Local anesthesia and general how to understand. Local anesthesia (anesthesia): preparation, types, consequences

Local anesthesia is a local loss of tissue sensitivity, created artificially using chemical, physical or mechanical means in order to perform painless operations while maintaining the patient’s full consciousness.

The following types are distinguished: local anesthesia:

· Anesthesia of nerve endings - terminal anesthesia, which can be carried out by lubrication, irrigation. By cooling (superficial anesthesia), infiltration with an anesthetic solution and the “tight creeping infiltrate” method, sheath anesthesia according to A.V. Vishnevsky.

· Conduction anesthesia, in which pain relief can be achieved by anesthesia of the nerve trunks and ganglia, intravascular or intraosseous injection of an anesthetic, as well as injection of the drug into the spinal canal or epidural space.

Indications and contraindications for local anesthesia.

Indications for local anesthesia:

1. Type and volume of operations (not large abdominal operations up to 1-1.5 hours, not abdominal operations on soft tissues).

2. Intolerance to general anesthesia due to concomitant diseases or serious condition.

3. Refusal of the patient from general anesthesia.

4. Elderly and weakened patients.

Contraindications for local anesthesia:

1. The patient’s refusal of local anesthesia.

2. Intolerance to novocaine drugs.

3. Mental illness.

4. Nervous excitement.

5. Children's age.

6. Volume of transactions.

Features of some types of local anesthesia.

Anesthesia by lubrication or irrigation. This type of anesthesia of the mucous membranes with solutions of local anesthetics is more often used in ophthalmology, otorhinolaryngology, urology and endoscopic practice. The mucous membrane of the nasal passages, oral cavity, pharynx, larynx, bronchi, etc. loses sensitivity 4-8 minutes after lubricating them 1-2 times with a 3-5% solution of novocaine, 0.25-2% solution of dicaine.

Anesthesia by cooling. This anesthesia is rarely used in surgery, only for superficially located ulcers. More often, local cooling is used to relieve pain from soft tissue bruises and diseases of the musculoskeletal system ( sports injury, arthrosis). Cooling anesthesia is carried out by spraying ethyl chloride onto the skin, the boiling point of which is +12-13 degrees.

Infiltration anesthesia. The basis of infiltration anesthesia is the impregnation of tissues in the area of ​​​​operative intervention with an anesthetic solution that acts as a nerve endings, and on nerve trunks. Currently, 0.25-0.5% solutions of novocaine are used for infiltration anesthesia. First, novocaine is injected intradermally with a thin needle, which lifts the skin and makes the skin pores more visible. This area of ​​skin resembles a lemon peel. After the “lemon peel” has formed, long needles are used to infiltrate the tissues layer by layer from the outside to the inside without cutting them.

Anesthesia according to Vishnevsky. This method was developed by A.V. Vishnevsky in 1923-1928 and called it local anesthesia by the method of creeping infiltration. Anesthesia according to Vishnevsky is strictly layer-by-layer. After the formation of a “lemon peel”, as with infiltration anesthesia, the surgeon tightly pumps the anesthetic solution into the subcutaneous fatty tissue. After this, he makes an incision in the skin and subcutaneous fat and, as soon as he reaches the aponeurosis, creates a tight infiltrate underneath, etc. Thus, the surgeon acts alternately with a scalpel and a syringe. Under local anesthesia according to Vishnevsky, patients with inflammatory diseases(carbuncle, phlegmon). For this type of anesthesia, a 0.25% novocaine solution is used.

Conduction or regional anesthesia. This is a type of local anesthesia, which is carried out by exposing the anesthetic solution to the trunk of the sensory nerve, as a result of which the pain impulse from the body stops. surgical field into the brain.

Anesthesia of fingers according to Lukashevich- Oberst. A gauze or rubber flagellum is applied to the base of the finger, and 2 ml of a 2% novocaine solution is injected distal to it on both sides of the extensor tendon of the finger (from the inside and outside). The effect of the anesthetic manifests itself in less than 15 minutes, and only after complete anesthesia has occurred can one begin to open the abscess, treat the wound, and remove the nail.

Novocaine blockades. Perinephric is carried out at the intersection of the 12th rib and long back muscles with the patient lying on his side with a solution of novocaine 0.25% up to 100 ml. Perinephric block blocks the solar and lumbar plexuses. Used with medicinal and diagnostic purpose. Intercostal anesthesia is performed for fractures, cracked ribs, bruises of the chest, intercostal neuralgia. A 2% solution of novocaine is used.

Complications during local anesthesia and their prevention.

Complications associated with the use of anesthetics are mainly due to their overdose. Poisoning is very rarely observed when using novocaine, but Dicaine, Sovcaine and other drugs can cause poisoning, the manifestations of which, depending on the severity, can be divided into 3 stages.

Stage 1 is characterized by dizziness, pale skin, rapidly increasing general weakness, the appearance of cold sweat, dilated pupils, weak pulse filling, nausea, and sometimes vomiting.

Stage 2 – poisoning. It is characterized by motor agitation, blackouts, the appearance of a convulsive attack with clonic and tonic convulsions, a feeling of fear, the development of hallucinations, severe trembling, rapid pulse poor filling, vomiting.

In the 3rd stage of excitation, the central nervous system is replaced by depression, consciousness disappears, breathing becomes shallow and irregular, and respiratory arrest may occur due to paralysis of the respiratory center.

To prevent poisoning when using concentrated solutions anesthetics, it is necessary to prescribe barbiturates 40 minutes before using them.

Patient care after local anesthesia.

1. Bed rest - rest.

2. Special position of the patient or part of the body.

3. Weight or cold on the wound.

4. Administer painkillers and sedatives in a timely manner.

5. Protect the dressing.

6. Abstinence from food and water - individually.

7. After the local anesthesia wears off, additional painkillers should be discussed with your doctor.

Questions for consolidation

Much credit for the development of local anesthesia belongs to Russian scientists: V.K. Anrep, who discovered the local anesthetic properties of cocaine in 1880, A.I. Lukashevich, who began performing operations under conduction anesthesia in 1886, and especially A.V. Vishnevsky ( 1874—1948). He was a wonderful surgeon who did a lot for the development of general and military surgery. He developed the most safe method local anesthesia, thanks to which hundreds of thousands of wounded during the war were provided with the full necessary surgical care.

MECHANISM OF LOCAL ANESTHESIA

The main differences between local anesthesia and general anesthesia are the preservation of consciousness and the creation of an obstacle to the path of pain impulses below the brain or, more precisely, not above thoracic spinal cord. On this path, you can achieve both pain relief and eliminate other sensations - heat and cold, touch and pressure.

