Is anesthesia dangerous? Expert - about myths and real medical practice

• Myths about anesthesia
• Modern drugs for anesthesia
• Imaging Techniques for the Anesthesiologist
• Liver and brain toxicity
• Consequences of anesthesia for older people
• Epidural anesthesia
• Anesthesia in dentistry

Traditionally, the patient experiences the greatest fear when thinking about general anesthesia.

Let's start dispelling myths with terminology; general anesthesia does not exist in medical nature. After all, translated from Latin, anesthesia is a medicinal sleep, so any manipulation in which our consciousness turns off for at least a minute is called anesthesia. And it is always general, because there is no local sleep. Confusion arises because a synonym for anesthesia is general anesthesia.

Why general anesthesia is dangerous - myths about anesthesia

Over the past decades, general anesthesia has become much “softer”: the introduction of drugs with fewer side effects, a significant reduction in the use of narcotic drugs, the development and active use of a new generation of gas mixtures that enter the lungs through a ventilator and support a person in medicated sleep as much as necessary, all this has led to the fact that modern anesthesia has become practically safe. Proof of this is the fact that these days there is practically no question about the duration of anesthesia. If in the 70s, hours were counted, and the longer a person was in medicated sleep, the worse he “moved away from it,” but now serious operations last for 10–12 hours, and the next day the patient is transferred to a ward, which called “with a clear head.”

Another brick in the safety wall is the active introduction of imaging techniques in anesthesiology. If previously a doctor punctured large vessels and installed catheters in them blindly, based only on anatomical landmarks and his own experience, today everything happens under ultrasound control, the risk of error and the development of complications tends to zero.

The equipment controls the depth of anesthesia, automatically changes breathing parameters, selecting optimal criteria for each specific moment of the operation. The workplace of an anesthesiologist is difficult to distinguish from the cockpit of an airliner.

As you know, in the past, the liver and brain suffered the most from serious anesthetic drugs. Therefore, special attention is paid to neuro- and hepatoprotection. Modern drugs have minimal hepatotoxicity and virtually no damage to the liver, neurotoxicity is also significantly reduced, and special drug regimens are used to protect the brain. And it works, because stories about memory loss or deterioration of brain activity after anesthesia are becoming less and less common.

Science and clinical practice

I will try to tell you about the effect of anesthesia on the human body, and in particular on the brain.

Anesthesia is a state of loss of consciousness that is induced artificially and is characterized by its reversibility. Anesthesia produces pain relief, which allows it to be used in surgery to relieve the patient of the suffering associated with the sensation of physical pain. The state of anesthesia is achieved with the help of anesthetics; there is a certain medical specialization - an anesthesiologist who selects the optimal dose and combination of drugs based on the individual characteristics of the patient’s body, in addition, the type of medical effect matters. It often happens that anesthesia causes fear in people to a large extent more than the surgical operation itself. Among other things, there are many rumors and rumors about anesthesia; some fear that anesthesia can cause death. Is it really? How does anesthesia affect the human body? Is it dangerous, will anesthesia affect further memory problems and cognitive functions of a person?

I don’t want to offend anyone, but very often I hear amazingly illiterate and ignorant statements about anesthesia on this subject, not only from ordinary people, but also from doctors, but almost any non-anesthesiologist will be happy to tell you thoughtfully something like “anesthesia is always anesthesia” or “Anesthesia is not candy.” It’s good that at least the majority do not repeat the generally accepted nonsense that “anesthesia takes 5 years of a person’s life” or “affects the heart.” Patients who undergo operations under general anesthesia write with pleasure in various forums how afraid they are of “general anesthesia,” and a chorus of well-wishers echoes them: “yes, yes, anesthesia is like dying a little,” “anesthesia has a lot of contraindications,” “maybe allergic shock!” It seems that you can do without anesthesia and there is no need to monitor the patient’s somatic condition during the most complex and traumatic interventions. True, no one writes that pain has a very, very strong effect on health, that not everything can be tolerated.

