Consequences of general anesthesia for a 3-year-old child. Important information about anesthesia in children
Without anesthesia (general anesthesia) there would be no surgery, especially for children. Recently, general anesthesia in children has been used not only for complex surgical interventions, but also for a number of examinations, and even in the treatment of caries in dentistry. How justified is this approach? Most doctors say that it is quite reasonable. Indeed, often as a result of a psycho-emotional trauma caused by a pain reaction, a child develops persistent neurotic reactions (tics, night terrors, urinary incontinence).
Today, the concept of anesthesia is defined as a controlled state caused by medication, in which the patient is unconscious and has no reaction to pain.
Anesthesia, as a medical intervention, is a complex concept, it can include artificial respiration for the patient, muscle relaxation, intravenous drip administration of drugs, control and compensation of blood loss, antibiotic prophylaxis, prevention of postoperative nausea and vomiting, and so on. All these actions are aimed at ensuring that the patient safely undergoes surgery and “wakes up” after the operation without experiencing a state of discomfort. And of course, like any medical effect, anesthesia has its indications and contraindications.
The anesthesiologist is responsible for anesthesia. Before the operation, he studies the patient's medical history in detail, which helps to identify possible risk factors and suggest the most appropriate type of anesthesia.
Depending on the method of administration, anesthesia is inhalation, intravenous and intramuscular. And also according to the form of impact, it is divided into "large" and "small".
"Small" anesthesia is used for low-traumatic, short-term operations and manipulations (for example, removal of the appendix), as well as for various types of research, when it is necessary to turn off the child's consciousness for a short time. For this purpose, use:
Intramuscular anesthesia
Today it is rarely used, since the anesthesiologist does not have the opportunity to fully control its effect on the patient's body. In addition, the drug ketamine, intended for this type of anesthesia, seriously disrupts the processes of long-term memory, interfering with the full development of the child.Inhalation (hardware-mask) anesthesia
The child receives an anesthetic drug in the form of an inhaled mixture through the lungs with spontaneous breathing. Pain medications that are inhaled into the body are called inhalational anesthetics (halothane, isoflurane, sevoflurane)."Big" anesthesia- multicomponent effect on the body. It is used in operations of medium and high complexity, which are carried out with the obligatory shutdown of the patient's own breathing - it is replaced by breathing with the help of special devices. It includes the use of different groups of drugs (narcotic analgesics, drugs that temporarily relax skeletal muscles, hypnotics, local anesthetics, infusion solutions, blood products). Medicines are administered both intravenously and by inhalation. During the operation, the patient is artificially ventilated (ALV).
Leading experts admit that if 30 years ago the risk of complications from anesthesia reached seventy percent, today it is only one or two percent, and even less in leading clinics. Fatal outcomes due to the use of anesthesia, as a rule, are one in several thousand operations. In addition, the psychological profile of children makes it much easier for them to relate to what has already happened, they rarely remember any sensations associated with anesthesia.
However, many parents stubbornly believe that the use of anesthesia will negatively affect the future health of the child. Very often they compare their own feelings experienced earlier, after anesthesia. It must be understood that in children, due to the characteristics of the organism, general anesthesia proceeds somewhat differently. The intervention itself is usually much less than is the case with diseases in adults, and finally, completely new groups of medicines have appeared at the disposal of physicians today. All modern drugs have undergone numerous clinical trials - first in adult patients. And only after several years of safe use, they were allowed to be used in pediatric practice. The main feature of modern anesthetics is the absence of adverse reactions, rapid excretion from the body, and the predictability of the duration of the administered dose. Based on this, anesthesia is safe, has no long-term consequences for the health of the child and can be repeated many times.
Narcosis can be dangerous for children
Recently, more and more reports have appeared in foreign literature about negative effects of anesthesia in children in particular, that anesthesia can cause the development of cognitive disorders. Cognitive impairment refers to impaired memory, attention, thinking, and learning ability. In addition, scientists began to suggest that anesthesia transferred at an early age may be one of the causes of the development of the so-called attention deficit hyperactivity disorder.