Anesthesia can be performed in the following areas: 1) the surface of the laryngeal mucosa. trachea, bronchi, urethra and bladder (this is superficial, or terminal, anesthesia); 2) turning off pain receptors in the skin and other organs (infiltration and regional anesthesia); 3) along the course of a large nerve or nerve plexus (conductor anesthesia); 4) along the nerve roots outside the dura mater (epidural anesthesia); 5) at the level of nerve cells that conduct sensitivity in the spinal cord itself (spinal or spinal anesthesia).

PREPARATIONS FOR LOCAL ANESTHESIA

We will focus on several of the most commonly used substances.

Novocaine(procaine). White powder with a bitter taste, highly soluble in water and alcohol. Novocaine is selectively absorbed by nervous tissue and consistently turns off the feeling of cold, heat, pain and, finally, pressure. Active in alkaline tissue reactions. With inflammation (acid reaction in tissues), its activity decreases.

In the form of a 5-10% solution, it is used for anesthesia of mucous membranes, and a 1-2% solution for conduction anesthesia. It is practically not used for epidural and spinal anesthesia due to insufficient effectiveness.

Novocaine is most often used for infiltration anesthesia according to A.V. Vishnevsky.

Dicaine(pantocaine). It is 15 times stronger, but almost as many times more toxic than novocaine. It is used for anesthesia of mucous membranes in the form of 0.25; 0.5; 1 or 2% solutions, less often - for epidural anesthesia: 0.3% solution in fractional doses of 3-5 ml (but not more than 20 ml). Maximum single dose 0.07 g.

Lidocaine(xylocaine). The drug is 2 times more toxic, but 4 times stronger and acts longer (up to 5 hours) than novocaine. For anesthesia of mucous membranes, 4-10% solutions are used, in ophthalmic practice - 2% solution, for conduction anesthesia - 0.5-2% solution (up to 50 ml), for epidural anesthesia - 2% solution (up to 20 ml), for infiltration anesthesia - 0.5-0.25% solutions (500 and 1000 ml, respectively). Maximum dose 15 mg/kg.

Trimekain(mesocaine). 1.5 times more toxic and 3 times stronger than novocaine. For infiltration anesthesia, use 0.25% and 0.5% solutions of 800 and 400 ml, respectively. For conduction anesthesia - 1% (100 ml) or 2% (no more than 20 ml due to sharp potentiation!) solutions. In the form of a 2.5-3% solution in an amount of 7-10 ml, it is used for epidural anesthesia, and for spinal anesthesia, 2-3 ml of a 5% solution is sufficient. The maximum dose is 10-12 mg/kg.

Bupivacaine(marcaine, anecaine). It is the most powerful and long-acting anesthetic of those discussed above (2-3 times greater than lidocaine). For epidural anesthesia it is usually used as a 0.5% solution. The main dose is 40-50 mg, with a maintenance dose of 15-40 mg. Available in 20 ml bottles (1 ml contains 2.5 or 5 mg of the drug) and 1 ml ampoules (contains 5 mg).

Naropin(ropivacaine). One of the most modern anesthetics. The drug is produced in polypropylene ampoules containing 10 or 20 ml of a solution of various concentrations (0.2%, 0.75% and 1%), as well as infusion containers of 100 or 200 ml of 0.2% ropivacaine. Duration of action - up to 5 hours. Used for conduction and epidural anesthesia.

Ultracaine D-C Forte. 1 ml of the drug contains 40 mg of articaine hydrochloride and 12 mcg of adrenaline hydrochloride. The drug has low toxicity. Although the drug is intended for use in dental practice, there is currently experience in its use for epidural anesthesia.

PREPARATION OF THE PATIENT

The patient must be examined to exclude contraindications to local anesthesia (excitement, low contact, etc.). When clarifying the medical history, it is necessary to find out whether there have been previous reactions to local anesthesia.

It is necessary to prepare the patient psychologically: the safety and effectiveness of local anesthesia are explained to him.

It is necessary to carry out medication preparation, as with general anesthesia; It is advisable to include sedatives and antihistamines. Dentures are removed and the time of the last meal is checked. They prepare everything necessary to eliminate complications: anticonvulsants, a ventilator, an internal infusion system and vasoconstrictors.

ANESTHESIA OF THE MUCOUS (TERMINAL ANESTHESIA)

This method is often used in ophthalmology, otorhinolaryngology, pulmonology, urology; They are also used during tracheal intubation to prevent reflex reactions. For anesthesia, 4-8 drops are instilled into the conjunctiva and cornea, and 2-8 drops of a 2-5% trimecaine solution are instilled into the nasal mucosa. For anesthesia of mucous membranes bronchial tree 3 ml of 3% dicaine solution is sufficient.

CONDUCTION ANESTHESIA

Blockade brachial plexus . The patient lies on his back with a pad placed under his neck. The head is turned in the direction opposite to the blockade site. The needle point is 1 cm above the middle of the collarbone. The needle is inserted in the direction of the first rib. When the tip of the needle hits the nerve plexus, there is a feeling of a “shot” in the arm. After this, the needle must be pulled back 0.5 cm to avoid intraneural administration of the drug. For anesthesia, 40-60 ml of a 1% lidocaine solution or 0.25% marcaine solution is administered.

Blockade sciatic nerve . The patient is placed on the edge of the table. The solution is injected into a point located midway between the greater trochanter of the tibia and the tip of the coccyx.

Intercostal nerve block. After puncturing the skin, the needle is directed to the lower edge of the overlying rib and immediately, as soon as the tip of the needle touches it, the direction is shifted downward so as not to damage the vein and artery, but to inject the drug into the area of ​​the nerve located below them.

PARAVERTEBRAL ANESTHESIA

This is a type of regional local anesthesia. The essence of the method is to block the nerve trunks at the point where they exit the intervertebral foramina with a local anesthetic. It is necessary to anesthetize not only the affected segment, for example with intercostal neuralgia, but also two segments above and below it. A local anesthetic solution is injected separately into each segment. 5-10 ml of 0.5% novocaine solution is injected into the point chosen for injection. First, the skin is anesthetized and subcutaneous tissue. Then the needle is directed 4-5 cm lateral and slightly below the intended spinous process until it stops at the transverse process or rib. The needle is slightly removed and again moved forward and downward 1 cm under the rib towards the vertebral body. A local anesthetic is injected here.

With this method, you can get a needle into the pleura or abdominal cavity, injure the spleen or get into the subdural space. Therefore, you should carefully monitor the patient’s reactions and be prepared to deal with complications. But this method can be very useful for eliminating pain after lung surgery and multiple rib fractures.

