How many years of life does general anesthesia take? What do we know about drugs? Is general anesthesia harmful to the human body?

But in every joke - only a fraction of the joke.

Conquer the pain

- What is pain in terms of physiology, Ruslan Tanovich?

Ruslan Gilyalov

The reaction of the body to trauma, pathological processes, intensive medical intervention. The only exception is natural childbirth. People shouldn't be in pain. It can be different: acute, chronic, periodic, sudden ... It is quite possible to defeat it. But one thing is to alleviate the condition, another is to eliminate the cause.

- Is it true that general anesthesia takes 5 years of life, because it "cuts down" the central nervous system?

Not true. Adequately administered anesthesia does not interfere with vital processes. Narcosis is a multifaceted concept. It is individually selected for each patient.

- In Kazan, there were deaths when dentists used general anesthesia ...

Anesthesiology is a science demanding on technology. There are areas where its use is fraught with problems: maxillofacial and plastic surgery, dentistry ... For the patient's respiratory system - a risk. Not every dental clinic or private center has the necessary equipment, a qualified anesthesiologist. I don't think general anesthesia is needed in dentistry.

- You mentioned childbirth ... In America, even natural ones, as a rule, are anesthetized. Will our women endure everything?

In the Russian Federation, with normal delivery, general anesthesia is almost never used. The so-called anelgesia is used, i.e. blockade. This eliminates severe pain while maintaining muscle tone, the woman in labor consciously follows the advice of the obstetrician, and her body is mobilized. Such anesthesia is not harmful to either the mother or the child. If a caesarean section is necessary according to indications, other methods of anesthesia are used.

Know your rights!

Today, a patient who undergoes an operation has the right to know everything, incl. and about anesthesia ... Is he given a choice of anesthesia?

All interventions are carried out with the consent of the patient, if he is capable. The surgeon popularly explains the meaning of the operation, its prospects. Anesthesiologist - the same for anesthesia, unless, of course, the patient is interested. But for the majority, this is not interesting, the main thing is that it does not hurt, is not heard or seen. The anesthesiologist, ensuring the safety of the patient, chooses the most optimal option for a particular case, determines the degree of risk, predicts the consequences, since he has studied the data on the patient's condition. Taking into account the nuances, sometimes it is necessary to combine different types of anesthesia.

Light at the end of the tunnel

- Is resuscitation one of the youngest medical specialties?

In the Russian Federation, she is not even 70 years old. Our department was the first in the Republic of Tatarstan, at the Research Institute of Traumatology and Orthopedics on the street. Gorky. Abroad, anesthesiology and resuscitation are separated, in our country they are connected. I believe that this is correct, since we support, and sometimes even prosthetics with the help of equipment, a life support system. If the pathological processes are reversible, then the resuscitator can turn them towards life. It can be sudden coronary death, myocardial infarction, thromboembolism, etc. There are several intensive care units in the RCH, each dealing with its own contingent of patients. In the Perinatal Center, for example, there is no lethality at all. And in neurology, therapy or surgery, you can’t get anywhere without it, because here there are severe ailments, aggravated by concomitant, sometimes incurable, diseases. In our department, we most often deal with injuries, we deal with children, adolescents, and people of working age who lead an active lifestyle. Injuries received by them at work, as a result of an accident, during sports or, what to hide, criminal showdowns require the help of anesthesiologists-resuscitators.

- Is there an age limit for resuscitation in case of clinical death?

They are held by everyone, regardless of age. Patients may stay in the intensive care unit for a long time. Either vital functions are restored, or ...

- I recently read a story: 45 minutes after clinical death, the patient came to life. But the brain dies after a few minutes...

Most likely, this patient came to life due to the intensive work of resuscitators with massive medical support. But will his brain, which has been without access to oxygen and blood for so long, come to life? Brain death is equated to the death of a person, and the heart can still work for a long time ... I have been practicing for 17 years, but have not yet seen those who were in a coma for years, and then returned to normal life.

- How do you feel about euthanasia?

Our society is not yet ready for this. I saw many people who were incurable, suffering severely despite pain relief, and begged for an end to their suffering. But who will take it? Is it humane? Hope dies last... And for the patient, and for his loved ones, she always remains.

- What is the average cost of keeping a patient in the intensive care unit?

One day - about 12 thousand rubles. And anesthesia, for example, during a high-tech arthroplasty operation (this is a replacement of the hip joint), is about 3 thousand.

Everyone wants to live long, and if you get sick, then “it doesn’t hurt”. But medicine is not yet omnipotent. How are your days going?

