Observation of 1 patient after anesthesia. Assessment of the patient's condition
Before neurosurgery it is necessary to assess the patient's condition. Some assessment parameters are common to all patients undergoing surgery or other surgical procedures, but certain groups of patients require special or more detailed evaluation. This chapter will not consider the general principles of preoperative preparation of patients, but only the features characteristic of neurosurgical patients. This article is devoted to elective neurosurgical operations. The same principles apply to emergency operations, although time constraints require some variation. Features of preparing patients for some specific types of intervention will be discussed in the following articles on the MedUniver website.
Objectives of preoperative assessment of the patient's condition
Preoperative examination performs five overlapping functions:
Determining the urgency of surgical treatment.
Timely assessment of the patient's condition and preoperative drug therapy, which may affect anesthesia and surgical technique.
Identification of patients whose condition can be improved by treating concomitant diseases before surgery.
Identification of patients requiring special postoperative care
Educate patients about the benefits and risks of selected anesthetic technique, pain management, and postoperative care. Despite the fact that these principles relate more to the organization of planned operations, they also apply to urgent and emergency operations.
Peculiarities organizations Preoperative examination depends on many factors specific to each clinic. However, there are general principles:
Timeliness of preoperative assessment of the patient's condition. There should be sufficient time between the preoperative examination and the date of the planned operation to complete the investigations and evaluate the results so that all issues can be resolved in a timely manner. But at the same time, if the time interval between examination and surgery is too long, neurological symptoms may progress.
Multidisciplinary approach in preoperative assessment of the patient's condition. Preoperative preparation includes not only medical aspects, but also issues that are usually addressed by nursing staff, such as social adaptation, fears and anxiety about the disease and the upcoming operation. The surgeon and anesthesiologist may have different requirements for organizing the process, so they should be involved in the preparation.
Some clinics may employ specially trained nurses to perform the duties of both a nurse and a surgeon and anesthesiologist, but more often, the responsibilities of the anesthesiologist are performed to some extent by resident physicians.
Documentation in the preoperative assessment of the patient's condition. Medical records must be clear and unambiguous. The system must function in such a way that it is always possible to identify patients with significant underlying diseases or disorders identified during the study early. Consensus recommendations should be made regarding the prevention of thromboembolism, the use of appropriate testing methods, and the continuation (or discontinuation) of certain drugs (aspirin, clopidogrel, NSAIDs, warfarin).
History and examination. Regardless of who performs the preoperative examination, it is necessary to highlight key parameters that are especially important in neuroanesthesiological practice.
Patient's airway. It is certainly important to note a history of difficulty with intubation. Patients with degenerative diseases of the lower spine may also have disease in the cervical spine, which may cause limited movement or be associated with myelopathic symptoms on movement. Surgery on the cervical spine can lead to fixation of the cervical spine in a position that precludes direct laryngoscopy.
Have a large number patients with traumatic brain injury there is concomitant damage to the cervical spine.
Many patients with acromegaly obstructive sleep apnea (OSA) is noted, and some may also have sleep apnea of central origin. Treatment of acromegaly does not necessarily lead to reversal of the anatomical changes that predispose to OSA.
Patient's respiratory system. Patients with upper cervical myelopathy associated with internal or external compression of the spinal cord may have significant difficulty breathing. They can be difficult to recognize due to limitations in physical activity caused by neurological deficits.
In patients with damage to the bulbar structures associated with their neurological disease (cerebellopontine angle tumors, multiple sclerosis, syringomyelia/syringobulbia) or depression of consciousness, there is a risk of aspiration, which can often be prevented with careful examination and careful history taking.
Patient's cardiovascular system. Hypertension is quite common in neurosurgical patients. Most often this is essential arterial hypertension, but sometimes it is associated with the neurosurgical disease itself or with its therapy, for example, with an acute increase in ICP, acromegaly, hypo- or hyperthyroidism; prescribing corticosteroid therapy.