EPIDURAL ANESTHESIA

The epidural space is located between the dura mater of the spinal cord and the inner surface of the spinal canal. It is filled with loose connective tissue, in which the venous plexuses are located; The posterior (sensory) and anterior (motor) roots of the spinal nerves pass through this space. They need to be anesthetized.

The patient is placed on his side, with his legs brought to his stomach (the puncture can also be performed in a sitting position; in this case, a stand is placed under the legs, and the back is bent as much as possible). Depending on the desired level of anesthesia, the injection site is chosen: for anesthesia of the chest - Th 2 - Th3, the upper half of the abdomen - Th7 - Th8, the lower half of the abdomen - Th 10 - Th 11, the pelvis - L 1 - L 2, the lower extremities - L 3 - L 4 .

The puncture site is treated twice with alcohol (but not iodine!) and covered with sterile linen. A thin needle is used to anesthetize the skin and subcutaneous tissue. Then the epidural anesthesia needle with an attached syringe filled with isotonic sodium chloride solution is inserted strictly along the midline in the intervertebral space. The needle is advanced without violence, only by pressing the 1st finger on the syringe plunger. While the needle passes through the ligaments, despite the pressure, the solution does not flow out of the syringe, but as soon as the end of the needle enters the epidural space, the resistance disappears and the solution begins to leave the syringe. Inject 1-2 ml isotonic solution sodium chloride, disconnect the syringe from the needle and make sure that it is positioned correctly (no blood or liquid should flow out of it). After this, 4 ml of local anesthetic solution (test dose) is administered, carefully observing the patient’s breathing, pulse and consciousness. 5 minutes after administration of the test dose, if there are no signs of spinal anesthesia, the main dose is administered, which is determined by the doctor individually for each patient.

For long-term anesthesia, special needles are used (for example, a Tuohy needle), through which a polyethylene or fluoroplastic catheter is inserted 2-4 cm upward into the epidural space. A solution of local anesthetic is injected through it during the operation as needed.

To prolong the effect of the local anesthetic, 1-2 drops of a 0.01% adrenaline solution are often added per 10 ml of solution. In recent years, to enhance the effect of the local anesthetic, small doses of narcotic analgesics (morphine, promedol, fentanyl) have been added to the solution. This allows you to reduce the dosage of local anesthetic and provide long-term postoperative analgesia.

Anesthesia after the administration of a local anesthetic does not occur immediately, but after a certain period of time, called latent or latent period. This interval varies for different local anesthetics, for example, for lidocaine or trimecaine it is 10-15 minutes, and for dicaine or bupivacaine it can reach 20-25 minutes.

The clinical picture of epidural blockade develops in the following sequence.

At first, the patient feels a feeling of warmth in the lower extremities, then a feeling of numbness, crawling “pins and needles” appears, and, finally, motor blockade occurs when the patient cannot lift his leg. True, this does not happen in all cases, more often in older people. The degree of development of the blockade is determined by injections with an injection needle. Anesthesia is considered sufficient when the patient ceases to distinguish between sharp and dull touch.

The effect of epidural anesthesia on the body.

central nervous system. Epidural anesthesia does not directly affect the central nervous system. However, the shutdown of a certain part of the body that occurs when it occurs leads to the development of the so-called deafferentation brain, i.e. removing the exciting effect of sensitive impulses coming from the periphery. As a result, brain inhibition occurs, which is manifested by drowsiness and a feeling of calm.

The cardiovascular system. By the time anesthesia sets in, there is usually a decrease in blood pressure. This is a natural manifestation of epidural anesthesia, caused by the blockade of sympathetic nerve fibers, leading to dilation of blood vessels and the capacity of the vascular bed. As a result, relative hypovolemia occurs, which leads to the development of hypotension. With high epidural blockade, bradycardia may develop as a result of depression sympathetic nerves hearts.

Respiratory system. With high epidural anesthesia, some respiratory depression is possible due to blockade of the intercostal muscles.

Epidural blockade has a bronchodilator effect, which is used in the treatment of status asthmaticus.

Digestive system . As a result of the sympathetic blockade that occurs during epidural anesthesia, intestinal motility increases. This effect is used in the treatment of intestinal paresis. On the other hand, this dictates the need for thorough cleansing of the intestines before a planned operation, because involuntary defecation is possible.

From the outside urinary system Possible urinary retention. True, such complications are quite rare, and are more often caused by the action of narcotic analgesics, especially morphine.

SPINAL ANESTHESIA

A local anesthetic solution is injected with the patient sitting or on his side into the subarachnoid space. Use special thin (No. 24-26) needles. The puncture is usually performed in the space between the III and IV lumbar vertebrae. The needle goes through the same anatomical formations, as with epidural anesthesia, but in addition it is necessary to puncture the dura mater. Entry into the subarachnoid space is determined by the flow of cerebrospinal fluid from the needle. After this, a local anesthetic solution is injected. Use a 5% solution of lidocaine (1.5 ml) or a 0.25-0.5% solution of bupivacaine (2-3 ml).

The clinical picture and effect on the body of spinal and epidural anesthesia are largely similar. Unlike epidural, the speed of blockade development during spinal anesthesia is higher (no more than 3-5 minutes). Failures and incomplete anesthesia occur less frequently. Spinal anesthesia gives very good muscle relaxation.

During spinal anesthesia, the density of the injected local anesthetic is important. If it is less than the density of the cerebrospinal fluid, the solution is called hypobaric; if it is equal to it, it is isobaric; if it is greater than the density of the cerebrospinal fluid, it is called hyperbaric. Knowing the density of the solution allows you to determine in which direction the local anesthetic will spread. Hypobaric solutions spread upward from the injection site, hyperbaric solutions spread downward, and isobaric solutions remain at the injection level.

INDICATIONS AND CONTRAINDICATIONS FOR EPIDURAL AND SPINAL ANESTHESIA.

Indications for epidural and spinal anesthesia in " pure form"are operations on the lower extremities, pelvic bones, pelvic organs, and anterior abdominal wall.

In combination with multicomponent anesthesia, they can be used for extensive and traumatic operations on the upper floor of the abdominal cavity and chest organs.

Epidural and spinal anesthesia are of great importance for the treatment of various pain syndromes in oncology, traumatology, cardiology, etc.

Contraindications are divided into absolute and relative. Absolute intolerance to local anesthetics, hypocoagulation, purulent skin diseases at the puncture site, shock, hypovolemia, hypotension. Relative contraindications are spinal deformities, obesity, and certain diseases. nervous system.