Most of us know about anesthesia that it is used during operations as an anesthetic; this is where our knowledge ends and fears, worries, and speculation begin. General anesthesia, or anesthesia, is a time-limited state of unconsciousness during the administration of special painkillers, during which time the patient undergoes a surgical operation, after which the patient’s consciousness is restored. The actions of the anesthesiologist are aimed at relieving the patient of pain during the operation, as well as to ensure a normal and painless transition to a state of consciousness, with no discomfort.

How general anesthesia affects the human body should be discussed based on what type of anesthesia is used. General anesthesia is divided according to several criteria, but again we will not go deeper, but will only name and characterize the main types used in practice. For major operations on internal organs located above the diaphragm, which separates the chest cavity from the abdominal cavity, anesthesia with artificial ventilation of the lungs is usually used, and, in heart operations, with artificial circulation. Anesthesia drugs can be administered either intravenously or through inhaled air, or both. Sometimes such anesthesia is also supported by spinal (subdural) or epidural anesthesia, which, in turn, can be used independently. During spinal anesthesia, the drug is injected under the dura mater into the fluid that washes the spinal cord at the level of its segments responsible for sensitivity in the surgical area. For the duration of the anesthetic, these segments and all those located below them become insensitive to pain, and the anesthetized parts of the body become immobile. With epidural anesthesia, the drug that causes it is injected above the dura mater, at the level of the nerve trunks extending from the spinal cord and, washing them, causes an interruption of sensory and motor nerve impulses at the site of action of the drug. Organs located below the operation site may not be anesthetized. Both types of such anesthesia are considered gentle: they are the least aggressive and have the advantages of general and local anesthesia, while practically not having their disadvantages. Epidural anesthesia can also be prolonged. In this case, a thin catheter (tube) is placed over the dura mater and brought out. It is glued to the patient’s back and painkillers are added there: this postoperative pain relief is the most effective. These types of anesthesia require a very small amount of a drug from the group of local anesthetics; until recently, pain relief was done with lidocaine, but now drugs have been proposed that act longer and are more effective in smaller doses.

The anesthesiologist chooses the type of anesthesia based on the individual characteristics of the person being operated on; the choice depends on his physical condition, on what kind of operation is being performed, and even the level of qualification of the surgeon and the anesthesiologist himself matters. In order to perform the same operation on different people, different types of anesthesia can be applied to them; the ideal combination of drugs is selected for the patient, which is achieved by mixing different drugs and types of pain relief. Thus, the importance of a specialist anesthesiologist is extremely difficult to overestimate; this doctor is always present during all major operations.

People who have undergone surgery, and therefore general anesthesia, report the following symptoms and unpleasant moments after the use of painkillers:

Firstly, memory impairments are possible, which can manifest themselves in different ways, from subtle isolated cases to regular and pronounced ones that arise suddenly.

Secondly, after using anesthesia, some note sleep disturbances, which can persist even several months after the operation.

Thirdly, immediately after surgery, the use of anesthesia can cause headaches, hallucinations, hearing and speech disorders. All these symptoms, as a rule, disappear within the next few hours after the application of anesthesia.

And this is not a complete list of troubles that can be caused by the use of anesthesia, as people who have suffered it say.

Now let's talk about the effect of general anesthesia on the brain:

Some of the consequences of anesthesia are memory impairment, decreased attention, and deterioration in learning ability. The disorders described above in medicine are called postoperative cognitive dysfunction. Memory impairments observed after anesthesia always cause a lot of trouble for patients. Patients are concerned about what happened to their memory after anesthesia, how long it will last, and what can be done to alleviate the condition. As a rule, anesthesiologists cannot give clear answers to the questions posed above. Memory impairment after anesthesia is not such a rare complication. Most studies regarding post-anesthesia memory impairment have focused on cardiac surgery. It has been shown that during the first week after anesthesia, memory impairment occurs in 30-80% of cardiac surgery patients. Patients who have undergone non-cardiac surgery are at slightly lower risk of developing memory impairment after anesthesia. Thus, in the first week after anesthesia, a decrease in memory and attention is observed in 25% of patients, and after 3 months – in 10% of patients. There are studies that show that after undergoing anesthesia, cognitive disorders can persist for a year or more.