Development of arterial hypertension in the perioperative period is a risk factor for bleeding after craniotomy, therefore, if time permits, it is necessary to adjust blood pressure. Neurosurgical emergencies such as intracranial hematoma, TBI, SAH, and spinal cord injury can lead to serious cardiovascular complications. These issues will be discussed separately in subsequent chapters.
Patient's nervous system. Before anesthesia, a thorough assessment of the patient's neurological status should be carried out, which is necessary mainly for the postoperative period. The patient's mental state must also be assessed. If the patient has a disturbance of consciousness, you should clarify the details of his medical history with relatives, friends or the attending physician.
Symptoms increased intracranial pressure include headache when changing body position (postural headache), worse in the morning, when coughing or sneezing, accompanied by vomiting. Other symptoms include papilledema, unilateral or bilateral mydriasis, third or fourth cranial nerve palsy, absent brainstem reflexes (or in severe forms, systemic hypertension, bradycardia, and respiratory failure—Cushing's triad). The Glasgow Coma Scale should also be assessed.
The frequency and type of seizures should be described along with other known precipitating factors.
Patient's endocrine system. Many patients suffer from type 2 diabetes. Glycemia should be monitored, especially in patients who have recently been prescribed corticosteroids.
Patient's blood system. It is necessary to find out whether the patient or family has cases of hematomas with minor injuries, prolonged bleeding and other characteristic signs of coagulation disorders. Liver disease should be considered a risk factor for coagulopathies. Risk factors for venous thromboembolism should also be identified and attempts to eliminate them should be made.
In an outpatient setting, before releasing a patient after surgery and anesthesia, the doctor must make sure that the adequacy of his reactions and behavior has been restored. This should be based on assessment of the patient’s general condition and his psychophysiological functions. Immediately after anesthesia, the patient is placed in a horizontal position in the ward or postoperative observation room. After regaining consciousness are asking about well-being. If there is lethargy, weakness, or nausea, the patient should lie down for a longer time. It is necessary to find out from each patient how he orients himself in space and time by asking him a few simple questions. Quite often, special tests are used for these purposes, for example TestBidway, - disappearance of postoperative drowsiness and restoration of orientation (E. Garry et al., 1977). The patient's answers are rated on a 5-point system:
4 points - the patient does not respond to verbal commands and painful stimulation;
3 points - the patient responds to painful stimulation, but does not make contact;
2 points - the patient responds to a verbal command and reacts to painful stimulation, but is not oriented in space and time;
1 point - the patient responds to all forms of stimulation, is well oriented in time and space, but feels drowsy;
0 points - the patient is well oriented in space and time, there is no drowsiness.
After the above phenomena disappear, check the recovery motor coordination. It is necessary to make sure that there is no nystagmus, check stability in the Romberg position, perform a finger-nose test, and note the absence of ataxia when walking with eyes closed and open. The patient must be fully oriented and stable in relation to the functions of vital organs, not experience nausea or vomiting, and be able to move, drink and urinate.
They also determine the clarity and speed of thinking, attention and orientation in the environment. For this you can use a special Bourdon test(crossing out a given letter in 10 lines of regular book text) or Haratz test(writing 5-7 three-digit numbers, and each subsequent one should begin with the last digit of the previous one). Correct or with a small number of errors and fairly rapid completion of these tests indicate a complete restoration of attention and orientation.
Pain is eliminated by prescribing analgesics per os. After which the patient must be escorted home and must be under control for the first day. The patient should also be instructed to: contact the clinic if complications arise; refrain from drinking alcohol, as well as from driving a car and using any technical devices during the first 24 hours, since the complete restoration of all body functions cannot be accurately predicted. The corresponding entry must be made in the individual outpatient card - the main medical and legal document.