7 days a week - ambulance, 3-4 times a month - flights through the air ambulance line. Permanent vigils. There is no time to read literature in order to get acquainted with the latest in the specialty, broaden one's horizons... But world medicine is moving forward, you need to be in the know, share experience, including with foreign colleagues... By the way, we have something to exchange: our department is a traditional leader in the Republic of Tatarstan on the use of some methods of anesthesia in traumatology and orthopedics, which are safe for the patient, very effective and much cheaper than general anesthesia. At some professional medical forum, we would report this. Since the existence of human civilization, there is no topic more relevant than life and death.

How often complications occur after anesthesia and whether it is dangerous to wake up during general anesthesia, Vladimir Kulabukhov, candidate of medical sciences, spoke about this and much more.

Anesthesia takes 5 years of life and deprives a person of memory - everyone knows these myths, even if he has never had such a procedure. The head of the Department of Anesthesiology and Resuscitation of the Department of Thermal Injuries of the Federal State Budgetary Institution “Institute of Surgery named after A.I. A.V. Vishnevsky" Vladimir Kulabukhov.

Before surgery

Natalya Kozhina: Vladimir Vitalievich, during anesthesia, the patient is entirely dependent on the anesthesiologist. Is it possible to assess the degree of competence of a specialist before the operation?

Vladimir Kulabukhov: By and large, no. But the existing certification system for doctors says that if an anesthetist is allowed to carry out this manipulation by a medical institution, then he owns all the methods of anesthesia necessary for a particular situation. In general, the anesthesiologist, like any doctor who will treat the patient, is appointed by the head of the department.

It turns out that I cannot say to an anesthetist who does not inspire confidence in me: “Sorry, I don’t like you, I want another specialist”?

Under the public health law, everyone has the right to choose their doctor. But in the beginning, the anesthesiologist is not the attending physician, although at the time of the operation itself, responsibility is shared between him and the surgeon. Of course, you can ask another specialist, but categorically declare: “I don’t want this anesthesiologist, but I want this one,” - this is probably not entirely correct. Although legally there is such a possibility.

- Do we have enough anesthesiologists today?

Unfortunately, the shortage of specialists in the field of anesthesiology and resuscitation - we have a single specialty - is approximately 50%. This is due to the huge physical and psychological stress, low wages. People do not go into this specialty, plus everything else, because the role and place of the doctor in our society has been significantly reduced in recent years.

It's important to know

- When does the anesthesiologist get acquainted with the patient, if we are talking about a planned operation?

The anesthesiologist always examines the patient at least 24 hours in advance. But there are situations when it is desirable to do this earlier. There are a number of conditions that cannot be corrected 24 hours before surgery. For example, patients with oncology are often emaciated. This affects not so much the anesthesia itself, but the consequences, the patient's recovery from anesthesia, wound healing, the results of the operation, etc. If the anesthesiologist examines the person earlier, he will be able to give some advice, because there are special methods of preparation, additional nutrition.

Another important point is that the anesthesiologist must definitely examine the patient in terms of the presence and compensation of his concomitant pathology. It is no secret that people over 40 often have arterial hypertension, various chronic diseases, all this can subsequently slow down the healing process.

The person must be prepared to answer frankly all the questions of the anesthesiologist. And he will definitely ask about bad habits, the presence of allergies or some other health problems, surgeries and injuries in the past, etc. There are situations when the anesthesiologist may advise, if the disease allows, to postpone the operation and prepare for it. Such recommendations should not be neglected.

- How often do complications occur after anesthesia?

Complications are natural, since this is a serious invasive procedure, but they are extremely rare. 1 complication for 250 thousand anesthesias! This is much less than, for example, the number of victims in car accidents. Therefore, to say that anesthesia is a terrible thing from which a person may not wake up is nothing like that. Naturally, in young and initially healthy people, the risks of complications are lower than in the elderly.

I was given anesthesia at the age of 19, I quite fit your definition of a “young body”, but I got out of it for a very long time. What other factors affect the condition of a person after this procedure?

The fact is that during anesthesia we interact not only with the patient's body, but also with his brain, and here the reaction can be different for everyone. Of course, the mood of a person affects whether he was afraid of anesthesia or not. People are different. One of the very reputable doctors William Osler said: "If all people were the same, then medicine would turn into a science, and would not remain an art."

In addition, there are people who metabolize drugs quickly, and there are those who have this process is slow. This is a genetic feature. Of course, the latter will take a little longer to come out of anesthesia.

- Are there any strict contraindications for general anesthesia?

None. The modern development of anesthesia and surgery is such that there are practically no contraindications to surgery, if necessary. The task of modern anesthesiology is to ensure the safest and most comfortable conduct of this operation. By what methods - depends on the doctor. Of course, when it comes to planned operations, you can prepare your body. But often there are emergency operations when patients arrive and need to be operated on in the next hour or two. Then it is impossible to fully prepare such a person. Sometimes it is impossible to interview this patient - he is unconscious or in poor condition. Of course, in this case, the danger and risks increase. But the task still remains the same - to ensure maximum security.

