Anesthesia and Anesthesia: How they work and whether they should be feared
Anesthesia in the dentist’s chair, or even anesthesia on the surgical table they can be more frightening than the operations themselves: the injections are painful, and after general anesthesia they allegedly can not even recover. That this is true, and that myth, we understand together with experts: the highest category physician, anesthesiologist and resuscitator of the Vremya Krasoty aesthetic medicine clinic, Oleg Karmanov, implantologist, orthopedic surgeon of the Nova Dent network of dental clinics Mikhail Popov, and anesthesiologist and reanimatologist of the rematmatmatologist Yuri Timonin.
How does anesthesia work
Any anesthesia, local or general (the latter is also called anesthesia), is a medical intervention in the body that helps avoid painful stress. In response to a pain impulse from the injured area in the cerebral cortex, pain is realized. To prevent this, you need to block the nerve endings. Local anesthesia stops the transmission of pain impulse in a certain area - the drug passes through the cell membranes and interferes with the reactions in them. As a result, nerve impulses are blocked, the sensation of pain does not occur. Consciousness with local anesthesia is preserved, and the effect lasts an average of one to two hours. Anesthesia, or general anesthesia, is an effective method when a large area of the body is affected. In such a state, a person is fast asleep and well relaxed: the tension of muscles and other tissues should not prevent the surgeon from working.
Oleg Karmanov notes that it is wrong to fear anesthetic damage: it is much more dangerous to endure pain. In many cases, the risk of saying goodbye to life from a painful shock during an operation without anesthesia is very high. According to the doctor, modern anesthetics are well managed. This means that as soon as the active substance is no longer injected into the body, it quickly disintegrates - and the patient wakes up. The only absolute contraindication is an allergy to the drugs used, and possible side effects are usually associated with the presence in the solution of additional substances: vasoconstrictors (vasoconstrictor agents), preservatives and stabilizers.
How to prepare for an operation under general anesthesia and why it is bad after it
Depending on the type of intervention, it is necessary to undergo prescribed examinations — usually blood tests, an ECG, and sometimes, for example, an ultrasound scan of the lower extremities to rule out the presence of blood clots — and also give up alcohol and take certain medications for a certain time before surgery. If the test results satisfy the doctor, he will confirm the scheduled operation. In this situation, drugs with a mild effect are used and recovery from anesthesia is usually painless. It should be borne in mind that during the operation such processes as blood pressure drops can occur - but the work of the anesthesiologist does not stop after the patient is put into anesthesia; During the entire operation, the doctor controls the depth of anesthesia and brain activity. Used and the so-called neuroprotection - the protection of nerve cells with certain drugs.
Karmanov notes that the unpleasant consequences after recovery from anesthesia - impaired memory, confusion, hallucinations - usually occur during emergency operations when you need to act very quickly, for example, with a large loss of blood as a result of a car accident. In these cases, drugs are used with hypnotic, that is, hypnotic effects that can produce such side effects. With particular care, the doctor should also select painkillers for those who have cardiovascular diseases, problems with the respiratory system, kidney failure, hormonal disorders and diabetes.
Is it true that you can wake up during anesthesia or not wake up after?
It is theoretically possible to wake up during an operation, if the dosage is incorrectly calculated, the anesthetic is chosen incorrectly, or the body itself too quickly processes the injected drugs. But in practice this is extremely rare. Usually, the doctor keeps track of the situation well and knows when a “supplement” of the drug is needed to keep the patient's sleep calm.
The risk of not waking up after an operation under anesthesia also exists, but experts note that the probability of death is high only in emergency and neurosurgery. True, in these situations, death often occurs not because of anesthesia, but because of a serious condition - an acute injury or a life-threatening illness. In the case of planned operations, the probability of not surviving due to anesthesia is close to zero. In general, if the technique is respected and the necessary control is provided, anesthesia does not pose a threat to health and especially life.
What is sedation and why is it needed?
Sedation is the intravenous administration of non-narcotic hypnotic drugs that cause superficial sleep. It is used for various types of endoscopy, with colonoscopy, but most often in the dentist’s office. When a person is dormant, easy contact is possible with him: vital reflexes and body functions are preserved and the patient responds to the doctor's requests, for example, to turn his head or "bite a piece of paper." Sedation is accompanied by local anesthesia to numb the work area itself.