In inpatient conditions, the possibility of monitoring and monitoring the patient after undergoing intubation anesthesia is more favorable. Directly from the operating room after awakening and extubation, it is advisable to transfer the patient to special awakening wards, organized in the conditions of the intensive care unit and anesthesiology, where he remains for 2–3 hours under the dynamic supervision of specialists until he completely recovers from anesthesia with a guarantee of restoration of the vital parameters of the body’s homeostasis and eliminating possible complications associated with general anesthesia. If necessary (after extensive, long-term or traumatic surgical interventions in the maxillofacial area) with a probable threat of early complications from the vital functions of the body or their instability, it is advisable to transfer the patient from the operating room (in agreement with the operating surgeon and anesthesiologist) to intensive care wards using technical monitoring equipment on days 1–3 (sometimes in such cases, extubation is performed only in intensive care wards after full compensation of the patient’s condition). Subsequently, for further specialized treatment, the patient is transferred to the department of maxillofacial surgery, where, along with the main treatment, the development of post-anesthesia complications is also prevented (alkaline oil inhalations, physical therapy, control tests of the body’s homeostasis parameters are prescribed).
After undergoing neuroleptanalgesia or intravenous short-term anesthesia, the patient in a stable compensated condition can be transferred from the operating room directly to the wards of the maxillofacial surgery department under the supervision of the attending physicians and the nursing staff on duty.
The increased desire of anesthesiologists to predict outcomes and better plan intensive care is inextricably linked with the development and improvement of methods for assessing the treatment process.
Modern prediction of treatment results is based on the use of “score systems for assessing the severity of the condition.” Prediction of treatment for intensive care patients includes the APACHE II and III scales, TISS, Trauma Severity Score, and Glasgow Coma Scale. Prediction of the results of surgical treatment is based on the use of systems of “degrees of surgical and anesthetic risk” and “indices for predicting perioperative morbidity.” These “forecasting systems” are intended to provide both uniform rules for objective assessment of the treatment process and to contribute to the creation of treatment standards.
A limiting factor in the widespread use of “score systems” in the practice of an anesthesiologist is the inability to make a treatment prognosis for one patient. It is also important that these systems provide greater legal protection for the anesthesiologist and have little influence on the choice of therapy method:
1. The APACHE scale allows you to predict the outcome of treatment for certain categories of patients, but not for an individual patient.
2. Widespread use of the Goldman risk index is inappropriate due to interhospital differences in treatment tactics. The anesthesiologist can only assess the absolute risk of an isolated therapeutic effect.
3. The Treatment Intensity Score System (TISS) allows you to determine the severity of the disease and assess the possibility of providing the required amount of medical care to a particular patient, but comparison of ratings using this system is not possible due to the specificity of medical care in different ICUs.
4. The proposed classifications of anesthesia risk levels have little influence on the choice of anesthetic management method. The severity of the patient's condition at the time of surgery, the volume, and urgency of the surgical intervention are usually assessed separately.
In practice, the most important thing is to choose the optimal method of intensive care for one patient supervised by an anesthesiologist. The main tool used when choosing a treatment method, as well as when analyzing treatment, is to assess the severity of the patient's condition. But the purposes of “assessment” are different. When making a prognosis of a disease, the goal is to identify factors that determine the severity of the patient's condition and risk factors that may complicate the course of the disease. When choosing a treatment program, the goal is to choose a treatment method. This difference creates different ways of assessing the severity of the patient’s condition. And it is on the basis of this difference that methods for objectively assessing the severity of the patient’s condition can be developed, which can determine the choice of intensive care methods.
The principle of identifying and eliminating the cause of the disease underlies the development and improvement of modern methods of therapy. The nosological approach, actively used in treatment tactics, can also be applicable when assessing the patient’s condition.
According to the principle of “causality,” the occurrence of disease or even death occurs as a result of the body’s inability to resist or at least compensate for damaging mechanisms. Any damaging effect leads to the occurrence of compensatory reactions of the body, the direction of which is to preserve the functional and morphological structure of the body. Functional changes that occur in response to damage can be fixed, leading to morphological changes, which can subsequently act as a damaging factor, leading to the involvement of new compensatory mechanisms. During life, a person is constantly exposed to unfavorable factors and, in the absence of protective and compensatory mechanisms that arise in response to damage, is doomed to death.