How many anesthetics can the human body endure and is the patient's fear justified, who, for example, has undergone anesthesia 6 times and is terribly afraid of one more anesthesia, since it may be the last one?

I won't give you a number, because it simply doesn't exist. But there is a concept of statistics. For example, the more you fly on an airplane, the higher the risk that you could get into a plane crash. Of course, if a person endures 100 anesthesias, then they will probably get one when there are complications. There is a widespread opinion that each of our visits to a medical institution does not add health - this is not true. The causal relationship is inverse. A person goes to the hospital not because he is healthy, and he is maimed there. But because he is already sick, and some problems have already arisen that require treatment. Similarly, anesthesia - it is not carried out just like that. And the task of the anesthesiologist is to correctly carry out this procedure, taking into account previous anesthesia, the patient's condition.

Myths and horror stories

Let's talk about myths. Is it possible to wake up during anesthesia?

Yes, this is possible and is called "the presence of the patient during the operation." But such a “presence” does not represent any big trouble. Anesthesia has several components. Anesthesia - when a person does not feel anything, analgesia - pain relief, muscle relaxation - muscle relaxation, protection of the autonomic nervous system - this is done so that there are no reactions from the nervous system.

Anesthesia is, on the one hand, the comfort of the patient, on the other hand, it is a matter of the comfort of the operating team. And no more. After all, there is local anesthesia, which does not turn off consciousness. The person is present during the operation.

Awakenings happen. But there is nothing terrible in this. In addition to disturbing comfort. There is no need to be afraid of this. This is extremely rare, sometimes it just seems to a person that he has woken up.

How does anesthesia affect memory?

At the moment, there is a study that shows that it is not memory that decreases, but “cognitive perception”, that is, understanding after anesthesia. This is common in older patients. But oddly enough, there are exactly the same number of studies that say that anesthesia does not affect memory in any way. Therefore, there is no clear answer to this question yet. On the other hand, it is incorrect to say that all people who have undergone anesthesia do not remember well or think poorly.

- Then maybe there is evidence that anesthesia takes 5 years of life or is this also a myth?

There is no such data. Health takes away the disease for which anesthesia is performed. Here everything must be put on its feet. Slightly change the angle and explain to the population that it's not about anesthesia. But this myth is perhaps one of the most widespread among Russians.

And yet I cannot help but ask you: is it true that with each operation you need to apply an increasing dose of anesthesia?

And again I will tell you no, this is not true, "anesthesia" does not accumulate in the body. In general, if we start discussing all the myths about general anesthesia, then an hour of time will not be enough. Some, for example, believe that one can become a drug addict from anesthesia. It's impossible! Or here's another myth - anesthesia does not work on drunk people. It works, but worse. This simply raises the question of the choice of anesthesia. For people with alcohol or drug addiction, there should be a different approach. That is why the anesthesiologist must always truthfully answer all questions, the choice of initial anesthesia depends on this.

Often, patients refuse elective surgeries due to fear of anesthesia - we talked about this and many other myths related to anesthesia with the leading anesthesiologist - resuscitator of the Dr.Plastic clinic Fedor Nikolaevich Penderov .

Question: There is an opinion that anesthesia is very dangerous. And many refuse surgery for this very reason. Are these fears justified?

Answer: The fears are not justified. In any case, it is wrong to refuse surgical intervention because a person is afraid of anesthesia because of some myths, legends and fairy tales. The source of fear is always a lack of information or ignorance. If there are any questions, we are always happy to talk with the patient, tell everything and try to dispel these fears. If after that a person still has fears, then I can only say one thing: fear is not the feeling with which one should go to the clinic for an operation. The main thing is trust. Trust in surgeons, anesthesiologists, nurses and all medical staff. And if this trust is there initially, then everything will be fine.

Question: What modern types of anesthesia are currently used in plastic surgery?

Answer: In plastic surgery, the so-called in everyday life - general anesthesia is most often used. What is general anesthesia? This is a combined anesthesia, during which various types of drugs are used. Inhalation anesthetics are used - these are drugs that provide sleep, the so-called hypnotics. Analgesics are used - these are drugs that ensure the absence of pain during surgery. And muscle relaxants are used, which relax the muscles, which allows the surgeon to operate comfortably. These are the three main groups of drugs that should provide anesthesia. Anesthesia is a state of sleep in which a person does not feel anything. Accordingly, other drugs can be administered during anesthesia: both antibiotics and drugs that affect blood clotting, but they are not the main ones.