The reason for conducting a number of modern studies was the statements of many parents that after undergoing anesthesia, their child became somewhat absent-minded, his memory deteriorated, school performance decreased, and in some cases even some previously acquired skills were lost.
Back in 2009, the American journal Anesthesiology published an article on the significance of the first anesthesia, in particular, the age of the child in which it was performed, in the occurrence of behavioral disorders and impaired intellectual development. The results of the study showed that cognitive disorders most often developed in children who underwent anesthesia before the age of 2 years, rather than at a later time. However, it should be noted that this study was retrospective, that is, it was done "post factum", so the scientists concluded that new studies are needed to confirm the results.
Time passed and just recently in a relatively recent issue of the American journal Neurotoxicology and Teratology (Neurotoxicology and Teratology, August 2011), an article appeared with a heated discussion of scientists about the potential harm of anesthesia on the brain of a growing child. Thus, the results of recent studies on primate cubs showed that already 8 hours after anesthesia with isoflurane (1%) and nitrous oxide (70%), a significant number of nerve cells (neurons) die in the primate brain. Although this was not found in a rodent study, however, given the great genetic similarity between primates and humans, it was concluded that anesthesia could potentially harm the human brain during its active development. The scientists concluded that avoiding anesthesia at a vulnerable stage of brain development in children would prevent neuronal damage. However, a clear answer to the question of what time frame includes the sensitive period of development of the child's brain has not been received.
In the same year (2011) in Vancouver, at the annual meeting of the International Society for the Study of Anesthesia, a number of reports were made regarding the safety of anesthesia in children. Dr. Randall Flick (Associate Professor, Department of Anesthesiology and Pediatrics, Mayo Clinic) presented the findings of a recent Mayo Clinic study on the potential negative effects of anesthesia in young children. The study showed that under the age of 4 years, prolonged exposure to anesthesia (120 minutes or more) increases the likelihood of postanesthesia cognitive disorders by 2 times. In this regard, the authors of the study consider it justified to postpone the planned surgical treatment until the age of four, on the unconditional condition that the postponement of the operation will not harm the health of the child.
All these new data, combined with early animal studies, have led to the start of additional studies that should help determine the mechanism of action of individual anesthetics on the child's brain, establish new guidelines for choosing safe anesthesia, and thus minimize all possible negative effects of anesthesia in children. .
Very often anesthesia scares people even more than the operation itself. They are afraid of the unknown, possible discomfort when falling asleep and waking up, and numerous talks about the consequences of anesthesia that are harmful to health. Especially if it's all about your child. What is modern anesthesia? And how safe is it for the child's body?
In most cases, we only know about anesthesia that the operation under its influence is painless. But in life it may happen that this knowledge is not enough, for example, if the issue of an operation for your child is decided. What do you need to know about anesthesia?
anesthesia, or general anesthesia, is a time-limited drug effect on the body, in which the patient is in an unconscious state when painkillers are administered to him, followed by the restoration of consciousness, without pain in the operation area. Anesthesia may include giving the patient artificial respiration, providing muscle relaxation, setting droppers to maintain the constancy of the internal environment of the body with the help of infusion solutions, control and compensation of blood loss, antibiotic prophylaxis, prevention of postoperative nausea and vomiting, and so on. All actions are aimed at ensuring that the patient undergoes surgery and "wakes up" after the operation, without experiencing a state of discomfort.
Types of anesthesia
Depending on the method of administration, anesthesia is inhalation, intravenous and intramuscular. The choice of anesthesia method lies with the anesthesiologist and depends on the patient's condition, on the type of surgical intervention, on the qualifications of the anesthesiologist and the surgeon, etc., because different general anesthesia can be prescribed for the same operation. The anesthesiologist can mix different types of anesthesia, achieving the ideal combination for a given patient.
Narcosis is conditionally divided into "small" and "large", it all depends on the number and combination of drugs of different groups.
