General anesthesia

Content

Introduction

General or total anesthesia is a state of unconsciousness caused with medicines and kept under constant control by the anesthetist. The drugs used to induce this type of anesthesia, called general anesthetics, cause an artificial sleep so deep that it allows you to face any surgery without feeling any pain, without moving or remembering anything about what happened. For the same reasons, however, the person must be connected to a machine that allows him to breathe and the anesthetist must monitor the patient's vital functions throughout the duration of general anesthesia.

General anesthesia is essential in the case of interventions that require the person to be unconscious to ensure their safety and ensure maximum comfort during the operation.

It is the technique normally used for long-lasting or very painful interventions.

The exact mechanism of action of general anesthetics, whose effect is to interrupt the passage of any signal through the nerves, is still not clear. This means that any external stimuli are neither processed nor recognized by the brain as long as anesthesia is in progress.

Anesthetic visit

Before the intervention, the person undergoes a visit with the specialist doctor, the anesthetist, who will establish the most suitable type of anesthetic based on the information acquired during the interview. The anesthetist will assess the person's health over time, current health conditions and lifestyle habits (alcohol consumption, smoking) that could interfere with the anesthesia. In particular, you will ask for information on the medicines taken and on the presence of allergies or disorders associated with any anesthesia performed in the past. During the visit, the anesthetist will provide precise instructions on the behavior to follow in the days preceding the intervention, clearly indicating the preparation period for the intervention in which you must avoid eating solid foods and drinking liquids (total fasting).

He will also be ready to answer any questions and provide clarifications on the procedure and the risks of complications, illustrating what is written on informed consent. In order to start the procedure, in fact, the person must sign the informed consent to demonstrate that he understood what the anesthetist explained to him.

In the operating room

The anesthetist-resuscitator who will perform the anesthesia on the day of the operation could be different from the one who performed the pre-surgery anesthetic visit. However, do not worry because he will be in possession of the anesthesia file containing all the information necessary to perform the most suitable anesthesia.

For safety and to allow the administration of liquids or medicines throughout the procedure, a cannula is inserted into a vein in the arm or back of the hand through a needle before performing the anesthesia.

Immediately before the start of the surgery, the anesthetist will administer the general anesthetic in the form of liquid, injecting it through the cannula, or of gas, making it inhale through a mask applied to the face.

Normally, the anesthetic works very quickly. Within a minute it causes first a feeling of lightness and then loss of consciousness.

For the duration of the surgery, the anesthetist takes care of the person, checking their vital functions and making sure they continue to receive the dose of anesthetic necessary to maintain unconsciousness.

In addition, at the end of the surgery, he administers painkillers (analgesics) intravenously to ensure a comfortable and pain-free awakening.

Awakening

At the end of the operation, the anesthetist stops administering the anesthetic. The person wakes up gradually and is kept under observation in a special room (the recovery room), in which there are all the equipment to ensure the same safety as the operating room , until the total recovery of the state of consciousness, before being transferred to the ward.

General anesthetics can impair memory, concentration, and reflexes for a day or two. After waking up from general anesthesia it is absolutely necessary to remain under medical observation for at least 24-48 hours. Except in special cases, this observation takes place in the hospital. you may need to be hospitalized for several days.

Side effects

General anesthetics have some rather common undesirable side effects described, generally, by the anesthetist during the preoperative visit. Most of the disorders due to anesthesia occur immediately after the operation and have a limited duration.

They include:

  • nausea and vomit, they generally occur immediately after surgery and can last until the next day
  • chills And cold, lasting from a few minutes to a few hours
  • confusional state And memory loss, more common in older people and those with pre-existing memory problems. Usually, these are temporary disorders, but in some cases they can persist for a long time
  • bladder disorders, with difficulty urinating
  • dizziness, which are treated with the administration of fluids
  • bruises, redness And ache, in the cannula insertion area or where the drugs were injected. They generally regress spontaneously
  • pain in the throat, sometimes caused by the insertion of the tube for artificial respiration into the mouth
  • damage to the mouth or to the teeth, caused by the passage of the breathing tube into the trachea. A small percentage of people may have small cuts to the lips and tongue, or injuries to the teeth, following a difficult intubation. It is always necessary to inform the anesthetist about the state of their teeth or about the presence of dental prostheses.

Risks and complications

The risks and possible complications of general anesthesia, however very rare, are:

  • severe allergic reaction to anesthesia (anaphylaxis)
  • awakening during the surgery, to avoid this danger, the dose of anesthetic administered is monitored continuously
  • eye damage, although the anesthetist takes care that nothing damages the eyes, temporary lesions may rarely occur on the surface of the eye; if they are painful they can be relieved with an ophthalmological ointment
  • death, this is a very rare occurrence, occurring in one case out of 100,000

The risk of serious complications increases in the case of complex or urgent interventions, in the presence of concomitant diseases, in smokers and in overweight people.

Other types of anesthesia

In addition to general anesthesia, there are the following types of anesthesia:

  • local anesthesia
  • epidural (or epidural) anesthesia
  • spinal anesthesia
  • nerve blocks

Bibliography

NHS. General anaesthesia (English)

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