The EMC employs an experienced team of anesthesiologists. The entire process of preparing the patient for surgery is organized in such a way as to minimize the risk of complications. It is mandatory to consult an anesthesiologist a few days before the operation. The patient talks about existing health changes, concomitant diseases, allergic reactions, and previous surgeries. The anesthesiologist evaluates the results of tests and additional research methods, discusses with the patient the planned type of anesthesia, and, if necessary, prescribes consultations with specialists, for example, a cardiologist for complex problems with the cardiovascular system. It is necessary to discuss the medications you are taking with the anesthesiologist, some of them must be canceled before surgery. On the morning of the operation, the anesthesiologist will definitely meet with the patient again, find out how he feels, mood, and answer any questions that arise. The anesthesiologist attentively accompanies the patient throughout the entire period from admission to the operating room to transfer to the hospital after surgery.
In the operating room, the anesthetic nurse connects a monitor to the patient, which monitors blood pressure, electrocardiogram, pulse, oxygen content in the body, and the patient's breathing rate and volume in a preset mode throughout the operation. If necessary, the depth of the patient's sleep and the degree of muscle relaxation can be monitored.The anesthesiologist evaluates all vital patient parameters, ensures that the patient is not in pain, and calculates the dose and frequency of administration of various medications.
Anesthesia (anesthesia or anesthesia) is a temporary loss of sensitivity, including pain, under the influence of various medications. Anesthesia is an important component of surgery, and it ensures that there is no pain during surgery. Anesthesia is performed with the highest degree of responsibility.
Anesthesia methods
General anesthesia
During anesthesia, the patient's sleep is maintained by constant, precisely dosed administration of sleeping pills intravenously (through a plastic intravenous catheter installed before surgery) or by inhalation (inhalation through a mask). Pain relief is provided by analgesics, which are also administered throughout the operation.
The patient's breathing during general anesthesia can be independent, but is most often supported by breathing apparatus that "adjusts" to the rhythm and depth of human breathing. During short and uncomplicated operations, the anesthesiologist uses a laryngeal mask through which the patient breathes a mixture of oxygen, air, and anesthetic gases. For longer operations requiring complete muscle relaxation, where muscle relaxants are used, endotracheal anesthesia is performed. Under medical sleep, a thermoplastic tube with a special cuff is inserted into the patient's airways, which completely protects the lungs and allows artificial ventilation.
In patients with concomitant diseases of the cardiovascular system, necessary medications are administered during anesthesia to support heart function or normalize blood pressure. Blood sugar levels are monitored in patients with diabetes mellitus. If necessary, any parameter can be examined in the laboratory in a short time during the operation.
Regional anesthesia
It allows you to anesthetize certain areas of the body. Spinal and epidural anesthesia are the most well-known, when a small amount of local anesthetic blocks the conduction of pain and motor nerve impulses in the lower body. Most operations on the lower extremities are performed under this type of anesthesia. For patients of older age groups, this anesthesia is an alternative method for prosthetics of knee and hip joints.
Regional anesthesia is also used for operations on the upper extremities. With the help of a special device, the location of the nerve plexus is precisely determined (in the neck, axillary region, or individual nerves on the forearm and hand) and a local anesthetic is administered. After 20-30 minutes, the arm loses its sensitivity and ability to move.
The nerve block lasts for 2-3 hours, then all the usual sensations are gradually restored. During the action of regional anesthesia, a light drug-induced sleep can be maintained, eliminating the "presence" of the patient during surgery. This issue must be discussed in consultation with an anesthesiologist before surgery. At the patient's request, sleeping pills will not be administered, and he will be able to monitor the operation on the monitor without experiencing any unpleasant sensations.
Regional anesthesia is also used for pain relief in the postoperative period, most often during operations in the knee, shin, and foot areas, ensuring the absence of pain for 8-12 hours.
Local anesthesia
Currently, it is used only for small operations on the body surface. A type of local anesthesia is applicative, when an ointment with an anesthetic is applied to the skin, and after 30-40 minutes it becomes possible to painlessly puncture the veins to take blood tests.
Risks of anesthesia
Anesthesia is a safe manipulation, but like all medical procedures it has certain risks. Life-threatening complications (cardiac arrest, respiratory arrest, severe allergic reactions) are extremely rare.
However, the risk of anesthesia is considered increased if:
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The patient has some kind of chronic disease (hypertension, coronary heart disease, asthma, diabetes mellitus, etc.). If these diseases are well compensated, the risk increases slightly.
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The patient is allergic to any medications
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The patient smokes, uses alcohol and drugs
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The patient was inattentive to the recommendations for preparing for surgery and anesthesia, for example, he did not keep up with the required time interval for food restrictions, or did not coordinate with the anesthesiologist to take his medications.
Dangers of general anesthesia
During general anesthesia, protective reflexes are inhibited, so there is a danger of gastric contents entering the respiratory tract, which can be life-threatening. In this regard, food should not be consumed within 6 hours before the operation, and 4 hours before the operation it is not recommended to drink water, chew gum, or smoke. If the patient did not follow this rule, the operation is postponed or canceled for his safety.
It is important to inform the anesthesiologist about loose teeth or removable dentures, as there is a possibility of damage to teeth or vocal cords during endotracheal anesthesia during intubation tube placement.
In rare cases, nausea and vomiting may occur in the early postoperative period, which is associated with an individual reaction to drugs for anesthesia.