The three main groups that I have listed must be delivered to the body. Which way? In some cases, inhalation anesthesia is used, when a person breathes a mixture of gases. And during some operations, these drugs are administered intravenously - this is intravenous anesthesia. Typically, intravenous anesthesia is used for short-term manipulations, for 15-20 minutes, for example, scar correction. In this case, we manage only intravenous anesthesia. In other cases, it is either combined or inhalation anesthesia.

What is everyone afraid of? Everyone is afraid of the so-called endotrochial tube. And everyone says: “Is it true that they will put this tube in my throat?” It seems that everyone remembers how they once put it on! But even if it is necessary to put it, there are such operations when it is necessary, for example, or when the patient lies on his stomach during the operation - you can’t get away from this. But for the patient, besides the fact that he knows that they will put it on him, and he always knows about it. Since before the operation at the consultation, we tell in detail what we will use. And then the patient signs a consent to the use of anesthesia, where everything is detailed. So as soon as the patient learns from this tube, he immediately becomes nervous. But in fact, he does not feel either how they put it on, or how they remove it. In all other cases, a laryngeal mask is used - this is not a tube that is placed behind the vocal cords, it is a mask that is located in the oral cavity. The patient does not feel it either during or after the operation.

Question: Many people are afraid of general anesthesia. Is it always necessary? And can it be replaced?

Answer: What is local anesthesia? We all go to the dentist: an injection is made into the gum, and some area of the lower or upper jaw becomes numb, and manipulations are performed, the person does not feel pain. But tactile sensations persist: sensations of touch, a sensation of pressure ... This is how local anesthetics work: novocaine, lidocaine, tetracaine and others. The same can be done during plastic surgery, but not always, but only with small interventions - for the correction of small scars or small stitches. It is impossible to start extensive and large operations under local anesthesia, for example, breast replacement, because the muscles and very painful anatomical areas of the human body are affected. With liposuction or some other operations, this is dangerous. Because it is impossible to guarantee that a person will not feel pain. And the patient's pain during the operation is not only a state of his comfort, although this is very important, it is also the body's reaction: increased heart rate, increased pressure, increased bleeding. And in this way it becomes dangerous for a person - it is an uncontrollable situation. And one more nuance - in order to avoid pain during local anesthesia, when large areas are operated on, a large amount of local anesthetic must be injected, and its amount is pharmacologically limited. You can not drive endless doses, its effect becomes toxic. Thus, a very narrow range of operations can be performed under local anesthesia, and these are mainly corrective operations. And by the way, most patients even in these cases ask: “is it possible not to be present at your operation?” I do not think that anyone wants to be present in the operating room at this moment: to listen to what is happening, to see, but to see how it is right - no, they are fenced off with a screen. But it's still such a stress to lie on the operating table. For example, I would also like to get general anesthesia from a dentist. But this is not a question of the patient's desires, there are indications and contraindications.

Question: There is an expression that "40% of the success of the operation is the work of the anesthesiologist." Do you agree with this or not?

Answer: What a mathematical division! And the remaining 60 - whose is it interesting? No I do not agree. If someone at some stage makes a mistake or does their job incorrectly, then it must be said that all 100% of what went wrong is his. And when everyone does their job to the extent that they should do it, then it cannot be measured in percentage terms. The surgeon must perform the operation, the anesthesiologist must create optimal conditions for this, so that the operation is as comfortable as possible for both the surgeon and the patient.

When the patient is under anesthesia, the anesthesiologist is responsible for all the vital functions of the body - breathing, heartbeat, pulse, pressure. What the patient breathes, what drips into him in the form of droppers, solutions, what is administered intravenously - this is called monitoring. Absolutely complete monitoring of the patient lies with the anesthesiologist. Anesthesiologists appeared much later than surgeons, and anesthesiology, by the way, greatly expanded the possibilities of surgery. So before that, surgeons were all doing this. Imagine a surgeon operating and asking the nurse what the patient's pulse is. The nurse says to him: “he has 120”. At this time, he operates and says: “do this for him here.” And then he asks: "what is his heartbeat or pressure." Something like this needs to be done again. And the surgeon, performing complex operations, still had to think about the patient's condition and say how to correct it. It was very difficult. And when surgeons were relieved of this part of the work and given the opportunity to do only what they have to do - operate without thinking about anything. Then surgery stepped forward very widely. This does not mean that the surgeon cares what is happening with the patient now. It is customary for us that the anesthesia monitor is always turned towards the surgeon. And when the operation takes place in our clinic, but anywhere, the surgeon still glances at this monitor. And all the same, when he hears some sounds of equipment, when he sees unnecessary movements of the anesthesiologist: “What? What is going on with you? Are we still working or not? This is a joint work, and the team principle of the work of the surgeon, anesthetist, nurse and all involved is very important. Therefore, long-term teams feel each other well and know what will happen in the next moment. And this is very important, just the trust that I was talking about, not only the patient's trust in specialists, but also trust within the team. So the anesthesiologist is responsible for all the vital functions of the human body during the operation - it is not only falling asleep and waking up. There is no big syringe with the inscription "anesthesia", with which the doctor walks around the patient, makes an injection, and everything works. Everything is much more complicated.