The "small" anesthesia includes inhalation (hardware-mask) anesthesia and intramuscular anesthesia. With hardware-mask anesthesia, the child receives an anesthetic in the form of an inhalation mixture with spontaneous breathing. Painkillers administered by inhalation to the body are called inhalation anesthetics (Ftorotan, Isoflurane, Sevoflurane). This type of general anesthesia is used for low-traumatic, short-term operations and manipulations, as well as for various types of research, when it is necessary to turn off the child's consciousness for a short time. Currently, inhalation anesthesia is most often combined with local (regional) anesthesia, since it is not effective enough in the form of mononarcosis. Intramuscular anesthesia is now practically not used and is becoming a thing of the past, since the anesthesiologist absolutely cannot control the effect of this type of anesthesia on the patient's body. In addition, the drug, which is mainly used for intramuscular anesthesia - Ketamine - according to the latest data, is not so harmless to the patient: it turns off long-term memory for a long time (almost six months), interfering with full-fledged memory.
"Big" anesthesia is a multicomponent pharmacological effect on the body. It includes the use of such drug groups as narcotic analgesics (not to be confused with drugs), muscle relaxants (drugs that temporarily relax skeletal muscles), hypnotics, local anesthetics, a complex of infusion solutions and, if necessary, blood products. Medicines are administered both intravenously and inhaled through the lungs. The patient undergoes artificial lung ventilation (ALV) during the operation.
Are there any contraindications?
There are no contraindications to anesthesia, except for the refusal of the patient or his relatives from anesthesia. At the same time, many surgical interventions can be performed without anesthesia, under local anesthesia (pain relief). But when we talk about the patient's comfortable condition during the operation, when it is important to avoid psycho-emotional and physical stress, anesthesia is necessary, that is, the knowledge and skills of an anesthetist are needed. And it is not at all necessary that anesthesia in children is used only during operations. Anesthesia may be required for many diagnostic and therapeutic measures, where it is necessary to remove anxiety, turn off consciousness, enable the child not to remember unpleasant sensations, the absence of parents, a long forced position, a dentist with shiny instruments and a drill. Wherever a child's peace of mind is needed, an anesthesiologist is needed - a doctor whose task is to protect the patient from operational stress.
Before a planned operation, it is important to take into account the following point: if the child has a concomitant pathology, then it is desirable that the disease is not exacerbated. If a child has been ill with an acute respiratory viral infection (ARVI), then the recovery period is at least two weeks, and it is advisable not to carry out planned operations during this period of time, since the risk of postoperative complications increases significantly and breathing problems may occur during the operation, because a respiratory infection primarily affects the respiratory tract.
Before the operation, the anesthesiologist will definitely talk with you on abstract topics: where the child was born, how he was born, whether the vaccinations were made and when, how he grew up, how he developed, what he was sick with, whether he will examine the child, get acquainted with the medical history, scrupulously study all the tests . He will tell you what will happen to your child before the operation, during the operation and in the immediate postoperative period.
Some terminology
Premedication- psycho-emotional and drug preparation of the patient for the upcoming operation, begins a few days before surgery and ends immediately before the operation. The main task of premedication is to relieve fear, reduce the risk of developing allergic reactions, prepare the body for the upcoming stress, and calm the child. Medicines can be administered by mouth as a syrup, as a spray into the nose, intramuscularly, intravenously, and also in the form of microenemas.
Vein catheterization- placing a catheter in a peripheral or central vein for repeated administration of intravenous medications during surgery. This manipulation is performed before the operation.
Artificial lung ventilation (ALV)- a method of delivering oxygen to the lungs and further to all tissues of the body using a ventilator. During the operation, temporarily relaxing the skeletal muscles, which is necessary for intubation. Intubation- introduction of an incubation tube into the lumen of the trachea for artificial lung ventilation during surgery. This manipulation by the anesthetist is aimed at ensuring the delivery of oxygen to the lungs and protecting the patient's airways.
Infusion therapy- intravenous administration of sterile solutions to maintain the constancy of the water and electrolyte balance of the body of the volume of circulating blood through the vessels, to reduce the consequences of surgical blood loss.
Transfusion therapy- intravenous administration of drugs made from the patient's blood or donor's blood (erythrocyte mass, fresh frozen plasma, etc.) to compensate for irreparable blood loss. Transfusion therapy is an operation for the forced introduction of foreign matter into the body, it is used according to strict vital indications.