COMPLICATIONS

I. Complications caused by the action of local anesthetic.

These complications can occur with any type of local anesthesia. Three types of complications are most likely to occur: damage to the central nervous system, cardiac conduction system and allergic reactions, as well as their combination. The occurrence and severity of complications depend on the following factors: 1 - the nature of the local anesthetic; 2 - its dose; 3 - type of local anesthesia; 4 - adding to the solution vasoconstrictor drugs.

The stronger the local anesthetic, the more dangerous it is: its strength decreases in the sequence sovcaine - dicaine - trimecaine - lidocaine - novocaine. The most dangerous are spinal, then epidural and regional anesthesia, performed near large vessels (plexus anesthesia).

CNS lesions. The patient becomes restless (less often drowsy), complains of dizziness, ringing in the ears, speech becomes slurred, a metallic taste appears in the mouth, and nystagmus can often be detected. Convulsive twitching occurs in individual muscles, and in the most severe cases- general convulsions. The latter are especially pronounced in respiratory and metabolic acidosis.

Hemodynamic disorders. The conduction system of the heart and vascular tone (sympathetic blockade) are most affected. Therefore, bradycardia appears (up to cardiac arrest) and blood pressure sharply decreases (up to cardiovascular collapse).

Allergic reactions. May be allergic dermatitis: the appearance of many red spots on the skin, sometimes on an edematous basis, itching, attack bronchial asthma, and in the most severe cases - anaphylactic shock.

Prevention. The main thing is to carefully collect anamnesis. At the slightest suspicion of intolerance to local anesthetics, you should either abandon this method altogether, or use it in preparation antihistamines, benzodiazepines (sibazon, relanium) and phenobarbital. It is very important to use a test dose of local anesthetic (introduce it intradermally and evaluate the reaction), not exceed a single maximum dose and stop anesthesia if there is a suspicion of entry into a large vessel (conductor anesthesia, epidural anesthesia) or into the cerebrospinal fluid tract (epidural anesthesia, paravertebral anesthesia) .

Intensive therapy. If the central nervous system is predominantly affected, 2.5-5 mg of sibazone or (carefully!) 2% sodium thiopental solution is administered intravenously until the seizures are eliminated.

If hemodynamic disturbances occur, the patient is transferred to the Trendelenburg position and vigorous infusion therapy is administered. If necessary, vasoconstrictor drugs and glucocorticoid hormones (12 mg dexazone, 60 mg prednisolone) are administered.

In case of cardiac arrest, the entire complex of cardiopulmonary resuscitation is performed.

II. Complications of epidural and spinal anesthesia.

Complications of a traumatic nature. The mildest of them are injuries to the periosteum and spinal ligaments. Manifested by pain at the puncture site. They usually go away on their own within a few days. More serious complications are damage to a vessel with possible education epidural hematoma, nerve root damage, puncture of the dura mater. A puncture of the dura mater, if diagnosed in a timely manner, usually does not lead to any serious disorders the patient’s health,” with the exception of headaches that last for several days and are caused by the leakage of cerebrospinal fluid and a decrease in intracranial pressure.

Breathing disorders. This often happens with high epidural and spinal anesthesia, when the roots of the intercostal nerves are blocked. In this case, the only breathing muscle remains the diaphragm. In these conditions, assisted ventilation is sometimes required.

Hemodynamic disorders. As mentioned above, hypotension is an almost constant companion to epidural and spinal anesthesia. A decrease in blood pressure by less than 40% of the initial value is not considered a complication and can be easily stopped by accelerating the infusion rate. When blood pressure decreases by more than 40%, it is necessary to take more vigorous measures: massive infusion therapy, and if it is ineffective, the introduction of vasoconstrictor drugs, preferably ephedrine in a dose of 0.2-0.3 ml.

If the dura mater is punctured unnoticed and a full dose of local anesthetic is administered, a terrible complication can develop - a total spinal block, which is characterized by a sharp decrease in blood pressure and respiratory arrest. If immediate action is not taken, death may occur. It is necessary to transfer the patient to mechanical ventilation. administration of vasopressors. powerful infusion therapy.

Purulent complications. If the principles of asepsis are not observed, the development of purulent epiduritis and meningitis is possible. Powerful antibacterial therapy is indicated, and in some cases, surgical intervention to open and drain the purulent focus.

Local anesthesia is divided into 3 types: superficial (terminal), infiltration, regional (conduction anesthesia of the nerve plexuses, spinal, epidural, intraosseous).

Superficial anesthesia is achieved by applying an anesthetic (lubrication, irrigation, application) to the mucous membranes. Use high concentrations anesthetic solutions - dicaine 1-3%, novocaine 5-10%. A variation is cooling anesthesia. It is used for minor outpatient procedures (opening ulcers).

Infiltration Anesthesia according to A.V. Vishnevsky is used for surgical interventions that are small in volume and duration. Use a 0.25% solution of novocaine. After anesthesia of the skin (“lemon peel”) and subcutaneous fatty tissue, the anesthetic is injected into the corresponding fascial spaces. Along the intended incision, a tight infiltrate is formed, which, due to high hydrostatic pressure, spreads along the interfascial canals, washing the nerves and vessels passing through them.

The advantage of the method is that the concentration of the anesthetic solution is low and part of it flows out through the wound during the operation, eliminating the risk of intoxication, despite the administration of large volumes of the drug.

Intraosseous regional anesthesia is used for operations on the limbs.

Use a 0.5-1% solution of novocaine or a 0.5-1.0% solution of lidocaine.

A tourniquet is applied to a highly raised limb (for bleeding) above the site of the intended surgical intervention. The soft tissue above the site of needle insertion into the bone is infiltrated with an anesthetic solution to the periosteum. A thick needle with a mandrin is inserted into the cancellous bone, the mandrin is removed and an anesthetic is injected through the needle. The amount of anesthetic solution administered depends on the site of its administration: for foot surgery - 100-150 ml, for hand surgery - 60-100 ml.

Pain relief occurs within 10-15 minutes. At the same time, the entire pain is numbed peripheral section limbs to the level of application of the tourniquet.

Conductor anesthesia is carried out by introducing an anesthetic solution directly to the nerve trunk at various points along its passage - from the point of exit from the spinal cord to the periphery.

Depending on the location of the site where pain sensitivity is interrupted, there are 5 types of conduction anesthesia: stem, plexus (nerve plexus anesthesia), nerve ganglion anesthesia (paravertebral), spinal and epidural.

Stem anesthesia.

The anesthetic solution is injected along the nerve innervating this area.

Anesthesia according to A.I. Lukashevich-Oberst: Indications - operations on the finger.