Question: What should the anesthesiologist find out at the consultation before the operation with the patient?

Answer: The anesthesiologist collects information: everything is important. There is a standard set of questions that are always asked. Whether there is an allergy, when was the last meal, they always ask if there were operations or anesthesia. Basically, the anesthetist is interested in how the anesthesia that the patient had went through: how he woke up, what sensations he had, complications, or maybe he was told that something happened to him during the operation. Also interested in what medications a person takes constantly, because they can affect anesthesia. Then analyzes are not only formal forms, where everything should be normal. They help to understand if there are any exacerbations of chronic diseases. All this is important because these diseases can worsen during or after surgery. This is especially true for cardiac or pulmonary pathologies, those organs and systems that are vital. Therefore, at this stage of communication with the patient, information and knowledge are collected that may be useful and help the anesthetist, which may be vital to him in certain situations. We must know everything before the operation, with us - as with a priest.

Question: There is a myth that general anesthesia shortens a person's life by several years, is it true?

Answer: How much does it reduce? And how to understand and calculate it? There is no way to check this. But we do not introduce anything into the body that would shorten life. Of course, these are not oranges and not vitamins, this is not useful. But all the drugs that we introduce into the body are quickly excreted. Modern pharmacology has reached such a development that all drugs have a very short half-life of drugs. Each drug that enters the body should leave it in two to three hours. Only the metabolites of these drugs remain, which are inactive. 30-40 years ago they introduced drugs that could circulate in a person's blood for another week - this is really harmful. And now the drugs are eliminated as quickly as possible and minimally toxic. Of course, there is some impact, but it is minimal. And we are trying to level it.

Question: Tell me a little about the risks of using general anesthesia.

Answer: There are always risks. But I want to draw your attention to the fact that the point is not at all about the risks, but about how these risks are assessed before the operation, how adequately they are understood by the doctor and the patient. How much they are needed by both the doctor and the patient, and how ready there is in the institution where the operation is taking place, to respond in time to these risks and stop them or level their consequences. When we get on a plane and fly to rest on the sea with suitcases, we also have huge risks, and beyond our control. Here the situation is slightly different - all risks are weighed, we approximately know the probability of their occurrence, and we absolutely know exactly how to respond to them if this or that situation arises - step by step, minute by minute, protocol. Therefore, it is important here what kind of risks we have - controllable or uncontrollable. When a person flies in an airplane (I'm not afraid to fly), these are uncontrollable risks. When he lies down on the operating table and enters the clinic, where they perform operations and perform anesthesia professionally, the possible risks are very highly controllable. And of the complications that occur, the most common are allergic reactions to any drugs. Accordingly, there are drugs that stop this reaction. The most important thing is to notice in time and absolutely understand exactly what needs to be done to prevent this from happening.

Question: Does the duration of anesthesia affect health? And what is more dangerous - to combine several operations so that anesthesia lasts longer, but is applied once, or is it better to separate them?

Answer: It all depends on many factors: on the preoperative state of health, on the age of the patient. If a person is operated on at the same time on his legs, undergoes surgery on his chest, and does something else, it may be better for him. He will spend less time, he will have not five anesthesias, but one, say five hours. If his body is really ready for this at this point in time: the patient is at the age when this is possible, and all his tests indicate that he will endure this with the least possible complications. And another important point is the postoperative period. Imagine a man woke up and after a while he realizes that he was simultaneously operated on his chest, stomach, legs, a pair of arms and had a small operation on his head. How does he feel about all this? Probably, in everything the measure is important. A couple of operations can and should be combined. And save up six operations and say: “let’s do them all right away, I still have a week left from my vacation.” This is already another edge, and one should not go on about the patient in this case.

It is also worth considering that the longer the anesthesia, the more drugs we inject, and the more difficult the postoperative period. It all depends on the skill of the surgeon. Of course, there are such operations that you cannot do in less than 3 hours - this must be adequately understood in advance. But the faster, which does not mean poor quality, this operation is performed, the shorter the anesthesia and the more favorable the postoperative period.

Question: What conditions after anesthesia can the patient have?