Based on the foregoing, it can be assumed that the assessment of the patient’s condition should take into account the following points:
1. Damage assessment
2. Compensation assessment
3. Assessment of compensation mechanisms
“Damage assessment” implies the identification of acute or chronic damage to the structure of the body. Analysis of information should include all organs and systems of the body. The decisive influence on the prognosis of treatment is the volume of damage, the time during which the injury occurred, the “aggressiveness of the injury” (damage to vital organs, massive bleeding, etc.).
“Compensation assessment” allows you to assess both the compensatory capabilities of a particular person and the strength of the damaging impact. Evaluation options include two parameters: compensated and not compensated.
“Assessment of compensation mechanisms” allows us to identify both the quantitative and qualitative nature of the mechanisms involved, as well as the tension of compensatory reserves.
This patient assessment scheme allows for a more qualitative assessment of the patient’s condition; guide the doctor to choose the optimal treatment method for this particular person; predict outcomes and better plan intensive care.
A distinctive feature of the preoperative examination is the need to select a method of anesthesia and plan an option for anesthetic protection. A difficulty for the doctor is the fact that assessing the functioning mechanisms of body systems at the time of surgery does not allow the anesthesiologist to identify objective data that determines the choice of anesthesia method and the choice of an adequate level of pain protection. At the same time, the traditional idea of anesthesia as “protecting the patient from surgical stress” takes little into account the patient’s condition at the time of surgery, the direction of his protective and adaptive reactions and, as a result, does not fully reflect the adequacy of the chosen anesthetic technique. The creation of uniform rules for objective assessment of the patient’s severity, which could determine the choice of anesthesia method, becomes one of the priorities in improving the methods of the intraoperative stage of treatment.
The use of the proposed scheme for assessing the severity of the patient’s condition provides an opportunity for the doctor to better prepare for anesthesia. A thorough assessment of the extent of previous injury and the preservation of the body’s compensatory reserves at the time of surgery allows the anesthesiologist to choose the optimal methods of intensive care for the patient under his supervision. The availability of information about the type and volume of the planned operation, the features of the surgical technique, and the likelihood of complications occurring during surgical treatment provides an opportunity to better formulate an action plan and determine the range of tasks for intensive care during the surgical stage of treatment. And the main task of intensive therapy at the surgical stage should be to maintain and/or correct the functions of the body systems through a preliminary assessment of the mechanisms of their functioning at the time of surgery.
When choosing a method of anesthesia, the anesthesiologist must take into account that an operation is the elimination or correction of a violation of the structure of an organ or organ systems by deliberately causing additional damage to the body. A distinctive feature of surgical intervention is that compensatory reactions that arise in response to surgical trauma are often unable to respond to surgical invasion in a timely and adequate manner, and, thus, surgical intervention, the purpose of which is to treat the patient, is itself a powerful damaging factor, in the absence of sufficient protection, leading to worsening of the disease or death.
The use of means of assessing and monitoring the vital functions of the body, the possibility of urgently using additional methods of intensive care allows the anesthesiologist to promptly correct any disturbances in homeostasis at any stage of surgery, but does not affect the body’s defense mechanisms from surgical trauma. In the absence of sufficient pain protection, the use of the most modern methods of Intensive Therapy “distorts” the results of the operation and negatively affects the process of further treatment. The effectiveness of anesthetic (pain) protection is becoming one of the main factors that determines the prognosis of treatment.
Anesthesia becomes an active part of the therapy of the surgical stage of treatment, part of intensive care. Taking this provision as a basis, the anesthesiologist has the opportunity to plan an option for anesthesia, taking into account the required level of protection from surgical trauma. Formulate the objectives of anesthesia for each individual patient, from minimal sedation to total analgesia, based on the main task - prevention and/or correction of depletion of factors of the body's analgesic system in response to injury.
Modern anesthesia care should be regarded as a set of therapeutic measures during the surgical stage of treatment, part of the patient’s treatment program, where “pain protection” is an active part of the therapeutic actions.
This view of anesthesia care will allow us to set different requirements for the quality and improvement of anesthesia methods, and, no less important, for improving methods for assessing the treatment process.
Introduction.