A rubber bandage is placed at the base of the finger. Distally, from the dorso-lateral side, 2 ml of 1-2% novocaine solution is slowly injected through a thin needle on both sides in the area of ​​the main phalanx.

Plexus and paravertebral anesthesia.

The anesthetic solution is injected into the area of ​​the nerve plexuses or into the area where the nerve nodes are located.

Spinal anesthesia.

The anesthetic is injected into the subarachnoid space of the spinal canal.

Indications: surgical interventions on organs located below the diaphragm.

Absolute contraindications: inflammatory processes in the lumbar region, pustular skin diseases of the back, uncorrected hypovolemia, severe anemia, mental illness, curvature of the spine, increased intracranial pressure.

Relative contraindications: heart failure, hypovolemia, septic condition, cachexia, increased nervous irritability, history of frequent headaches, ischemic disease hearts.

Premedication: a) psychological preparation of the patient, b) prescription sedatives on the eve of surgery, c) intramuscular administration of standard doses of narcotic and antihistamines 30-40 minutes before surgery.

Anesthesia technique. Puncture of the spinal space is performed with the patient sitting or lying on his side with a well-bent spine, hips pressed to the stomach and head bent to the chest.

The method requires strict asepsis and antisepsis, but iodine is not used due to the risk of aseptic arachnoiditis.

First, the tissue in the puncture area is infiltrated with anesthetic. A thick needle is passed strictly along the midline between the spinous processes at a slight angle in accordance with their inclination. The depth of needle insertion is 4.5-6.0 cm.

When the needle is slowly passed through the ligamentous apparatus, resistance from dense tissue is felt, which suddenly disappears after puncturing the ligamentum flavum. After this, the mandrel is removed and the needle is advanced 2-3 mm, piercing the dura mater. A sign of precise localization of the needle is the flow of cerebrospinal fluid from it.

Solutions of local anesthetics, depending on their relative density, are divided into hyperbaric, isobaric and hypobaric. When the head end of the operating table is raised, the hypobaric solution spreads cranially, and the hyperbaric solution spreads caudally, and vice versa.

Hyperbaric solutions: Lidocaine 5% solution in 7.5% glucose solution, Bupivacaine 0.75% in 8.25% glucose solution.

Possible complications:

· bleeding (damage to vessels of the subdural and subarachnoid space);

· damage to nerve formations;

leakage of cerebrospinal fluid with subsequent headaches;

· a sharp decline blood pressure (hypotension);

· breathing disorders.

Epidural anesthesia. A local anesthetic is injected into the epidural space, where it blocks the anterior and posterior roots of the spinal cord in a limited space.

Indications for epidural anesthesia and analgesia:

· surgical interventions on the chest, abdominal organs, urological, proctological, obstetric and gynecological, operations on the lower extremities;

· surgical interventions in patients with severe concomitant pathology (obesity, cardiovascular and pulmonary diseases, impaired liver and kidney function, deformation of the upper respiratory tract), in elderly and old age;

· severe combined skeletal injuries (multiple fractures of the ribs, pelvic bones, lower extremities);

· postoperative pain relief;

as a component of therapy for pancreatitis, peritonitis, intestinal obstruction, status asthmaticus;

· to relieve chronic pain syndrome.

Absolute contraindications to epidural anesthesia and analgesia:

· reluctance of the patient to undergo epidural anesthesia;

· inflammatory skin lesions in the area of ​​the proposed epidural puncture;

· severe shock;

· sepsis and septic conditions;

· violation of the blood coagulation system (danger of epidural hematoma);

increased intracranial pressure;

· hypersensitivity to local anesthetics or narcotic analgesics.

Relative contraindications to epidural anesthesia and analgesia:

· spinal deformity (kyphosis, scoliosis, etc.);

diseases of the nervous system;

· hypovolemia;

· arterial hypotension.

Premedication: a) psychological preparation of the patient, b) prescription of sedatives on the eve of surgery, c) intramuscular administration of standard doses of narcotic and antihistamines 30-40 minutes before surgery.

Technique of epidural anesthesia. Puncture of the epidural space is performed with the patient sitting or lying on his side.

Sitting position: the patient sits on the operating table, the lower limbs are bent at a right angle at the hip and knee joints, the torso is bent forward as much as possible, the head is lowered down, the chin touches the chest, the hands are on the knees.

Side lying position: lower limbs maximally bent at the hip joints, knees brought to the stomach, head bent, chin pressed to the chest, lower angles of the shoulder blades located on the same vertical axis.

The puncture level is selected taking into account the segmental innervation of organs and tissues.

Following all the rules of asepsis and antiseptics, a 0.5% solution of novocaine anesthetizes the skin, subcutaneous tissue and supraspinous ligament.

The needle for epidural anesthesia is inserted strictly along the midline, corresponding to the direction of the spinous processes. The needle passes the skin, subcutaneous tissue, supraspinous, interspinous and yellow ligaments. When passing the latter, significant resistance is felt. Loss of resistance to fluid injection with free movement of the syringe piston indicates that the needle has entered the epidural space. This is also evidenced by the retraction of a drop into the lumen of the needle when deep breath and lack of flow of cerebrospinal fluid from the needle pavilion.

After making sure that the needle is positioned correctly, a catheter is inserted through its lumen, after which the needle is removed and the catheter is fixed with an adhesive plaster.

After catheterization of the epidural space, a test dose of local anesthetic is administered in a volume of 2-3 ml. The patient is observed for 5 minutes, and if there is no evidence of the development of spinal anesthesia, the main dose of local anesthetic is administered to achieve epidural anesthesia. Fractional injection of anesthetic provides anesthesia for 2-3 hours.

Use: Lidocaine 2% Trimecaine 2.5% Bupivacaine 0.5%

Complications of epidural anesthesia can be caused by technical factors (damage to the dura mater, venous trunk), entry of anesthetic into the spinal canal, infection of soft tissues and meninges(meningitis, arachnoiditis), anesthetic overdose (drowsiness, nausea, vomiting, convulsions, respiratory depression).

At hypersensitivity To local anesthetics, anaphylactic reactions, including shock, are possible.

Novocaine blockades.

One of the methods of nonspecific therapy, in which a low-concentrated solution of novocaine is injected into various cellular spaces to block the nerve trunks passing here and achieve an analgesic or therapeutic effect.

The purpose of this event is to suppress painful sensations, improve impaired blood flow, improve tissue trophism; block autonomic nerve trunks.