Regional (local) anesthesia- a method of anesthetizing a certain part of the body by bringing a solution of a local anesthetic (pain medication) to large nerve trunks. One of the options for regional anesthesia is epidural anesthesia, when a local anesthetic solution is injected into the paravertebral space. This is one of the most technically complex manipulations in anesthesiology. The simplest and most well-known local anesthetics are Novocaine and Lidocaine, and the modern, safe and longest acting one is Ropivacaine.
Preparing a child for anesthesia
The most important is the emotional sphere. It is not always necessary to tell the child about the upcoming operation. The exception is cases when the disease interferes with the child and he consciously wants to get rid of it.
The most unpleasant thing for parents is a hungry pause, i.e. six hours before anesthesia, you can’t feed a child, four hours you can’t even drink water, and water is understood as a transparent, non-carbonated liquid, odorless and tasteless. who is on, you can feed the last time four hours before anesthesia, and for a child who is on, this period is extended to six hours. The fasting pause will avoid such a complication during the onset of anesthesia as aspiration, i.e. entry of the contents of the stomach into the respiratory tract (this will be discussed later).
Do an enema before surgery or not? The patient's intestines must be emptied before the operation so that during the operation, under the influence of anesthesia, involuntary stool discharge does not occur. Moreover, this condition must be observed during operations on the intestines. Usually, three days before the operation, the patient is prescribed a diet that excludes meat products and foods containing vegetable fiber, sometimes a laxative is added to this on the day before the operation. In this case, an enema is not needed unless requested by the surgeon.
In the arsenal of the anesthesiologist, there are many devices to divert the attention of the child from the upcoming anesthesia. These are breathing bags with the image of different animals, and face masks with the smell of strawberries and oranges, these are ECG electrodes with the image of cute muzzles of favorite animals - that is, everything for a comfortable falling asleep for a child. But still, parents should be next to the child until he falls asleep. And the baby should wake up next to the parents (if the child is not transferred to the intensive care unit after the operation).
During the operation
After the child has fallen asleep, anesthesia deepens to the so-called "surgical stage", at which the surgeon begins the operation. At the end of the operation, the "strength" of anesthesia decreases, the child wakes up.
What happens to the child during the operation? He sleeps without experiencing any sensations, in particular pain. The condition of the child is assessed clinically by the anesthesiologist - by skin, visible mucous membranes, eyes, he listens to the lungs and heartbeat of the child, monitoring (observation) of the work of all vital organs and systems is used, if necessary, laboratory express tests are performed. Modern monitoring equipment allows you to track heart rate, blood pressure, respiratory rate, the content of oxygen, carbon dioxide, inhalation anesthetics in the inhaled and exhaled air, blood oxygen saturation in percentage terms, the degree of sleep depth and degree of pain relief, the level of muscle relaxation, the possibility of conducting a pain impulse along the nerve trunk and much, much more. The anesthetist conducts infusion and, if necessary, transfusion therapy, in addition to drugs for anesthesia, antibacterial, hemostatic, and antiemetic drugs are administered.
Getting out of anesthesia
The period of recovery from anesthesia lasts no more than 1.5-2 hours, while the drugs administered for anesthesia are in effect (not to be confused with the postoperative period, which lasts 7-10 days). Modern drugs can reduce the period of recovery from anesthesia to 15-20 minutes, however, according to the established tradition, the child should be under the supervision of an anesthetist for 2 hours after anesthesia. This period may be complicated by dizziness, nausea and vomiting, pain in the area of the postoperative wound. In children of the first year of life, the usual sleep and wakefulness pattern may be disturbed, which is restored within 1-2 weeks.
The tactics of modern anesthesiology and surgery dictate the early activation of the patient after surgery: get out of bed as early as possible, start drinking and eating as early as possible - within an hour after a short, low-traumatic, uncomplicated operation and within three to four hours after a more serious operation. If the child is transferred to the intensive care unit after the operation, then the resuscitator undertakes further monitoring of the child's condition, and continuity in the transfer of the patient from doctor to doctor is important here.