Answer: The work of an anesthesiologist does not end with the operation. It does not mean at all that the patient woke up, said “thank you”. And the doctor went to the next patient. The anesthesiologist observes the patient long enough during the postoperative period. It is important that he finally wakes up, that all his functions are restored, that he drinks and eats, that there is no trembling, that there is no nausea after the operation, that there is no pain syndrome. Because the most important assessment by the patient of his comfort is whether or not there is pain. It is necessary to soberly assess the capabilities of anesthesiologists and surgeons. It is impossible to make sure that after the operation it does not hurt in the same way as before it. The pain threshold is different for everyone, but the sensations are quite tolerable, like after overtraining in the gym, and these are not my words, as the patients say. Agree that these feelings are quite tolerable. But if somewhere and sometime there are such sensations that a person screams in pain and climbs the wall, then this is unacceptable. Therefore, the postoperative period is, first of all, pain relief and prevention of various complications: prevention of infectious complications, before the operation, a person does not eat or drink for some time, and all this must be replenished. He is given some kind of aqueous electrolytes, sometimes even before and during the operation. And this is all the work of an anesthesiologist.

Question: What affects the calculation of the dose of anesthesia? For example, if the patient is a child.

Answer: A child is generally a separate issue, there is a separate profession - pediatric anesthesiologists-resuscitators. Children have a slightly different physiology than adults. But in general, the most important parameters are the weight, age, and sometimes height of the patient. The calculation of drugs for anesthesia is based on the age and weight of the patient, and then adjusted depending on the stage of the operation. There are painful stages of the operation and less painful stages, respectively, the level and depth of anesthesia vary depending on this.

Question: What are the contraindications to anesthesia?

Answer: Contraindications for anesthesia are usually the same as for surgery. But if a person has appendicitis or peritonitis, or a stab wound and he was brought to the hospital, and the anesthesiologist says: “you know, he has contraindications for surgery, his pressure is not the same and the tests are not all ...”. This is a funny situation. And if a healthy person comes to the clinic to change his appearance, that is, we perform a planned operation and study his condition closely, collecting tests. It often happens that we are the first to find deviations in his health. And we are sometimes the first frontier that indicates a health problem, a person goes for treatment, and then he comes and says: “thank you.” Thus, the absence of full health or exacerbation of chronic diseases, or acute diseases in the autumn-winter period (ARVI, acute respiratory infections) are certainly a contraindication to surgery and, accordingly, anesthesia. A person is ill with something now, he needs to be cured, rest, and then the operation can already be performed.

Question: Tell us more about allergic reactions. And how often do they happen?

Answer: There is more talk about allergic reactions than they actually are. I have been working for more than 15 years and reactions in the form of anaphylactic shock, when the injection was on a needle, and the person immediately lost consciousness, I, frankly, did not see, and my colleagues did not tell me. Thank God, maybe I won't. But for some reason, the Internet is full of this, and programs tell. The most common allergic reactions are skin redness, skin itching, or slight swelling at the injection site. There are drugs that stop these reactions. We always ask before the operation what the patient is allergic to. And if a person says that he is allergic to some drug. It is clear that we will no longer do it, but we will also already have allergy alertness. Because if a person is allergic to this drug, then he may be allergic to other drugs. And if he's never been operated on, he doesn't know that. This must be kept in mind and kept in mind at all times. We, like pilots, sit at the helm, and there are a lot of instruments around that we need to pay attention to.

General anesthesia (general anesthesia) is a general anesthesia of the body, achieved by immersion in the state of inhibition of the central nervous system. This results in sleep, loss of consciousness and amnesia.

Surgery requires high-quality anesthetic support. The powerful development of these two areas of medicine occurred synchronously. The central link that united them was general anesthesia. Methods of its implementation are constantly being improved and new ones are replacing the old ones. Thanks to their combination, combined anesthesia is achieved, which becomes a kind of "golden mean" of anesthesiology. What is good and what is bad about one or another is described in this article.

The concept of general anesthesia

General anesthesia is a variety based on the immersion of the cortical centers of the brain into a drug-narcotic sleep of different depths. To achieve this state allows a complex of neuroleptics, anesthetics and analgesics (narcotic and non-narcotic).

They can enter the body in different ways, which is a predetermining factor in the classification of methods of general anesthesia. In this regard, inhalation (by inhalation of volatile and gaseous compounds) and non-inhalation (by parenteral administration) methods are distinguished. Their stages are almost identical and are represented by four stages:

Analgesia - a gradual loss of consciousness with the loss of all types of sensitivity;
Excitation - inherent only in some drugs and is represented by short-term excitability of the brain;
Surgical stage - complete extinction of excitability and any kind of sensitivity of the brain;
Awakenings - the gradual return of pain, movement and consciousness.

The severity and characteristics of each of the stages depends on the properties of the narcotic that are used for pain relief. Non-pharmacological methods of general anesthesia are not currently used.

