A breastfed newborn can be fed for the last time four hours before anesthesia, and for a bottle-fed baby this period is extended to six hours. A fasting pause will allow you to avoid such complications during the onset of anesthesia as aspiration, i.e. entry of stomach contents into the respiratory tract (this will be discussed later).
Should I do an enema before surgery or not? The patient's intestines must be emptied before the operation so that during the operation under the influence of anesthesia there is no involuntary passage of stool. Moreover, this condition must be observed during operations on the intestines. Usually, three days before surgery, the patient is prescribed a diet that excludes meat products and foods containing plant fiber, sometimes a laxative is added to this the day before the operation. In this case, an enema is not needed unless the surgeon requires it.
The anesthesiologist has many devices in his arsenal to distract the child’s attention from the upcoming anesthesia. These include breathing bags with images of different animals, and face masks with the scent of strawberries and oranges, and ECG electrodes with images of cute faces of your favorite animals - that is, everything for a child to fall asleep comfortably. But still, parents should stay next to the child until he falls asleep. And the baby should wake up next to his parents (if the child is not transferred to the intensive care unit after the operation).
What happens to the child during surgery under anesthesia?
After the child has fallen asleep, the anesthesia deepens to the so-called “surgical stage”, at which the surgeon begins the operation. At the end of the operation, the “strength” of anesthesia decreases and the child wakes up.
What happens to the child during the operation? He sleeps without experiencing any sensations, particularly pain. The child's condition is assessed clinically by the anesthesiologist - by looking at the skin, visible mucous membranes, eyes, he listens to the child's lungs and heartbeat, monitoring (observation) of the work of all vital organs and systems is used, and, if necessary, rapid laboratory tests are performed. Modern monitoring equipment allows you to monitor heart rate, blood pressure, respiratory rate, the content of oxygen, carbon dioxide, inhalational anesthetics in the inhaled and exhaled air, oxygen saturation in the blood as a percentage, the degree of depth of sleep and the degree of pain relief, the level of muscle relaxation, the ability to conduct a pain impulse along the nerve trunk and much, much more. The anesthesiologist carries out infusion and, if necessary, transfusion therapy; in addition to drugs for anesthesia, antibacterial, hemostatic, and antiemetic drugs are administered.
Why is laser better than drops for a runny nose?
A runny nose is primarily caused by viruses. They are smaller and more active than bacteria; they quickly block the cell, penetrating inside and causing mutagenic transformations. They can come out of it in a modified, more stable form for a further harsh attack on the cellular system. Under the influence of viruses, cells change beyond recognition. Their structure and function become distorted. Against this background, choosing a medicine to alleviate the patient’s condition and eliminate disorders “with one click” can be quite difficult.
Remember what happens when your nose is stuffy? Take the first one you come across, spray it in your nose and wait for the effect. Then, if there is no effect, take a second, third.
Patients quite often complain about an incessant runny nose for months. Unfortunately, delaying treatment and failure to obtain the desired result is a common occurrence. Periodic courses of various drugs aimed at viral infection in its various forms suppress the activity of the main noticeable process and transform it into many invisible ones. One of which is allergies of varying activity. Its critical form may be diffuse bronchopulmonary changes and bronchial asthma. Everyone understands that this is very serious.
A few words about nasal sprays. Sometimes you can’t do without them at home. However, you need to remember the chemical characteristics of such drugs. Their activity is especially high and corresponds to that declared by the manufacturer only when exposed directly to the surface of the mucous membrane. The appearance of a diffuse aerosol of mucus in the path blocks the effect. Therefore, it is necessary to remember about timely toileting of the nasal cavity in preparation for home therapy. The rules say: blow your nose, rinse your nose with distilled or saline pharmaceutical water and only then use medications. But even if all the rules are followed, the effect of the drugs is not endless and addiction occurs.
The laser eliminates such addiction. It continues to remain active even when working through mucus. The radiation of a therapeutic laser is specially scattered and penetrates the cellular system to the required depth without disturbing the tissue. The result is improved blood circulation, reduced swelling, blockade of viral particles and antigens.
Coming out of child anesthesia
The period of recovery from anesthesia lasts no more than 1.5-2 hours while the drugs administered for anesthesia are in effect (not to be confused with the postoperative period, which lasts 7-10 days). Modern drugs can reduce the period of recovery from anesthesia to 15-20 minutes, however, according to established tradition, the child must be under the supervision of an anesthesiologist for 2 hours after anesthesia. This period may be complicated by dizziness, nausea and vomiting, and pain in the area of the postoperative wound. In children of the first year of life, the usual pattern of sleep and wakefulness may be disrupted, which is restored within 1-2 weeks.
The tactics of modern anesthesiology and surgery dictate early activation of the patient after surgery: get out of bed as early as possible, start drinking and eating as early as possible - within an hour after a short, low-traumatic, uncomplicated operation and within three to four hours after a more serious operation. If a child is transferred to the intensive care unit after surgery, then the resuscitator takes over further monitoring of the child’s condition, and here continuity in the transfer of the patient from doctor to doctor is important.
How and with what to relieve pain after surgery? In our country, painkillers are prescribed by the attending surgeon. These can be narcotic analgesics (Promedol), non-narcotic analgesics (Tramal, Moradol, Analgin, Baralgin), non-steroidal anti-inflammatory drugs (Ketorol, Ketorolac, Ibuprofen) and antipyretic drugs (Panadol, Nurofen).
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