Indications for use:

1) treatment of various nonspecific inflammatory processes, especially in the initial stage of the inflammatory reaction;

2) treatment of diseases of neurogenic etiology;

3) treatment pathological processes in the abdominal cavity, caused by disorders of the autonomic nervous system (spasm and atony of the intestinal muscles, spasm or atony of the stomach, spasm of the ureter, etc.).

Case anesthesia (blockade) according to A. V. Vishnevsky.

Indications: fractures, compression of the limbs, surgical interventions on the limbs.

Execution technique. To the side of the projection of the neurovascular bundle, 2-3 ml of a 0.25% novocaine solution is injected intradermally. Then, with a long needle, applying an anesthetic solution, they reach the bone (on the thigh, injections are made along the outer, anterior and posterior surfaces, and on the shoulder - along the posterior and anterior surfaces), the needle is pulled back 1-2 mm and injected, respectively, 100-130 ml and 150-200 ml of 0.25% novocaine solution. The maximum anesthetic effect occurs after 10-15 minutes.

Cervical vagosympathetic blockade.

Indications. Penetrating chest wounds. Carried out to prevent pleuropulmonary shock.

Technique. Position the patient on his back, place a cushion under his neck, and turn his head in the opposite direction. Surgeon index finger displaces the sternocleidomastoid muscle along with the neurovascular bundle medially. Point of insertion: the posterior edge of the specified muscle just below or above the place where it intersects with the outside jugular vein. Inject 40-60 ml of 0.25% novocaine solution, moving the needle inward and anteriorly, focusing on the anterior surface of the spine.

Intercostal blockade.

Indications. Rib fractures.

Technique. The patient's position is sitting or lying down. Novocaine is administered along the corresponding intercostal space in the middle of the distance from the spinous processes to the scapula. The needle is directed to the rib, and then slides down from it to the area where the neurovascular bundle passes. Inject 10 ml of 0.25% novocaine solution. To enhance the effect, add 1 ml of 96° alcohol to 10 ml of novocaine (alcohol-novocaine blockade). It is possible to use a 0.5% solution of novocaine, then inject 5 ml.

Paravertebral blockade.

Indications. Rib fractures, severe pain radicular syndrome, Degenerative-dystrophic diseases of the spine.

Technique. At a certain level, a needle is inserted, 3 cm away from the line of the spinous processes. The needle is advanced perpendicular to the skin until it reaches the transverse process of the vertebra, then the end of the needle is slightly shifted upward, advanced 0.5 cm in depth and 5-10 ml of a 0.5% novocaine solution is injected.

Perinephric blockade.

Indications. Renal colic, intestinal paresis, acute pancreatitis, acute cholecystitis, acute intestinal obstruction.

Technique. The patient lies on his side, with a bolster under his lower back, the leg below is bent at the knee and hip joints, from above - extended along the body.

Find the intersection of the XII rib and the long back muscles. 1-2 cm are retreated from the top of the angle along a bisector and a needle is inserted. Direct it perpendicular to the surface of the skin. The needle is located in the perinephric tissue if, when removing the syringe from the needle, the solution does not drip from the pavilion, but when breathing the drop is drawn inward. 60-100 ml of 0.25% novocaine solution is administered.

Pelvic blockade (according to Shkolnikov-Selivanov).

Indications. Fracture of the pelvic bones.

Technique. On the injured side, 1 cm medially from the superior anterior spine ilium insert the needle and move it perpendicular to the skin along inner surface wing of the ilium. 200-250 ml of 0.25% novocaine solution is administered.

Mesenteric root block.

Indications. It is carried out as the final stage of all traumatic surgical interventions on the abdominal organs to prevent postoperative intestinal paresis.

Technique. 60-80 ml of a 0.25% novocaine solution is injected into the root of the mesentery under the peritoneum.

Blockade of the round ligament of the liver.

Indications. Acute diseases of the hepato-duodenal zone (acute cholecystitis, hepatic colic, acute pancreatitis).

Technique. Stepping back from the navel 2 cm upward and 1 cm to the right, advance the needle perpendicular to the skin until a sensation of piercing the aponeurosis appears. After this, 30-40 ml of a 0.25% novocaine solution is injected.

General anesthesia. Modern ideas about the mechanisms of general anesthesia. Classification of anesthesia. Preparing patients for anesthesia, premedication and its implementation.

General anesthesia- a temporary, artificially induced condition in which there are no or reduced reactions to surgical interventions and other nociceptive stimuli.

Common components are divided into the following:

Inhibition of mental perception (anesthesia) – sleep. This can be achieved with various medications (ether, fluorotane, relanium, thiopental, GHB, etc.).

Analgesia - pain relief. This is achieved by using various means(local anesthesia, inhalational anesthetics, non-steroidal anti-inflammatory drugs, narcotic analgesics, Ca++ channel blockers, etc.).

Relaxation – relaxation of striated muscles. It is achieved by introducing depolarizing muscle relaxants (myorelaxin, listenone, ditilin) ​​and non-depolarizing (arduan, pavulon, norcuron, tracrium, etc.).

Neurovegetative blockade. Achieved by neuroleptics, benzodiazepines, ganglion blockers, inhalational anesthetics.

Maintaining adequate blood circulation, gas exchange, acid-base balance, thermoregulation, protein, lipid and other types of metabolism.

Special components of general anesthesia. The choice of components is determined by the specifics of the pathology, surgical intervention or resuscitation situation. These problems are solved by private anesthesiology. For example, conducting a benefit for coronary artery bypass grafting differs from the benefit for neuro surgical interventions Oh.

Due to the use of a large arsenal of anesthetic drugs for multicomponent anesthesia, there is no single anesthesia clinic. Therefore, when we talk about anesthesia clinic, we mean monocomponent anesthesia.

Modern ideas about the mechanism of general anesthesia.

The influence of anesthetics primarily occurs at the level of formation and propagation of action potentials in the neurons themselves and especially in interneuron contacts. The first idea that anesthetics act at the level of synapses belongs to C. Sherrington (1906). The subtle mechanism of the effect of anesthetics is still unknown. Some scientists believe that, by fixing on the cell membrane, anesthetics interfere with the depolarization process, others believe that anesthetics close sodium and potassium channels in cells. When studying synaptic transmission, the possibility of the action of anesthetics on its various links is noted (inhibition of the action potential on the presynaptic membrane, inhibition of the formation of the transmitter, decrease in the sensitivity of the receptors of the postsynaptic membrane to it).

