What is anesthesia? How does it work? What does an anesthesiologist do?

8 February 2020 |   Category: Pain, Surgery
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Anesthesia is a way of preventing pain by employing various methods and anesthetic medications before surgical or therapeutic operations. These pain-blocking medications can be administered intravenously or by inhalation. The procedure may numb a small area or lead to a temporary sleep state where you will be completely unconscious. It may take several minutes or hours, depending on the type of surgery. Anesthesiologist is a doctor who specializes in administering anesthesia. He/she ensures that the operation is performed in safer conditions, carefully observes and regularly checks the patient’s vital functions such as blood pressure, respiration and heart function.

What is anesthesia?

Anesthesia is a medical treatment that prevents patients from feeling pain during surgical interventions. In general, regional or local anesthesia, anesthetic medications with different effects on nervous system are employed. General anesthetics put patients to sleep during the procedure whereas local and regional anesthetics do not put patients to sleep, but only numb a part of the body. Medications are administered by injection, inhalation, topical lotion, spray, eye drops or skin patch.

Anesthesiologists, who are experts in pain management, suggest the best option to doctors and patients depending on the type of surgery, general health of the patient, and personal preferences.

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Why is anesthesia given?

Anesthesia, meaning numbness, is a set of medical practices developed to ensure that the patient does not feel pain, but feels safe before, during and after surgery. Anesthetics suppress nerve cells, allowing doctors to work comfortably in internal organs during time-consuming procedures.

When do you need anesthesia?

Anesthesia is required in small procedures such as colonoscopy, specific biopsies, dental procedures; in cesarean or normal delivery; groin hernia, chest, upper abdomen and anal region operations, hip-knee prosthesis and varicocele surgery.

How is anesthesia given?

  • Before the procedure, the anesthesiologist asks the patient some questions (age, medical history, medications, past anesthesia experiences, etc.) to minimize risks.
  • The medication is administered to the patient via a vein or breathing.
  • The patient gradually goes to sleep.
  • After the patient is asleep, a tube is placed in his mouth, and medication is given to relax the muscles in the trachea. The tube ensures that he/she gets enough oxygen and protects his/her lungs from blood or stomach fluids. At this stage, breathing and heart rate become irregular, and a danger of vomiting and suffocation may arise. Thanks to modern medications, this risk can be avoided.
  • The surgery begins. At this stage, the anesthesiologist constantly monitors the patient and control his/her values such as respiration, temperature, fluid and blood pressure by giving the medications as much as the patient needs. The priority of the specialist is to keep the patient at this stage during the operation.
  • When the operation is done, the anesthesiologist reverses the medications and the process to awaken the patient. The patient wakes up slowly in the operating room or in a private room.

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How do you feel under anesthesia?

Before general anesthesia, some patients may have stress and anxiety about situations like starting the surgery without full sleep, feeling pain during surgery, saying things they don’t want while sleeping, fear of death on the table. While waking up, confusion and restlessness may be experienced, attention and memory may be impaired, and some patients may even cry, cry and express the subconscious.

While under anesthesia, nothing is usually felt; but in a rare case of anesthetic awareness, some patients reported that they woke up during surgery. In this case, which is more common in cesarean section, heart surgery or emergency operations following traumatic injuries performed under general anesthesia, patients stated that they could not move their body, they wanted to shout but they couldn’t, heard the talk, felt they were pulled and suffocated. Although very rare, pain can be felt.

Precautions before and after anesthesia

  • Do not eat or drink anything within 6 hours before anesthesia.
  • Stop using aspirin and some blood thinners a week before the procedure. Some vitamins and herbal medicines can also cause complications during surgery.
  • Patients with diabetes, sickle cell anemia and sleep apnea require special attention.
  • Remove your denture, glasses, hearing aids, jewelry and similar accessories.
  • Anesthesia medications can remain in your body for 24 hours after being administered. Therefore, when you leave the hospital, you should have somebody to accompany, do not drive for at least 24 hours, do not make an important decision and do not have alcohol.
  • Do not take any medication unless prescribed by the doctor after anesthesia.

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Types of anesthesia and areas of use

It has four main types. Which method is applied depends on the patient’s age, weight, current medical condition, type and area of surgery.

General anesthesia

Before a surgery that may take long, general anesthesia ensures a reversible loss of consciousness and analgesia (pain desensitization) by numbing the whole body. The aim is to prevent pain during operation by making the patient completely unconscious.

Usually intravenous medications and inhaled gases are combined. General anesthetics are often safe, but may pose a risk to the elderly or those with chronic diseases such as diabetes.