Scientists have not reached a consensus on which type of anesthesia has the least effect on the brain. According to some, disorders of cognitive functions such as memory, attention and learning occur with the same frequency, both with general anesthesia and with regional methods of anesthesia (spinal anesthesia; epidural anesthesia). Others have concluded that regional anesthesia is associated with fewer incidents of memory and attention impairment.

There is no clear answer regarding the harmfulness or harmlessness of individual anesthesia drugs. It is believed that sharp changes in the delivery of oxygen to the brain are important in the development of memory impairment during anesthesia. During anesthesia, it is possible to develop certain conditions that are associated with the development of temporary oxygen starvation of the cerebral cortex. These conditions are associated with a significant drop in blood pressure and a marked decrease in oxygen levels in the blood.

Despite the fact that the causes of post-anesthesia intellectual impairments continue to remain unclear, scientists have found a number of factors that increase the risk of developing attention and memory impairments after anesthesia: older age, repeated anesthesia, long-term surgery, low level of education of the patient, and those that developed after surgery. infectious and respiratory complications.

In order not to scare potential patients, as a neurosurgeon I can say that often all problems with memory and cognitive functions are reversible! There is a sufficient arsenal of tools to solve this issue, which in most cases will help not lead to the development of complications or will help restore lost functions as quickly as possible.

The most important thing I want to say in conclusion is that, of course, the risk of anesthesia and the volume of surgical intervention are always assessed. You always need to make a CHOICE!

The choice is of course yours, but after an explanation from the TEAM (anesthesiologist and surgeon) about the development of possible pros and cons - and the occurrence of possible complications.

By the word TEAM I mean a well-coordinated team (anesthesiologist, surgeon, nurses) who work in one direction - for the benefit of the patient with a good quality of life!

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.

What is the drug Propofol?

Let's figure out what kind of medicine this is - Propofol. This is an ultra-short-acting sleeping pill, i.e. It works practically only while it is administered (or while it is present in the blood in sufficient concentration). Method of administration: intravenous.

The effect of Propofol includes 2 important components - hypnotic and amnesic. This means that under the influence of Propofol a person falls asleep and after waking up does not remember what happened during sleep. Propofol does not provide an analgesic effect, so it must be combined with analgesics.

The main active ingredient of Propofol is 2,6-diisopropylphenol. Its main advantage is that it has the same effectiveness as some other previously used drugs, but is safer, provides an easier recovery from anesthesia and fewer side effects.

The substance is insoluble in water, therefore it is used in the form of an aqueous emulsion of oils in which the active ingredient is dissolved (currently soybean oil). It appears as a white liquid resembling milk.

Anesthesia in dentistry

And one more question that interests many: is it worth agreeing to general anesthesia when installing dental implants? In fact, in this case there is no choice. After all, if we are talking about installing 1-2 implants, you can really get by with local anesthesia, but when a dentist does half of the jaw at a time, then working without anesthesia will turn into real torture for both the doctor and the patient. Considering these facts and the safety of modern anesthesiology, most patients agree with the doctor’s proposal and prefer to wake up with a finished result.

How to restore the health of an elderly person after surgery

Of course, an elderly person needs care, especially during the difficult postoperative period. Doctors use all kinds of health checks using special equipment. Be sure to check heart function, blood pressure and other body functions. After the operation, the pensioner is provided with care and the following medical measures are taken:

• procedures for treating sutures with antiseptic agents, as well as regular dressing changes
• taking medications, in particular antibiotics
• correcting electrolyte imbalance
• body temperature control
• emotional support

In fact, all points are simple to implement and require only conscientious implementation.

How to prepare for treatment

To ensure that sedation does not have any negative effects on the patient’s body, a thorough diagnosis of the health status before it is necessary - it will allow you to exclude possible contraindications, choose medications, and also find out what difficulties may arise during medicated sleep.