CARE FOR PATIENTS AFTER ANESTHESIA
Anesthesia(ancient Greek Να′ρκωσις - numbness, numbness; synonyms: general anesthesia, general anesthesia) - an artificially induced reversible state of inhibition of the central nervous system, which causes loss of consciousness, sleep, amnesia, pain relief, relaxation of skeletal muscles and loss of control over some reflexes. All this occurs with the introduction of one or more general anesthetics, the optimal dose and combination of which is selected by the anesthesiologist, taking into account the individual characteristics of the particular patient and depending on the type of medical procedure.
From the moment the patient enters the ward from the operating room, the postoperative period begins, which continues until discharge from the hospital. During this period, the nurse should be especially attentive. An experienced, observant nurse is the doctor’s closest assistant; the success of treatment often depends on her. In the postoperative period, everything should be aimed at restoring the patient’s physiological functions, normal healing of the surgical wound, and preventing possible complications.
Depending on the general condition of the person being operated on, the type of anesthesia, and the characteristics of the operation, the ward nurse ensures the desired position of the patient in bed (raises the foot or head end of a functional bed; if the bed is an ordinary one, then takes care of the headrest, bolster under the legs, etc.).
The room where the patient is admitted from the operating room must be ventilated. Bright light in the room is unacceptable. The bed must be placed in such a way that it is possible to approach the patient from any side. Each patient receives special permission from the doctor to change the regime: they are allowed to sit down and stand up at different times.
Basically, after non-cavitary operations of moderate severity, if the patient feels well, he can get up near the bed the next day. The nurse should monitor the patient’s first rise from bed and not allow him to leave the room on his own.
Care and monitoring of the patient after local anesthesia
It should be borne in mind that some patients have increased sensitivity to novocaine, and therefore, after surgery under local anesthesia, they may experience general disorders: weakness, drop in blood pressure, tachycardia, vomiting, cyanosis.
Cyanosis is the most important sign of hypoxia, but its absence does not mean that the patient does not have hypoxia.
Only careful monitoring of the patient’s condition allows one to recognize incipient hypoxia in time. If oxygen starvation is accompanied by carbon dioxide retention (and this happens very often), then the signs of hypoxia change. Even with significant oxygen deprivation, blood pressure may remain high and the skin may remain pink.
Cyanosis- bluish coloration of the skin, mucous membranes and nails - appears when every 100 ml of blood contains more than 5 g% of reduced (i.e., not associated with oxygen) hemoglobin. Cyanosis is best determined by the color of the ear, lips, nails and the color of the blood itself. The content of reduced hemoglobin may vary. In anemic patients who have only 5 g% hemoglobin, cyanosis does not occur with the most severe hypoxia. On the contrary, in plethoric patients, cyanosis appears with the slightest lack of oxygen. Cyanosis can be not only due to a lack of oxygen in the lungs, but also due to acute cardiac weakness, in particular cardiac arrest. If cyanosis appears, you should immediately check the pulse and listen to heart sounds.
Arterial pulse- one of the main indicators of the cardiovascular system. They are examined in places where the arteries are located superficially and are accessible to direct palpation.
More often, the pulse is examined in adults at the radial artery. For diagnostic purposes, the pulse is determined in the temporal, femoral, brachial, popliteal, posterior tibial and other arteries. To count your pulse, you can use automatic blood pressure meters with pulse indicators.
It is better to determine your pulse in the morning, before eating. The patient should be calm and not talk while counting the pulse.
When body temperature rises by 1 °C, the pulse increases in adults by 8–10 beats per minute.
Pulse voltage depends on blood pressure and is determined by the force that must be applied until the pulse disappears. At normal pressure, the artery is compressed with moderate force, so the normal pulse is of moderate (satisfactory) tension. With high pressure, the artery is compressed by strong pressure - this pulse is called tense. It is important not to make a mistake, since the artery itself can be sclerotic. In this case, it is necessary to measure the pressure and verify the assumption that has arisen.
If the artery is sclerotic or the pulse is difficult to palpate, measure the pulse on the carotid artery: feel the groove between the larynx and the lateral muscles with your fingers and press lightly.
At low pressure, the artery is easily compressed, and the tension of the pulse is called soft (relaxed).