Despite all the value of information about the subtle mechanisms of interaction of anesthetics with cellular structures, anesthesia seems to be a kind of functional state central nervous system. Significant contributions to the development of this concept were made by N. E. Vvedensky, A. A. Ukhtomsky and V. S. Galkin. In accordance with the theory of parabiosis (N. E. Vvedensky), anesthetics act on the nervous system as strong irritants, subsequently causing a decrease in the physiological lability of individual neurons and the nervous system as a whole. Recently, many experts have supported the reticular theory of anesthesia, according to which the inhibitory effect of anesthetics has a greater effect on the reticular formation of the brain, which leads to a decrease in its ascending activating effect on the overlying parts of the brain.

Local anesthesia - what is it? This is what is called short-term, but strong pain relief, which occurs as a result of the interaction of soft tissue with an anesthetic (painkiller).

Doctors use this type of anesthesia every day to perform a variety of operations. It has a lot of characteristic features that are worth knowing about.

What is local (local) anesthesia?

Other, correct with medical point In terms of vision, the name of this procedure is local (local) anesthesia.

It is usually used for minor but rather painful operations, which would be quite difficult for a person to endure without additional pain relief.

The areas where the anesthetic substance hits are the area of ​​skin over which medical or cosmetic procedures are planned, as well as other areas located under the epidermis layer.

The most commonly used injection method is local anesthesia. With this introduction active substance reaches the surface of soft tissue, although in some situations a deeper immersion of the anesthetic is required.

The injection method uses extremely small syringes that have thin needles. Therefore, the injection will be quite painless and will not cause much discomfort or fear in the patient.

Types of anesthesia

Local anesthesia is most often used during operations. There are several types that have different principle and the mechanism of action on the human body.

Peripheral nerve block

This method of pain relief is very widely used in practice during the operation, as well as for a short period after it. Can be used as independent equipment pain relief, as well as in combination with other techniques.

The main principle of the blockade peripheral nerves– injection of the required substance into the “correct” place on the human body.

The active component of the analgesic is concentrated around the nerve endings and acts directly on them.

Peripheral nerve blockade can only be performed on an empty stomach, and only after verbal information to the patient and his written consent.

Anesthesia of the spinal roots

There are two main types of such anesthesia - spinal and epidural anesthesia. They are of the conductor type.

The main principle of action is blocking the roots of the spinal cord without directly affecting its functionality.

Before conducting them, the doctor must provide the patient with mandatory psychological preparation.

Spinal and epidural anesthesia have much in common.

These two types of anesthesia can be used as local, combined, and also (for example, when performing caesarean section in women during artificial childbirth).

The second name for epidural pain relief is epidural. How is this local anesthesia given?

During the procedure, an anesthetic will be injected into the patient through a catheter in the spinal area. After this, the human body will be insensitive to pain for some time.

It is used to relieve pain in the chest, groin, abdominal cavity, and legs. It is performed extremely rarely for anesthesia of the arms and neck area, and never for anesthesia of the head.

Spinal anesthesia in its technique is very similar to epidural. Interesting feature This type of anesthesia is that it is performed in a lateral or sitting position, and during the operation the patient has the opportunity to communicate directly with the doctor.

A contraindication to epidural anesthesia, other than age, is height less than 150 cm.

Other types of local anesthesia

There are also the following types of local anesthesia:

1. Blocking of the receptor apparatus and its branches (terminal anesthesia, etc.).
2. Blocking the sensitive apparatus of a certain area of ​​the limb by soaking the operated tissue with an analgesic.

How does the analgesic work?

What to choose - local or general anesthesia? If the operation is simple and the patient does not show signs of significant mental distress, the doctor will prescribe local anesthesia.

Christine Blaine

plastic surgeon

There is a false assumption in society that local anesthesia is safer than general anesthesia. This is not true. For minor surgical procedures, local or general anesthesia can be equally safe. However, for larger surgical procedures including liposuction of large or multiple areas, tummy tuck or major operations on the chest or face, general anesthesia will result in fewer risks and/or complications than local anesthesia. There is a limit to the amount of local anesthesia that can be administered without risk of cardiac arrhythmia. Always check to see if your surgeon has the option of general anesthesia with a board-certified anesthesiologist if you are having any major surgical procedure.

Before using local anesthesia, read about all its types in more detail, find out the difference between local and general anesthesia.

Absolutely everyone knows that anesthesia (narcosis) has its consequences, has an effect on the body that is far from positive, but under certain circumstances it is impossible to do without it.

But does the effect of anesthesia always have a negative impact on health? Or something specific is dangerous, for example, an incorrectly calculated and administered amount of a substance is not entirely clear.

In order to understand this, you need to understand what anesthesia is.

What it is?

According to the definition, anesthesia is a decrease in the sensitivity of the human body as a whole or a separate part of it to external influence, up to complete loss of control and awareness of what is happening. In simple terms, it is the loss of the ability to feel pain for some time, as well as to be aware of the surrounding reality.

The name itself comes from the Greek word “ἀναισθησία”, which literally means “without feelings”.

What type of anesthesia is there?

There is enough in the world a large number of methods for classifying anesthetic processes, most of which are understandable only to a narrow circle of specialists.

The most widely accepted, “simplified” classification divides anesthesia into the following groups:

1. Local.
2. General.
3. Inhalation.

Local anesthesia

The main types of anesthesia with local effect include:

• Application is a superficial anesthesia applied to a certain area of ​​the skin or mucous membrane from above, while the drug used penetrates the tissue, “dulls” the nerve endings, leading to almost complete loss sensitivity - used quite widely, for example, in dental treatment and urology.
• Infiltration - with this type of anesthesia, an injection is given, leading to a complete blockade of nervous activity in a separate area of ​​the body, and, accordingly, to a loss of sensitivity in it.
• Conduction - in this case, an anesthetic is injected into the paraneural area, which entails blocking the transmission of impulses along the fiber of the trunk of a large nerve; anesthesiologists use this type of anesthesia during surgical interventions on the thyroid gland, and for pain relief during gynecological surgical procedures.
• Spinal or spinal - the drug with this method of anesthesia is injected into the cerebrospinal fluid, orally spinal column and sensitivity is blocked at the level of the roots of the nerve branches; this type of anesthesia is used for certain types of operations on the legs and spine.
• Epidural - the drug is also injected into the spinal column, but using a catheter and into the epidural zone; pain relief occurs by blocking the transmission of impulses by the spinal cord; it is often used as a supplement to general anesthesia and, if necessary, in obstetric practice.

General

Overall impact general view pain relief per person is as follows:

1. Complete reversible inhibition of all activity of the central nervous system.
2. Loss of memory and awareness of what is happening.
3. Complete “insensibility” of the body.
4. Relaxing everyone muscle fibers in body.

The general form of pain relief can be:

• Mononarcotic - only one drug is used.
• Mixed - two or more related remedies are used.
• Combined – doctors use several types of drugs from different groups at the same time.