According to anesthesiologist Yuri Timonin, propofol does not cause side effects, and the substance itself has a short-term effect and is rapidly eliminated from the body. A big plus of sedation is that it allows you to increase the treatment time to 3.5-4 hours, without stress for the patient, with a slight awakening and the absence of unpleasant consequences after it. Doctors recommend this method for hypertension and angina, as well as those who are afraid of dentists before losing consciousness.
Is dental anesthesia safe during pregnancy?
Implantologist Mikhail Popov emphasizes that local anesthesia not only does not threaten the health of the fetus, but is also recommended for dental treatment, especially in the second and early third trimester of pregnancy. Anesthetic is absorbed into the blood in insignificant quantities and does not penetrate through the placenta, therefore, the course of pregnancy and the condition of the fetus will not be affected. Yuri Timonin adds that local anesthesia allows for 1-1.5 hours to “turn off” a sufficiently large portion of the jaw associated with a blocked nerve. And the harm from it is always less than from the source of infection in the mouth.
Women should warn the dentist about pregnancy before starting treatment: this information will make it possible to make a choice in favor of drugs without adrenaline, which are best suited for expectant mothers. To postpone the solution of non-urgent dental problems is at 35-40 weeks of pregnancy - but if urgent treatment is necessary, for example, in inflammatory processes and ulcers, local anesthesia is done during the entire period of pregnancy. As for sedation, this method is contraindicated for pregnant women: the effects of drugs on the fetus on it are not fully understood.
Epidural anesthesia: the pros and cons
Thanks to epidural anesthesia, when the anesthetic is injected into the space along the spinal canal, contractions become less painful and childbirth is noticeably calmer - while the woman is conscious. With a good dose calculation, the sensitivity disappears almost exclusively in the pelvic area, and the sensations in the legs and the ability to move them remain. Such anesthesia is also called walking epidural, although in fact it will not work - the legs will be weak, and sensors or catheters in different parts of the body will not allow you to go far. The psychological aspect is also important: when you know in advance that it won't hurt, it is much easier to relax and not worry.
According to Oleg Karmanov, with already performed epidural anesthesia, it is quicker and easier to switch to an emergency caesarean section, if there is a need for it: you do not have to spend time for anesthesia. But it is not always necessary to rely on epidural anesthesia, at a certain stage of labor it is too late to perform it. The method has a number of contraindications, including intervertebral hernia and serious circulatory disorders and clotting. Dangerous complications of epidural anesthesia are extremely rare.
What to expect from anesthesia in the future
The main feature of modern anesthetics is good handling. It is necessary to stop the flow of the drug, and it begins to quickly disintegrate. As a result, it is convenient for the doctor to control the time and depth of anesthesia for various conditions: an anesthesiologist will select one mix of drugs for a patient with heart disease, another for a person with respiratory problems. In both cases, it will be anesthesia with minimal drug load on the body. At the same time, various devices for anesthesia, such as modern intravenous catheters, increase safety and comfort during surgery. Careful monitoring of the patient's condition (measurement of the pulse, blood pressure, the amount of oxygen in the blood in the automatic mode) is another bonus of general anesthesia in modern conditions.
The local anesthetics of the new generation have much fewer side effects and contraindications than even a decade old, and the waiting time for the effect has been reduced to five minutes. Doctors agree: over time, the percentage of allergic reactions will be zero at all, and the injection itself will be completely painless. The controllability of the process during anesthesia will also increase: it will be possible to introduce and remove a person from a state of deep sleep even faster, and also to return him to his senses at any suitable moment. Oleg Karmanov does not exclude that in the near future, instead of intravenous anesthesia, a pill-shaped remedy will appear: he ate the pill and fell asleep.
True, anaesthesiologists still will not remain idle: the patient's condition is very important to constantly monitor and correct correctly. But whether it will be possible to replace anesthesia with hypnosis is a big question. In 2006, British television showed an operation to remove a stomach tumor under hypnosis, without anesthesia, and in 2008, in a Iranian clinic, a hypnotized woman successfully underwent a caesarean section without anesthesia. Nevertheless, Mikhail Popov notes that, despite appearing information about such cases, there is no scientific research on this topic yet.
Photo:vitaly tiagunov - stock.adobe.com, Africa Studio - stock.adobe.com, arska n - stock.adobe.com