Important to remember! The term general anesthesia is widely used in clinical practice and everyday life, although it is not entirely appropriate. The concept of anesthesia in itself implies general anesthesia and the person's being in an unconscious state!

The main types of general anesthesia

A complex of antipsychotics, anesthetics, narcotic and non-narcotic analgesics allows a person to enter a state of deep medical sleep. The routes of entry into the body determine the types of general anesthesia during operations. There are several types of it:

Inhalation anesthesia is the absorption of vaporous and gaseous medicinal substances into the bloodstream through the lung tissue after they are inhaled or artificially introduced into the respiratory tract. Widely used in dentistry for children in the treatment of teeth;
Non-inhalation anesthesia - dosed administration of drugs directly into the venous blood or intramuscularly. The second method is used extremely rarely. According to the depth of medical sleep and the types of drugs used, non-inhalation anesthesia is divided into:
Classical intravenous anesthesia with thiopetal, ketamine, sodium oxybutyrate, recofol. A deep drug-induced sleep is achieved with moderate muscle relaxation and preserved breathing;
Neuroleptanalgesia is a superficial anesthesia in the form of drug-induced drowsiness with lethargy, which distinguishes such general anesthesia from classical intravenous anesthesia. It is carried out with the help of neuroleptics fentanyl and droperidol;
Ataralgesia is a type of intravenous analgesia similar to neuroleptanalgesia, achieved by the administration of the tranquilizer diazepam in combination with fentanyl;
Multicomponent general anesthesia is the deepest combined anesthesia. The state of such a drug-induced sleep can be achieved with the help of a phased introduction of drugs from different pharmacological groups (narcotic analgesics, antipsychotics, anesthetics), inhalation agents in combination with muscle relaxants (arduan, dithylin). At the same time, reflexes and neuromuscular transmission are blocked so much that a person is not able to breathe on his own, which is why general anesthesia is dangerous for an adult and for a child. Therefore, multicomponent anesthesia is always carried out against the background and controlled hardware artificial ventilation of the lungs.

How dangerous is general anesthesia

The consequences of the general for the body of an adult can be different. They depend on many factors: the general condition of the patient, the complexity and duration of the operation, the type of anesthesia, compliance by the specialist and the patient with the rules for preparing and managing patients. It must be understood that the anesthesiologist-resuscitator interferes with the physiology of the respiratory and cardiovascular systems and uses potentially lethal drugs for purposes that are not originally curative. Therefore, both the state of anesthesia and being in intensive care can be considered inherently dangerous. But competent anesthesiologists perform anesthesia as correctly as possible, they know what to do in the most difficult clinical situations, which minimizes the risk of general anesthesia during surgery.

Important to remember! The need for anesthesia requires a differentiated approach to the choice of its specific type. Only in this way will general anesthesia, the consequences of which can only be partially predicted, be safe for the patient!

A typical question of patients who are to undergo surgery is: “how is general anesthesia harmful for an adult and for a child?”. Dangers are represented by the possibility of allergic and anaphylactic reactions, respiratory and cardiac arrest, ingestion of vomit from the stomach into the respiratory tract and asphyxia, decompensation of existing chronic diseases of the internal organs and the central nervous system. The pattern of their occurrence is such that the more severe the patient's condition and the larger the operation, the greater the degree of operational and anesthetic risk.

To date, a lot of clinical studies have been carried out showing how harmful general anesthesia is for a child, what is the danger of its use in children of different age groups. On their basis, postulates were formed, on which pediatric anesthesiology is built as a separate section of medical science. Parents should not look for additional information on this topic, because apart from panic and absolute misunderstanding, they will bring nothing more.

There is a pattern that the older the child, the fewer side effects and complications. Therefore, the expediency of the operation and the type of anesthesia corresponding to it should be determined taking into account this rule. Most often, they resort to inhalation and intravenous anesthesia, which are considered less dangerous and sparing in relation to a growing organism. But large interventions require multicomponent general anesthesia with controlled breathing, regardless of the age of the child. If the dosage of narcotic drugs is observed, there are no serious consequences. In general, there are no people who do not tolerate anesthesia well. There is only poor anesthesia, lack of proper control, or a poorly trained anesthesiologist.

General anesthesia takes 5 years of life?

This is one of the most widespread myths among the population. Let's refute it.

No, anesthesia does NOT take years off your life.

Disease can take away health, not anesthesia, which is carried out to remove it surgically. Much more than pain relief, stress for the body is the operation itself, the very intervention in the integrity of the body.