Tests and examinations before treatment under sedation

Before treatment or dental restoration under anesthesia, you will need to take a number of tests and undergo some examinations. You can take tests directly in our clinics completely free of charge: they are included in all types of dental implantation.

• general and biochemical blood test (AST, ALT, urea, creatinine, total protein, glucose, electrolytes), valid for 14 days,
• blood test for HIV, hepatitis C and B, syphilis, blood group and Rh factor, valid for 3 months,
• hemostasiogram or coagulogram (blood test), valid for 1 month.

All of the above tests are performed directly in our clinics completely free of charge. It is also additionally necessary to provide the results of the following examinations:

• ECG (electrocardiogram),
• Chest x-ray or fluorography – research results for the last 6 months are accepted: images or a specialist’s opinion (description of the images),
• For patients over 50 years of age, consult a general practitioner or cardiologist.

In a number of laboratories, these tests can be performed in a comprehensive manner: medical companies are developing special profiles called “hospital” profiles, in particular “for hospitalization in a surgical hospital.”

Lifestyle before treatment under sedation

• the operation is carried out without signs of acute respiratory viral infections and other infections. If you feel sick or become ill, be sure to notify your personal manager to reschedule your surgery,
• food: on the day before surgery, a light breakfast is allowed: dry toast, tea or weak coffee without milk. If the operation is in the morning, then you need to limit yourself to dinner only,

Important! Before surgery, under sedation, you cannot eat for 6 hours!

• drinks: stop drinking liquids 2 hours before surgery,
• alcohol: prohibited 2-3 days before surgery,
• taking medications: orally – no later than 2 hours before surgery,
• women are advised not to use cosmetics and must also remove all coating from their nails,
• After the operation, we do not recommend driving, so you must come to the clinic by taxi/public transport or ask someone you know to bring you.

Follow the link to study a detailed reminder about preparing for implantation.

Recommended dose of Propofol

The dosage of Propofol depends on age, body weight, and various individual characteristics. The starting dosage for sleep induction for the average adult is approximately 40 mg every 10 seconds, or 2-2.5 mg/kg body weight. For children over 8 years of age, approximately the same dosages are used; for younger children, higher doses are possible.

The maintenance dosage to maintain anesthesia is 4-12 mg/kg/h for adults and 9-15 mg/kg/h for children.

Will it hurt during and after treatment?

No, there won't be any pain either. 1-2 hours after treatment, when the anesthesia wears off, tolerable pain may occur. It is associated exclusively with tissue injury. The doctor will prescribe painkillers for you: whether to take them or not is up to you to decide, based on your own condition. More than half of our patients after dental implantation take painkillers only for the sake of prevention - so that the pain does not overtake them in the middle of the night while sleeping, about 30% do not take them at all, and the rest do not take them as prescribed, because there is slight discomfort.

Analogs

Propofol can, if necessary, be replaced with other drugs of similar action. Propofol analogues from the group of non-inhalational anesthetics:

• brietal,
• hexenal,
• ketamine,
• hypnomidate.

These drugs have a comparable effect in terms of mechanism and results (stimulation of GABA and suppression of excitatory neurotransmitters), but it must be borne in mind that almost all of them have more severe side effects and provide a more difficult recovery from anesthesia (drowsiness, headache, confusion, hallucinations etc.) compared to Propofol. In addition, not all of them can be used in childhood.

Of the inhaled analogues of Propofol, Sevoran has proven itself well. This drug has the same effect, is slightly more effective and safe, but it is a gas and the method of administration is less convenient - inhalation.

Propofol is currently the most successful drug for anti-stress treatment in dentistry, widely used for both adults and children of all age groups.

Are there any disadvantages to sedation?

Naturally, dental treatment or implantation under general anesthesia has certain disadvantages. In particular, the need for rehabilitation after the administration of the drug and a fairly large list of contraindications. However, our clinic conducts a thorough diagnosis of the body’s condition before using any anesthetics. If the doctor identifies certain risks, you will be denied sedation and will not take any risks. In addition, by working with professional anesthesiologists, any unpleasant consequences are reduced to a minimum.