An empty, relaxed pulse is called a small filiform. Thermometry. As a rule, thermometry is carried out 2 times a day - in the morning on an empty stomach (between 6 and 8 am) and in the evening (between 16-18 o'clock) before the last meal. During the indicated hours, you can judge the maximum and minimum temperatures. If you need a more accurate idea of the daily temperature, you can measure it every 2–3 hours. The duration of temperature measurement with a maximum thermometer is at least 10 minutes.
When performing thermometry, the patient must lie or sit.
Locations for measuring body temperature:
Armpits;
Oral cavity (under the tongue);
Inguinal folds (in children);
Rectum (weakened patients).
Care and monitoring of the patient after general anesthesia
The post-anesthesia period is no less important than the anesthesia itself. Most possible complications after anesthesia can be prevented by proper patient care and pedantic compliance with doctor's orders. A very important stage of the post-anesthesia period is transporting the patient from the operating room to the ward. It is safer and better for the patient if he is taken from the operating room to the ward on a bed. Repeated transfers from a table to a gurney, etc. can cause breathing problems, cardiac activity, vomiting, and unnecessary pain.
After anesthesia, the patient is placed in a warm bed on his back with his head turned or on his side (to prevent the tongue from retracting) for 4–5 hours without a pillow, covered with heating pads. The patient should not be woken up.
Immediately after surgery, it is advisable to place a rubber ice pack on the area of the surgical wound for 2 hours. The application of gravity and cold to the operated area leads to compression and narrowing of small blood vessels and prevents the accumulation of blood in the tissues of the surgical wound. Cold soothes pain, prevents a number of complications, and reduces metabolic processes, making it easier for tissues to tolerate circulatory failure caused by surgery. Until the patient wakes up and regains consciousness, the nurse should remain near him constantly, monitoring his general condition, appearance, blood pressure, pulse, and breathing.
Transporting the patient from the operating room. The delivery of the patient from the operating room to the recovery room is carried out under the guidance of an anesthesiologist or nurse in the recovery room. Care must be taken not to cause additional injury, not to displace the applied bandage, or to break the plaster cast. From the operating table the patient is transferred to a gurney and transported to the recovery room. The gurney with the stretcher is placed with the head end at a right angle to the foot end of the bed. The patient is picked up and transferred to the bed. The patient can also be placed in another position: the foot end of the stretcher is placed at the head end of the bed and the patient is transferred to the bed.
Preparing the room and bed. Currently, after particularly complex operations under general anesthesia, patients are placed in the intensive care unit for 2–4 days. Subsequently, depending on their condition, they are transferred to the postoperative or general ward. The ward for postoperative patients should not be large (maximum for 2–3 people). The ward must have a centralized oxygen supply and the entire set of instruments, devices and medications for resuscitation.
Typically, functional beds are used to give the patient a comfortable position. The bed is covered with clean linen, and oilcloth is placed under the sheet. Before putting the patient to bed, the bed is warmed with heating pads.
Caring for a patient who vomits after anesthesia
In the first 2–3 hours after anesthesia, the patient is not allowed to drink or eat.
Help with nausea and vomiting
Vomiting is a complex reflex act that leads to the eruption of the contents of the stomach and intestines through the mouth. In most cases, it is a protective reaction of the body aimed at removing toxic or irritating substances from it.
If the patient starts vomiting:
1. Sit the patient down, cover his chest with a towel or oilcloth, bring a clean tray, basin or bucket to his mouth, you can use vomit bags.
2. Remove dentures.
3. If the patient is weak or is prohibited from sitting, position the patient so that his head is lower than his body. Turn his head to the side so that the patient does not choke on vomit, and bring a tray or basin to the corner of his mouth. You can also place a towel folded several times or a diaper to protect the pillow and linen from contamination.
