Types of anesthesia - spinal and epidural anesthesia, endotracheal and local anesthesia

Inhalation anesthesia

This is the most commonly used type of anesthesia, which is characterized by ease of implementation, relatively easy control and short duration of action, which is important for minor surgical interventions. Inhalation anesthesia is the administration of drugs through a mask, which ensures their entry into the organs of the respiratory system. Most often, Narcotan, nitrous oxide, Trilene, Ftorotan and Etran are used for this type of anesthesia. There is a certain problem - to achieve the desired result, it is necessary that the effect of anesthesia be deep, and this is fraught with serious complications. Therefore, this type of anesthesia is most often used in pediatric surgery. Children under anesthesia administered by inhalation feel excellent, they do not experience respiratory dysfunction, and complications are extremely rare.

Contraindications to the use of Propofol

The drug cannot be used by everyone. Absolute contraindications for the use of Propofol are:

• presence of allergies to the components of the drug,
• children's age up to 1 month.

It is also not recommended to use Propofol during pregnancy, because it penetrates the placental barrier. During the feeding period, the use of the medicine is allowed, provided that the woman does not feed for several hours after using the drug.

Relative contraindications for Propofol:

• serious diseases of the cardiovascular system,
• respiratory diseases,
• pathologies of the liver and kidneys,
• anemia,
• epilepsy,
• lipid metabolism disorders.

In all these cases, consultation with a specialized doctor is necessary. In case of stable remission of the disease, in the absence of a conflict between Propofol and the medications taken by the patient and some other circumstances, the doctor may authorize the use of Propofol.

Intravenous anesthesia

This type of anesthesia refers to non-inhalation types of anesthesia, which are characterized by a long-lasting effect and a greater depth of effect compared to inhalation anesthesia. Intravenous anesthesia can be performed using the following drugs:

• Thiopental, Recofol, Oxybutyrate and Propofol - classic pain relief
• Fentathyl with diphenhydramine - neuroleptanalgesia, which can be carried out on spontaneous breathing or combined with artificial ventilation
• Sibazon with Fentathyl is ataralgesia, which provides superficial, gentle anesthesia and can be carried out with other types of anesthesia.

This type of anesthesia is used to remove abscesses and phlegmons that occur with complications; it is also possible to treat small benign tumors if their removal under general anesthesia is not possible.

Epidural anesthesia

Many operations take place while the patient is conscious. For example, operations on the lower extremities, genitals, hernias, and many others. Mainly due to the use of various types of spinal anesthesia, mainly epidural block. In this case, for pain relief you will need several milliliters of the drug, which are injected into the epidural space running along the spinal column. But for several hours, the absence of sensitivity below the level of the catheter is guaranteed.

Childbirth is increasingly taking place under epidural anesthesia. But we must remember that it is not recommended in cases of weak labor, when contractions, on the contrary, have to be stimulated. As for the situation when childbirth proceeds normally, data from many years of research indicate that epidural anesthesia during childbirth is safe and effective.

Today, many people prefer to undergo unpleasant examinations under general anesthesia - gastro- and colonoscopy, various biopsies and punctures. This is really a solution for those who are very afraid of even a little pain and do not want to experience painful minutes. The main thing is that the procedure is carried out under the supervision of an anesthesiologist, who accurately calculates the dosage of the drug and turns off consciousness to the minute. He monitors the patient's breathing and, if necessary, adds a little medicine. If these rules are strictly followed, studies under intravenous general anesthesia are absolutely safe.

Local anesthesia

Treatment under anesthesia is the only option for providing surgical care to a patient or performing complex manipulations. Often, a doctor will numb a specific area, which is achieved by injecting it with an anesthetic solution and is called local anesthesia. This type of anesthesia is used for opening ulcers, treating teeth, and excising a hernia. Local anesthesia is the injection of an anesthetic into the skin and other anatomical structures of the place where surgery is expected to be performed.

The anesthetic injections are superficial; only in exceptional cases can the doctor administer the drug more deeply. Local anesthesia is performed by injecting the drug through a very thin needle, so the actual anesthesia procedure is minimally painful. Often, the administration of an anesthetic is combined with sedation - sedatives are introduced into the patient’s body, which normalize the person’s psychological state, reducing feelings of anxiety and restlessness.

Despite the fact that local anesthesia is used very widely in medicine, the consequences of anesthesia can be quite serious. For example, local anesthetics can have a negative effect on the heart and brain, leading to heart rhythm disturbances, seizures and loss of consciousness. At the same time, doctors claim that local anesthesia, compared to general anesthesia, is safer for the patient’s health.

Not everyone can handle it

In recent years, it has become fashionable to treat teeth under anesthesia. A huge number of large and small medical centers have opened that actively advertise such treatment, but they are often completely unsuited to providing safe anesthesia. Meanwhile, dentistry is the only area where general anesthesia can often be associated with significant risks. Even in the USA and Europe, where the level of medicine is significantly higher than in Russia, doctors try to avoid anesthesia during dental procedures. The fact is that in this case, the anesthesiologist does not have access to the respiratory tract, is not able to control their protective reflexes, and cannot always prevent fluid (blood, pus) from flowing into the trachea - and such situations are life-threatening.

