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ANAESTHESIA

Anesthesia is the loss of feeling or sensation. It may be accomplished without the loss of consciousness, or with partial or total loss of consciousness.

Anesthesiology is a branch of medical science that relates to anesthesia and anesthetics. The anesthetist is a specialized physician in charge of supervising and administering anesthesia in the course of a surgical operation. Depending on the type of operation and procedures used, there are two types of anesthesia: general anesthesia, which causes a loss of consciousness, and local anesthesia, where the anesthetic ?freezes? the nerves in the area covered by the operation. In local anesthesia, the patient may be conscious during the course of the operation or given a sedative, a drug that induces sleep.

General: anesthesia resulting in amnesia, with a loss of protective airway reflexes. While usually administered with inhalational agents, general anesthesia can be achieved with intravenous agents, such as propofol. Amnesia is the main characteristic, while analgesia and muscle relaxation may be present, to varying degrees.

Regional:Loss of pain sensation, with varying degrees of muscle relaxation, in certain regions of the body. It is administered with local anesthesia to peripheral nerve bundles, such as the brachial plexus in the neck. Examples include the interscalene block for shoulder surgery, axillary block for wrist surgery, and femoral nerve block for leg surgery. While traditionally administered as a single injection, newer techniques involve placement of indwelling catheters for continuous or intermittent administration of local anesthetics.

Spinal: also known as subarachnoid block. It refers to a regional block resulting from a small volume of local anesthetics being injected into the spinal canal. The spinal canal is covered by the dura mater, through which the spinal needle enters. The spinal canal contains cerebrospinal fluid and the spinal cord. The subarachnoid block is usually injected between the 4th and 5th lumbar vertebrae, because the spinal cord usually stops at the 1st lumbar vertebra, while the canal continues to the sacral vertebrae. It results in a loss of pain sensation and muscle strength, usually up to the level of the chest (nipple line or 4th thoracic dermatome).

Epidural: It is a regional block resulting from an injection of a large volume of local anesthetic into the epidural space. The epidural space is a potential space that lies underneath the ligamenta flava, and outside the dura mater (outside layer of the spinal canal). This is basically an injection around the spinal canal.

Local anesthesia is similar to regional anesthesia, but exerts its effect on a smaller area of the body.

Not all surgical procedures require anesthetic. Sometimes no anesthetic is required, and conscious sedation is used, which does not result in loss of consciousness or significant analgesia, but frequently produces a degree of amnesia, and relaxes the patient.

Local anesthetics block pain in regions of the body without affecting other functions of the body or overall consciousness. They are used for medical examinations, diagnoses, minor surgical and dental procedures, and for relieving symptoms of minor distress, such as itching, toothaches, and hemorrhoids. They can be taken as creams, ointments, sprays, gels, or liquid; or they can be given by injection and in eye drops. Some local anesthetics are benzocaine, bupivacaine, cocaine, lidocaine, procaine, and tetracaine. Some act rapidly and have a short duration of effect, while others may have a slow action and a long duration. Sprays can be used on the throat and related areas for a bronchoscopy, and gels can be used for the urethra to numb the area for a catherization or cystoscopy.

Spinal anesthesia is used for surgery of the abdomen, lower back and legs. Spinal or epidural anesthesia is also used for surgery on the prostate gland and hip. A fine needle is inserted between two vertebrae in the lumbar (lower part) of the spine and the anesthetic flows into the fluid surrounding the spinal cord. The nerves absorb the anesthetic as they emerge from the spinal fluid. The area anesthetized is controlled by the location of the injection and the amount of absorption of the anesthetic by the spinal fluid.

There are a number of possible complications that can occur under general anesthesia. They include loss of blood pressure, irregular heart beat, heart attack, vomiting and then inhaling the vomit into the lungs, coma, and death. Although mishaps do occur, the chance of a serious complication is extremely low. Avoidance of complications depends on recognition of the condition of the patient before the operation, the choice of the appropriate anesthetic procedure, and the nature of the surgery itself. It is possible to have adverse reactions to local anesthetics, such as dizziness, hypotension (low blood pressure), convulsions, and even death. These effects are rare but can occur if the dose is too high or if the drug has been absorbed too rapidly. A small percentage of patients (1-5%) may develop headaches with spinal anesthesia.

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Date: 2016-06-13; view: 697