4. Stay near the patient while vomiting. Place the unconscious patient on his side, not on his back! It is necessary to insert a mouth dilator into his mouth so that during vomiting with his lips closed, aspiration of the vomit does not occur. After vomiting, immediately remove the container with vomit from the room so that a specific smell does not remain in the room. Let the patient rinse with warm water and wipe his mouth. In very weakened patients, each time after vomiting, it is necessary to wipe the oral cavity with a gauze cloth moistened with water or one of the disinfecting solutions (boric acid solution, light potassium permanganate solution, 2% sodium bicarbonate solution, etc. .).
Vomiting "coffee grounds" indicates gastric bleeding.
Anesthesia(pain relief) is a series of procedures designed to relieve the patient of pain. Anesthesia is performed by an anesthesiologist, but in some cases by a surgeon or dentist. The type of anesthesia is selected primarily depending on the type of operation (diagnostic procedure), the patient's health status and existing diseases.
Epidural anesthesia
Epidural anesthesia involves delivering an anesthetic into the epidural space using a thin polyethylene catheter with a diameter of approximately 1 mm. Epidural and spinal anesthesia belong to the so-called group. central blockades. This is a very effective technique that provides a deep and long-lasting block without the use of general anesthesia. Epidural anesthesia is also one of the most effective forms of pain treatment, including post-operative pain.
Epidural anesthesia is the most popular pain relief during childbirth. Its advantage is that the woman in labor does not feel painful contractions, so she can rest, calm down and concentrate on childbirth, and with a caesarean section the woman remains conscious and the pain after childbirth is reduced.
Indications for the use of epidural anesthesia
surgery on the lower extremities, especially if they are very painful, eg hip replacement, knee surgery;
operations on blood vessels - coronary artery bypass surgery of the thigh vessels, aortic aneurysm. Allows long-term treatment of postoperative pain, rapid re-operation if the first one fails, fights thrombus formation;
operations to remove varicose veins of the lower extremities;
abdominal surgery - usually together with weak general anesthesia;
major operations on the chest (thoracic surgery, i.e. lung surgery, cardiac surgery);
urological operations, especially in the area of the lower urinary tract;
combating postoperative pain;
Today, epidural anesthesia is the most advanced and effective way to combat pain after surgery or during childbirth.
Complications and contraindications for epidural anesthesia
Every anesthesia carries a risk of complications. Correct preparation of the patient and experience of the anesthesiologist will help to avoid them.
Contraindications to epidural anesthesia:
lack of patient consent;
infection at the puncture site - microorganisms can enter the cerebrospinal fluid;
bleeding disorders;
infection of the body;
some neurological diseases;
disturbances in the water-electrolyte balance of the body;
unstabilized arterial hypertension;
severe congenital heart defects;
unstabilized coronary heart disease;
serious changes in the vertebrae in the lumbar region.
Side effects of epidural anesthesia:
low blood pressure is a fairly common complication, but appropriate monitoring of the patient’s condition allows it to be avoided; The decrease in blood pressure is felt most strongly by patients in whom it is elevated;
back pain at the injection site; pass within 2-3 days;
“patchwork” pain relief - some areas of the skin may remain unpainful; in this case, the patient is given another portion of anesthetic or a strong analgesic, sometimes general anesthesia is used;
arrhythmia, including bradycardia;
nausea, vomiting;
delay and complication of urination;
point headache - appears due to puncture of the dura mater and leakage of cerebrospinal fluid into the epidural space;
hematoma in the area of injection of the anesthetic, with accompanying neurological disorders - in practice, a complication is very rare, but serious;
inflammation of the brain and spinal membranes.
Point headache should only occur during spinal anesthesia, since only in this case the anesthesiologist intentionally punctures the dura to inject anesthetic into the subdural space located behind the dura. When epidural anesthesia is performed correctly, headaches do not occur because the dura remains intact. Point headache occurs with varying frequency, more often in young people and women in labor; appears within 24-48 hours after anesthesia and lasts 2-3 days, after which it disappears on its own. The cause of pinpoint headache is the use of thick puncture needles - the thinner the needle, the less likely this complication is. Analgesics are used to treat point headaches. The patient must lie down. In some cases, an epidural patch is made from the patient's own blood. Some anesthesiologists recommend lying quietly for several hours after surgery and anesthesia.