During anesthesia, muscle tone is reduced, therefore, during prolonged operations, so-called positional compression of nerves is possible, which can lead to a decrease in sensitivity in any part of the body lasting up to several weeks.
The dangers of regional anesthesia
If blood pressure drops, dizziness, nausea, or difficulty breathing occur during spinal or epidural anesthesia, immediately inform the anesthesiologist or nurse. Specialists will take the necessary measures to improve your condition.
After surgery performed under spinal or epidural anesthesia, a decrease in sensitivity in the lower extremities persists for several hours. Emptying the bladder may also be difficult, and a catheter may be inserted into the bladder if necessary.
A headache may occur after spinal anesthesia. This rare complication may require several days of bed rest and pain medication.
Conversation with an anesthesiologist
Anesthesia is always preceded by a conversation with an anesthesiologist. If you have any questions, be sure to ask them during this conversation! You will be given a questionnaire where you need to accurately and in detail note all the information about your health status, previous and existing diseases, and medications currently used. You also need information about previous surgeries, possible allergies to medications, and your habits (playing sports, smoking, drinking alcohol, etc.). Before surgery, you must sign a consent form for surgery and anesthesia.
Preparing for the operation
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Before surgery and anesthesia
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Warn your doctor about any health changes, in particular for women – about the onset of menstruation or possible pregnancy
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Stop drinking and smoking 12 hours before your visit to the clinic
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Prepare for possible hospitalization for more than a day.
On the day of the operation
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Do not take food for 6 hours and drinks for 4 hours before surgery
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Do not use cosmetics, nail polish, or contact lenses. Painted or artificial nails can make it difficult for the oxygen sensor applied to the finger to work
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Take medications prescribed by an anesthesiologist with no more than one sip of water
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On the morning of the operation, take a shower
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You should arrive at the clinic at the time indicated in the direction
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Immediately before the operation, you need to change into special underwear provided by the nurse
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Remove and give all jewelry and rings, glasses, contact lenses and removable dentures to the nurse in the department
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Immediately before the operation, visit the toilet
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If necessary, bring a hearing aid or an inhaler used for asthma to the operating room.
After the operation
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Recovery after anesthesia takes place in the postoperative ward, where medical staff monitors breathing, pulse, blood pressure, and pain. If necessary, painkillers are administered and oxygen is supplied. If you have undergone spinal anesthesia, the restoration of mobility and sensitivity in the lower extremities is also monitored. You will be transferred to the hospital room only after waking up, provided that your condition is satisfactory.
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Depending on the complexity of the operation, postoperative treatment in the intensive care unit may be required.
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Pain may occur in the wound area after surgery. To prevent or treat it, you will be given pain medications. For different people, even with the same operations, the intensity of pain can vary greatly. Severe pain contributes to sleep disorders, causes fear and irritability. The sooner pain control is achieved, the sooner you will recover from the surgery. No need to endure the pain! If you feel pain, tell your nurse about it.
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Even if the operation is performed on an outpatient basis, and you can go home in the evening, you can only leave the clinic with the permission of the anesthesiologist or surgeon. You must be accompanied by a friend or family member (for children, the person driving the car cannot be an escort). All special recommendations will be given to you before you are discharged from the clinic.
On the first day after surgery, it is not recommended to:
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Take alcohol, sleeping pills or psychotropic substances, overeat in the evening after surgery
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Drive a car or use other potentially dangerous devices
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Stay in places that require special attention and make important decisions
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Stay alone on the first day after surgery.
Contraindications to anesthesia
The doctor does not have the right to refuse anesthesia to the patient during surgery.
For each planned intervention, there is a specific list of types of anesthesia that can be used. The type of anesthesia for each patient is determined during consultation with an anesthesiologist before surgery. Only by assessing the patient's condition, concomitant diseases, and medications that he is taking, the anesthesiologist can conclude which anesthesia is suitable for a particular patient during a particular operation. The anesthesiologist, together with the patient, draws up an individual anesthesia plan.
If the patient has had allergic reactions to lidocaine or novocaine in the past, he will be anesthetized using other drugs. An allergist's consultation and allergy testing may also be recommended beforehand.
Contraindications to general anesthesia:
- A serious condition of the patient, when the risk of anesthesia may be higher than the risk of the operation itself. This may be a recent myocardial infarction, severe heart or respiratory failure, or recent surgeries.
- Anatomical features of the patient (too high weight, short neck).
In these cases, the anesthesiologist and the surgeon determine which anesthetic aid is suitable for the patient.
Contraindications to regional anesthesia (spinal, epidural):
- the patient's own refusal;
- an infectious process at the injection site;
- tattooing at the injection site is a relative contraindication; in some cases, anesthesia can be administered in a different place or from a different angle.
Doctors will have to postpone anesthesia and the operation itself in the following cases:
- In the case of general anesthesia - if the patient has not followed the recommendations about avoiding food and fluids before surgery.
- In the case of regional anesthesia, if the patient has recently taken an anticoagulant (blood thinning) drug and it continues to act. Then anesthesia is possible only after the current dose of the drug has expired.
Thanks to new technologies and modern protocols, anesthesia is NOT contraindicated:
- active bleeding,
- severe infectious process (sepsis),
- cardiovascular diseases.
Indications for manipulation during drug-induced sleep in addition to local anesthesia:
- severe psychoemotional condition,
- late age and concomitant diseases,
- children's age.
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