Inhalation

According to the way in which the effect on the body is carried out, this anesthesia can be:

1. Masked.
2. Endotracheal.
3. Endobronchial.

Quite often used both as an independent form of anesthesia and as a supplement to general anesthesia.

What medications are used?

Some drugs used by anesthesiologists come in different forms and are used to provide different pain-relieving effects on the body.

For local anesthesia

When using anesthesia that has only a local, superficial effect, doctors usually use:

• lidocaine;
• Kamistad;
• tetracaine;
• proxymetacaine;
• inocaine;
• xylocaine.

The drugs are used in the form of:

1. Aerosols.
2. Mazey.
3. Gels.
4. Sprays

When choosing an infiltration method of influencing the body, the following are used:

• novocaine;
• ultracaine;
• lidocaine.

When implementing both conduction and spinal anesthesia, are selected the following drugs:

1. Procaine.
2. Bupivacaine.
3. Tetracaine.
4. Lidocaine.

In order for a person to be under epidural anesthesia, the following is used:

• ropivacaine;
• bupivacaine;
• lidocaine.

General

For general intravenous anesthesia of the human body, anesthesiologists usually use:

1. Hexenal.
2. Ketamine.
3. Fentanyl.
4. Sodium hydroxybutyrate.
5. Droperidol.
6. Seduxen.
7. Relanium.
8. Propanidid.
9. Viadryl.
10. Sodium thiopental.

This method is very different quick action on the body, but also cease their influence just as quickly; on average, any such drug keeps in unconscious from 20 to 30 minutes.

Inhalation

There are many drugs for this type of anesthesia, and even more mixtures of them, the compositions and ratios of which are at the discretion of the doctor.

Most often doctors use the following means and their mixtures:

• nitrous oxide;
• chloroform;
• xenon;
• propofol;
• fluorothane.

Possible consequences and complications after anesthesia

The most common complication during anesthesia, this is its overdose, which, unfortunately, is not always noticeable during medical procedures, but almost always leads to sad consequences that appear after surgical treatment, during the rehabilitation of the body.

The potential harm to health is directly dependent on the method by which anesthesia was administered and what drug or combination of drugs was used.

After local anesthesia

Despite the fact that for local anesthesia the dosage is almost always based on the doctor’s question whether it hurts or not, for example, when treating teeth, this method causes minimal harm to the body compared to other methods of pain relief.

The consequences of the application of superficial anesthetics are:

1. Edema.
2. Allergic reaction.
3. Slight dizziness.
4. Feeling nauseous.

Such symptoms can occur both as a result of exceeding the threshold of individual tolerance, and as a result of increased sensitivity to the drug used, an allergy to it.

The same consequences can occur when using the infiltration method of anesthesia. Both of these methods have a very gentle effect on both nervous tissue and the body as a whole, so the range of application of these particular methods to relieve pain during any procedure is very wide - from cosmetology to not particularly complex small operations, for example, the removal of warts.

With conduction and spinal local anesthesia, everything is quite complicated and dangerous. Among the possible consequences of an incorrectly calculated dose or an incorrectly administered drug, the most common are the following:

• transverse myelitis;
• neuropathy;
• partial or complete paralysis of a major nerve;
• spinal meningitis;
• “anterior horn” syndrome of the spinal cord;
• convulsions.

If the patient is given an epidural anesthesia, an error by the anesthesiologist can lead to complications such as:

1. Paralysis.
2. Epidural hematoma.
3. Attacks of spasmodic pain in the lower back.
4. Loss or reduction of sensation in general.

When performing local anesthesia, this type of drug injection into the spine is the most risky and dangerous for a sick person.

General

Harm after intravenous general anesthesia may appear quite a long time after the medical procedure. To the most common problems symptoms that occur after using this type of anesthesia include:

• tooth decay;
• a general drop in the activity of the central nervous system, a certain amoebism in reactions and behavior;
• leg cramps;
• the appearance of interruptions in breathing, pauses and snoring during sleep;
• cardiac dysfunction;
• dullness, sharp drop intelligence and thinking abilities;
• death of some brain cells.

To the very severe consequences This type of anesthesia is used when the patient does not wake up after surgery, falls into a coma that can last an indefinite amount of time, or dies due to cardiac arrest.

Inhalation

The consequences of delivering painkillers to the lungs include quite a lot of pathologies, but the most common are the following:

1. Inability to return to independent mechanical breathing after surgery due to various reasons- from the fact that the brain “forgot” how to do this, to the fact that the muscle tissue is numb and “frozen” and simply does not obey the weak nerve signals after “forgetting”.
2. Arrhythmia.
3. Tachycardia.
4. Bradycardia.
5. Partial muscle paralysis.
6. Acute spasmodic periodic pain in the heart.
7. Sudden stoppage of breathing, throat spasms, or convulsions in the lungs.

The worst harm that an error can cause when using this type of anesthesia is cardiac arrest, both during and after the operation.

Video: anesthesia and its consequences.

What do the doctor's say?

Any anesthesiologist before surgical intervention Be sure to have a very long and meticulous conversation with the patient; unfortunately, sick people often do not take this seriously, literally brushing off the doctor like an annoying fly.

However, the doctor talks to the patient for a reason; the purpose of the conversation is to identify possible side effects or any intolerance to certain components used in anesthesia.

Therefore, the very first thing that doctors always say is that you need to be as attentive and extremely sincere in a conversation with an anesthesiologist, since whether the patient wakes up or not largely depends on this conversation.

Also, when talking with a patient, anesthesiologists literally collect, like a puzzle, the entire life history in order to find out whether any interventions have been performed under anesthesia before, and what the person felt. If the patient cannot say that he was injected, then the doctor asks for details of the disease in order to determine this himself.

Therefore, the second thing the doctor will advise is to remember in as much detail as possible all the details of what the anesthesiologist is asking about, because in medical card Not everything is reflected. Eg. Quite often situations arise when a person has a tooth removed, and then vomits for several days.

This, as a rule, indicates intolerance to lidocaine, but there is no such information in the patient’s chart. Or, in childhood, a person suffered from inflammation of the middle ear, but no one contacted a doctor - this will also exclude the use of a number of drugs.

Therefore, the only thing that doctors advise, besides the fact that you shouldn’t stress yourself out before the upcoming operation and anesthesia, is to be extremely attentive and frank with the anesthesiologist, on whose actions half the success of the operation depends. And his actions, in turn, depend on the information he has. This means that the more the doctor knows about the patient, the more negative consequences anesthesia can be avoided.