Unfortunately, in our country, the willingness to pay often becomes the main indication - so to speak, “any whim for your money.” Dental treatment under anesthesia is exactly the case when you shouldn’t be capricious without good reason; the price can be prohibitively high. And if there is a real need for this, you must definitely contact specialized centers that have an operating unit with the necessary equipment, it is possible to provide emergency care, and in an emergency, place the patient in intensive care or at least in a post-anesthesia observation ward.

In all other cases, there are no contraindications to general anesthesia. On the contrary, some medical procedures and examinations are much more convenient and safer to do under anesthesia. For example, colonoscopy (examination of the intestines) throughout the civilized world is a necessary procedure for medical examination in people over 50 years of age, and it is necessarily performed under anesthesia. And the point is not only that without anesthesia it can be painful and psychologically uncomfortable. Another point is that if a patient has a bad heart or hypertension, then enduring pain is quite dangerous for him, and this can more often lead to complications than properly administered anesthesia.

Of course, the higher the qualifications of the anesthesiologist, the lower the risk of side effects from the use of anesthesia. And there is only one way out: when preparing for an operation or examination under general anesthesia, you need to choose a medical institution as carefully as possible, go not to where it is “cheaper and closer to home,” but to those specialists who inspire trust. It is better to rely not on intrusive advertising, but on objective information, on the experience of relatives and friends. You should not at all strive to ensure that your anesthesiologist is a candidate or doctor of science; it is much more important that he has extensive experience and extensive practice.

Endotracheal anesthesia

One of the most commonly used methods of anesthesia when performing complex surgical interventions is endotracheal anesthesia, which involves immersing the body in a state of deep narcotic (medicinal) sleep. At the same time, the muscles completely relax, and the patient does not breathe independently. To achieve the desired state, doctors carry out a set of measures for the patient:

1. Tracheal intubation is the insertion of an endotracheal tube into the lumen of the trachea, which is needed to provide artificial ventilation of the lungs.
2. Intravenous administration of narcotic anesthetics, sedatives and tranquilizers.
3. Administration of muscle relaxants – they block neuromuscular transmission.
4. Artificial ventilation.

The quality of endotracheal anesthesia depends not only on the experience of the anesthesiologist, but also on how correctly the patient’s condition is monitored. It is imperative to monitor blood pressure, pulse, and oxygen saturation.

There are no absolute contraindications

Now that professionally trained specialists have appeared, as well as high-tech equipment and modern medications, anesthesia has really become one of the safest things in our lives. For those who are best convinced by numbers, we can give the following example: in a relatively healthy person (it is clear that a 100% healthy person usually does not need surgery), the probability of severe complications from the use of anesthesia is 1 case in 200 thousand operations. That is, the risk of dying on the way to the hospital (for example, having an accident or being hit in the head by a brick or icicle from a roof) is 25 times higher than the risk of dying as a result of general anesthesia.

Some patients may experience such unpleasant consequences of anesthesia as nausea, dizziness, temporary memory loss, sore throat, hoarseness, etc. But these sensations, as a rule, pass quickly and do not harm the body. But with competent work of the anesthesiologist and an individual approach to the patient, such phenomena do not happen at all.

The point of view that several anesthesia taken over a short period of time is especially harmful to health has no basis in reality. For example, it is known that patients with severe burns receive general anesthesia often and for a long time (after all, they require regular dressings, as well as skin grafts and plastic surgery), and there is no reliable statistical evidence that anesthesia causes serious complications in them.

Someone was probably confused by the words about a “relatively healthy patient.” It is clear that among those who are routinely placed on the operating table, young and ideally healthy people are not so common. Concomitant diseases - hypertension, angina pectoris, bronchial asthma, etc. - can complicate the work of the anesthesiologist. But this is also the professionalism of an anesthesiologist. After all, this specialist should, before the operation, receive not a formal piece of paper from a neurologist, cardiologist or therapist with the inscription “anesthesia is indicated” or “anesthesia is contraindicated”, but objective information about the person’s state of health.

There are no absolute contraindications to the use of anesthesia, but with some concomitant diseases a certain degree of risk remains, which can and should be minimized. If the anesthesiologist determines that the patient's current health condition is not optimal for anesthesia, he will refer the patient to the appropriate specialist to correct the situation (for example, stabilize his blood pressure).

Analyzes

Before visiting an anesthesiologist, you need to undergo a series of tests and examinations to identify the stage of chronic diseases, the presence of hidden pathologies, assess blood clotting, heart condition, and the presence of allergies:

• ECG;
• blood test to determine the group and Rh factor;
• clinical and biochemical blood tests;
• prothrombin time (coagulogram, clotting test);
• OAM (general urinalysis);
• blood tests for syphilis, HIV, hepatitis C and B;
• examinations prescribed by the doctor, depending on the type of operation, these may be: CT, MRI, ultrasound, radiography.