General anesthesia is used in large scale operations such as brain, intestine, liver, heart, thyroid, vocal cord, ear and cancer surgeries. Also, it is needed for operations performed in children because they are very mobile. (1)

Local anesthesia

It is a type of anesthesia which has the least likelihood of side effects. A local anesthetic medication temporarily numbs only a small area of the body; the person is awake or calmed down. It takes short time, and is often used for outpatient procedures. (2)

It is usually used in dentistry, cataract surgery, removal of warts or moles, or in skin biopsy. Depending on the size of the area, it may be administered in the form of injections, sprays or ointments.

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Regional anesthesia

It is injected near a nerve group to numb a wider area of the body than local anesthesia. It is given through a small tube called injection or catheter. Most people who have undergone regional anesthesia will deeply calm down, but remain awake. It is applied on a large part of the body, such as the waist down, arm or leg. (3)

It is benefited during birth or arm, leg, joint or abdominal surgery. There are two main kinds of regional anesthesia: spinal and epidural.

  • Epidural anesthesia

Reduces pain during labor. It provides drowsiness from the navel to the upper legs, and the patient is awake. Painkillers take about 15 minutes to work. The amount of medication may be increased or decreased as required. The epidural accelerates the first stage of labor by helping the mother relax. The mother may still feel contractions and push effectively. (4)

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  • Spinal anesthesia

Spinal block is sometimes combined with epidural during normal delivery or cesarean delivery to reduce pain. A small amount of medication is injected into the spinal fluid to numb the lower half of the body. It provides very quick relief, but only lasts for one to two hours, and is usually given only once during childbirth. It is used in lower extremity and abdominal operations. (5)

Sedation

It is to administer a sedative medication before the operation to relax the patient by causing drowsiness. Sedation can be combined with local or regional anesthesia or used alone. There are different levels of sedation, and can cause various levels of consciousness. You may be conscious, but you may not remember anything afterwards.

The type of sedation you receive depends on many factors, such as your current health and the content of the procedure. This type of anesthesia is usually used in minimally invasive procedures such as colonoscopy or endoscopy. Headache and nausea may occur, but these side effects rapidly disappear. (6)

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Side effects of anesthesia

Among common side effects that should disappear in a short time are:

  • Throat ache
  • Nausea, vomiting
  • Dry mouth
  • Muscle pains
  • Itching
  • Hoarseness
  • Confusion, temporary memory loss
  • Difficulty in urinating
  • Dizziness
  • Chills and trembles (hypothermia)

Risks of anesthesia

Anesthesia is a safe procedure but it may rarely cause complications such as heart and respiratory problems, allergic reactions, even death. Risks depend on the type of the procedure, overall health of the patient and the type of the anesthesia.

  • The elderly or those with serious medical problems are at risk in terms of pneumonia, stroke and heart attack. Special conditions such as obstructive sleep apnea, high blood pressure, drug allergies, diabetes, heart, kidney or lung conditions increase the risk.
  • Although rarely, the patient may be partially awake and experience intraoperative awareness while under general anesthesia. He/she can not move, speak, and very rarely feel the pain. For some patients, this can cause long-term psychological problems, similar to post-traumatic stress disorder.
  • When anesthetics are injected near the lungs, the needle may accidentally enter the lung and cause the lung to collapse (pneumothorax).
  • Although very rare, it can cause permanent pain due to nerve damage.
  • If alcohol or drug use is not mentioned during the assessment made before anesthesia, an insufficient amount of medication may be given, which may cause high blood pressure or awareness.
  • Overdose anesthesia can result in respiratory failure and cardiovascular collapse.

What is the difference between an anesthesia and a narcosis?

General anesthesia and narcosis are usually used in the same sense. However, narcosis is a state of numbness that occurs along with loss of sensitivity without complete loss of consciousness. Anesthesia is a much larger practice that includes general, regional, local practices, sedation and narcosis.

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What is an anesthetist?

An anesthetist is a doctor who graduated a medical school and actively treats patients in intensive care units and ensures that the patient is safe during the operation. During the surgery, he/she monitors the patient’s vital signals with the help of highly developed electronic devices and manages the pain that may occur after surgery.

Anesthetists, who have the ability to reanimation, try to keep the patients alive until the problem disappears by applying life support to patients who have lost most of their vital functions. Since anesthesiologists are experts in pain control, they also treat patients suffering from chronic pain.

How to become an anesthesiologist?

Anesthesiology is a very comprehensive multidisciplinary branch of medicine. Anesthetists who can use high-level medical technology are experts in anesthesia monitoring, pain management and intensive care medicine. Anesthesiologists follow another Anesthesiology and Reanimation education after graduating from a medical school.

Those who want to specialize further continue their education for one year or more in a field such as pain management, pediatric anesthesiology, neuroanesthesia, palliative medicine or critical care medicine. However, this education system may differ from country to country. 

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