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Introduction

Introduction

The term anesthesia, of Greek derivation, means "loss of sensitivity". Drugs that induce anesthesia, called anesthetics, they are used during surgery, or other medical procedures, to numb some parts of the body or to generate a state of artificial sleep.

The use of anesthetics prevents the perception of pain and other unpleasant sensations, allowing the execution of a wide range of medical-surgical procedures.

Anesthetics are commonly divided into two classes: local anesthetics and general anesthetics.

The local anesthetics, used for minor procedures or interventions, cause the loss of sensitivity in a limited area of ​​the body, maintaining the state of consciousness.

The general anesthetics, used to perform more complex or long-lasting interventions, result in the loss of sensitivity and consciousness, making the person unaware of the intervention to which he is subjected.

How anesthetics work

How anesthetics work

Anesthetics reversibly interrupt the transmission of pain-related nerve impulses.

General anesthetics disrupt the nerve pathways that control wakefulness and consciousness. During this state of "artificial" sleep, any procedure can be performed as the anesthetized person is completely unconscious and insensitive to pain.

Local anesthetics temporarily block only the nerve fibers that carry the pain sensation. As soon as the effect of the anesthetics wears off, the nerve impulses are again able to reach the brain, allowing sensitivity to be resumed.

Types of anesthesia

Types of anesthesia

In addition to local and general anesthetics, there are different types of anesthesia based on the procedures adopted and the result to be obtained.

Unlike general anesthesia, the forms of local, truncular or peripheral anesthesia do not induce loss of consciousness, but eliminate the sensation of pain in a more or less large delimited area of ​​the body.

They include:

  • tolocal or troncular nesthesia (i.e. of a single nerve bundle), consists in the administration of a local anesthetic in a specific area of ​​the body (for example an arm or a part of it), to eliminate sensitivity or pain in the affected area
  • epidural or peridural anesthesia, it is a type of regional anesthesia used, generally, to remove the sensitivity in the lower part of the body, the one below the waist. It is used, for example, for pain control during labor and delivery
  • tospinal nestesia, it is a type of regional anesthesia, similar to the epidural, which ensures total loss of sensation in the lower half of the body for at least three hours by introducing the anesthetic directly into the cerebrospinal fluid of the spine
  • sedation, involves the use of a drug that induces a state of drowsiness and relaxation, both physical and mental, allowing you to face light, moderately painful or annoying procedures with serenity

The different anesthetic techniques can be used in combination. For example, at the end of a general anesthesia, a regional anesthetic can be administered to alleviate postoperative pain. Similarly, a sedative can be combined with a regional anesthetic to eliminate pain and cause a relaxed condition that allows the surgeon to operate in the best possible way.

Method of administration of anesthetics

Method of administration of anesthetics

Anesthetics can be administered:

  • in the form of ointments, sprays or drops (they are always local anesthetics)
  • through an injection, some subcutaneous or intramuscular anesthetics others in vein (intravenously)
  • in the form of gas or volatile liquids inhaled using a special mask (by inhalation)
The anesthetist

The anesthetist

The anesthetist (or anesthetist-resuscitator) is a specialist doctor who has followed a specialization course in anesthesia and resuscitation. He is the doctor who performs the anesthesia and is responsible for the safety and well-being of the anesthetized person.

In the event of a scheduled intervention, the anesthetist will carry out a preoperative visit to assess the general health of the person who will have to undergo the intervention. During the interview, the anesthetist himself will give information on the most suitable type of anesthetic for the intervention and personal preferences, if possible. In addition, he will illustrate the risks and unwanted side effects associated with anesthesia, and explain the options for treatment for postoperative pain control. Finally, the anesthetist will provide information on how to prepare for surgery. : fasting, rest, possible drug intake and will be available for further information and clarifications on the anesthesia procedure.

For the entire duration of the surgery, the anesthetist will closely monitor vital functions (for example: heart rate, breathing and blood pressure), making sure that the state of consciousness is fully recovered after the operation under general anesthesia.

Side effects

Side effects

Like all drugs, anesthetics can produce unwanted side effects. It is the anesthetist's task to report to the patient those relating to the anesthetic chosen for the operation, indicating the measures that can be taken to reduce its appearance.

The most common side effects of general anesthetics and some regional anesthetics are:

  • nausea and / or vomiting
  • dizziness and fainting
  • chills or cold
  • headache
  • itch
  • bruising and redness at the anesthetic injection site
  • difficulty urinating or passing urine (incontinence)
  • widespread aches and pains

Generally, these are short-term disorders which, if necessary, can be kept under control with appropriate treatments.

Risks and complications

Risks and complications

Anesthesia is a very safe procedure. Technological and pharmacological advances, combined with the high level of preparation of the anesthetist, mean that the risk of complications occurring is very low. However, this possibility exists, as with any type of surgery or medical procedure.

The potential risks and benefits associated with the surgery and anesthesia are carefully evaluated and communicated to the person who will have to undergo the surgery.

The possible complications, however very rare, include:

  • nerve damage (including permanent), which can cause disturbances in sensation or movement (paralysis) of a part of the body. Injuries to the peripheral nerves, which connect the spinal cord to the rest of the body, occur in less than 1 case per 10,000 anesthesia
  • allergic reaction to anesthesia drugs (anaphylaxis) which, however serious, can be treated promptly and effectively. Since it is a very rare complication, there are no official data on the frequency of allergic reactions to drugs used in anesthesia. According to some estimates, there is 1 severe case of anaphylactic shock for every 10,000-20,000 anesthesia
  • death, this is a very rare event, which occurs in approximately 10 cases out of every million anesthesia

The risk of potential complications related to anesthesia depends on several factors, including:

  • medical history And lifestyle of the person, the presence of serious illnesses, particular conditions such as pregnancy and / or unhealthy habits, such as tobacco smoking or being overweight, increase the risks. The smoker should stop smoking a few weeks before surgery to avoid respiratory problems, and those who are overweight should lose excess weight
  • type, complexity of the intervention and any urgency
  • type of anesthetic, in general local anesthesia, if suitable for the type of surgery, presents lower risks than general anesthesia

In the preoperative visit, the anesthetist will communicate the presence of specific risks, related to the physical condition of the person, and the possible complications of the operation.

Bibliography

Bibliography

NHS. Anesthesia (English)

Further links

Further links

Humanitas. Gradenigo. General anesthesia

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