A differentiated approach to the use of general anesthesia

If it is impossible to avoid the operation, a strict differentiated approach to the choice of the method of anesthesia is necessary. The more qualified the anesthesiologist, the better. If general anesthesia is needed, contraindications to a particular type of anesthesia should be determined first. They are mainly associated with the severity of the patient's condition or pathological conditions in which the probability of death approaches 100%. If general anesthesia is planned, it is necessary to carefully prepare for the operation, regardless of its type and duration. This will facilitate anesthesia and minimize the risk of complications.

A differentiated approach to the choice of anesthesia, depending on the type of surgical intervention, is given in the table.

In emergency operations for any abdominal interventions (with opening of the chest or abdominal cavity) and, moreover, injuries (traumatic shock, burn shock, etc.), only intubation (combined) anesthesia is used. Read also, with infectious diseases.

General anesthesia reviews

“I had operations under general anesthesia twice. Once more than 25 years ago, and the second time last winter. This is heaven and earth. The drugs have really changed. Before, you woke up and there was a feeling that you were born again. Memory otshibalo, a state of stupor, slowness. And all this did not last long enough. The new drugs gave only a slight unconsciousness for 15 minutes, incoherence of speech, which disappeared in almost 5 minutes.

Andrey, 45 years old

“The effects of general anesthesia were minimal. The operation was easy, so four hours later I was on my way home. Of course, there was a heaviness in the head, a slight nausea. In principle, when all the anesthesia came out, all the consequences receded. The main thing is to drink plenty of fluids, it helps to remove any muck. And the diet should be followed at least a couple of days. Then the consequences are minimal, at least for me it was.

Elena, 30 years old

I created this project to tell you about anesthesia and anesthesia in simple language. If you received an answer to your question and the site was useful to you, I will be glad to support it, it will help to further develop the project and compensate for the costs of its maintenance.

Myth 1. Anesthesia shortens life expectancy

Myth 2. Narcosis causes mental disorders

One of the side effects that are included in the instructions for drugs for anesthesia really are mental disorders. However, this is extremely rare and only in patients predisposed to them (for example, alcoholics) or in older people prone to age-related mental disorders. But all other patients are not threatened by any mental illness, and even more so by mental retardation.

Myth 3. Anesthesia can cause hallucinations.

Once upon a time, this was indeed true: outdated drugs for anesthesia provoked the appearance of such visions. These agents include ether, chloroform, ketamine, which have not been used in any of the fields of medicine for many years. The risk that an anesthesiologist in a modern clinic will force a patient to breathe chloroform is zero.

Previously, drugs that are prohibited today were used in anesthesia. Photo: commons.wikimedia.org

Myth 3. Narcosis poisons the body, causing irreversible consequences.

Constant migraines, memory impairment, weakening of the body due to the fact that each dose of anesthesia supposedly poisons it - all these "horror stories" can be found in abundance on all kinds of sites like "Down with official medicine!".

However, I repeat - the use of modern anesthetics does not lead to any serious consequences. Most often, asthenia and general malaise are the result of the disease from which the patient suffered.

Myth 4. Narcosis causes severe allergies

But, firstly, in a modern clinic, the patient must be offered to do an allergological test and, in accordance with its result, select the right remedy.

Secondly, the doctor is obliged to act in the same way if a number of drugs cannot be used due to the patient's condition or the presence of any pathology.

And thirdly, cases of allergy to anesthesia are so rare that, for example, I have never encountered this in my 18 years of work as an anesthesiologist.

Myth 5. Doctors impose anesthesia for any reason.

This is not true. For example, in dentistry, the doctor will always first offer the patient treatment under sedation, i.e. in a state of complete relaxation, when there are no emotional reactions to what is happening, while the patient can still communicate with the doctor. According to modern standards, anesthesia is mandatory for only a few categories of citizens: for people suffering from drug addiction or mental disorders, as well as in cases where treatment under sedation is not possible.

Myth 6. Anesthesia is addictive, and the dose of each subsequent one must be increased

It is impossible to make a drug addict out of a healthy person with one injection of anesthesia. Here, as always, the root of the delusion lies in those distant times when doctors actively used morphine and opium to reduce pain in a patient. A constant dose increase is also not required. However, it can be increased if the patient is taking stimulants (or drinking coffee that contains caffeine). And first of all, when calculating the dose, the duration of the surgical intervention is taken into account.

Myth 7. You can die from anesthesia

Many patients have heard about anaphylactic shock - an extreme degree of allergy, and therefore they are very afraid of anesthesia. But, as already mentioned, today there is a way to identify potential allergies in advance. As for asphyxia (a condition in which the patient cannot breathe), it can indeed occur during anesthesia, but not because of the drug itself, but because of the incompetent actions of medical personnel if the work methodology is violated. However, this is a human factor that is not excluded in any field of activity.