How and what to anesthetize after surgery? In our country, the appointment of painkillers is carried out by the attending surgeon. These can be narcotic analgesics (Promedol), non-narcotic analgesics (Tramal, Moradol, Analgin, Baralgin), non-steroidal anti-inflammatory drugs (Ketorol, Ketorolac, Ibuprofen) and antipyretics (Panadol, Nurofen).
Possible Complications
Modern anesthesiology seeks to minimize its pharmacological aggression by reducing the duration of action of drugs, their number, removing the drug from the body almost unchanged (Sevoflurane) or completely destroying it with enzymes of the body itself (Remifentanil). But, unfortunately, the risk still remains. Although it is minimal, complications are still possible.
The question is inevitable: what complications can arise during anesthesia and what consequences can they lead to?
Anaphylactic shock is an allergic reaction to the administration of drugs for anesthesia, transfusion of blood products, the administration of antibiotics, etc. The most formidable and unpredictable complication that can develop instantly can occur in response to the administration of any drug in any person. Occurs with a frequency of 1 per 10,000 anesthesia. It is characterized by a sharp decrease in blood pressure, disruption of the cardiovascular and respiratory systems. The consequences can be the most fatal. Unfortunately, this complication can be avoided only if the patient or his close relatives had a similar reaction to this drug earlier and he is simply excluded from anesthesia. An anaphylactic reaction is difficult and difficult to treat, the basis is hormonal drugs (for example, Adrenaline, Prednisolone, Dexamethasone).
Another formidable complication, which is almost impossible to prevent and prevent, is malignant hyperthermia - a condition in which, in response to the introduction of inhalation anesthetics and muscle relaxants, body temperature rises significantly (up to 43 ° C). Most often, this is an inborn predisposition. The consolation is that the development of malignant hyperthermia is an extremely rare situation, 1 in 100,000 general anesthesia.
Aspiration - the entry of stomach contents into the respiratory tract. The development of this complication is most often possible during emergency operations, if little time has passed since the last meal of the patient and the stomach has not completely emptied. In children, aspiration may occur during mask anesthesia with passive flow of stomach contents into the oral cavity. This complication threatens with the development of severe bilateral pneumonia and burns of the respiratory tract with acidic stomach contents.
Respiratory failure is a pathological condition that develops when there is a violation of oxygen delivery to the lungs and gas exchange in the lungs, in which the normal blood gas composition is not maintained. Modern monitoring equipment and careful observation help to avoid or diagnose this complication in time.
Cardiovascular insufficiency is a pathological condition in which the heart is unable to provide adequate blood supply to the organs. As an independent complication in children, it is extremely rare, most often as a result of other complications, such as anaphylactic shock, massive blood loss, and insufficient anesthesia. A complex of resuscitation measures is being carried out, followed by a long-term rehabilitation.
Mechanical damage - complications that can occur during the manipulations performed by the anesthetist, whether it be tracheal intubation, vein catheterization, gastric tube or urinary catheter placement. A more experienced anesthetist will experience fewer of these complications.
Modern drugs for anesthesia have undergone numerous preclinical and clinical trials - first in adult patients. And only after several years of safe use they are allowed in pediatric practice. The main feature of modern drugs for anesthesia is the absence of adverse reactions, rapid elimination from the body, predictability of the duration of action from the administered dose. Based on this, anesthesia is safe, has no long-term consequences and can be repeated repeatedly.
Without a doubt, the anesthesiologist has a huge responsibility for the life of the patient. Together with the surgeon, he seeks to help your child cope with the disease, sometimes single-handedly responsible for saving life.
06/26/2006 12:26:48 PM, MikhailIn general, a good informational article, it is a pity that hospitals do not provide such detailed information. In the first 9 months of life, my daughter was given about 10 anesthesias. There was a long anesthesia at the age of 3 days, then a lot of mass and intramuscular. Thank God there were no complications. Now she is 3 years old, develops normally, reads poetry, counts up to 10. But it’s still scary how all these anesthesias affected the mental state of the child. Almost nothing is said about this anywhere. As the saying goes, "saving the main thing, not to the smallest detail."
I had a proposal to our doctors, to give a certificate of all manipulations with children, so that parents can calmly read and understand, otherwise everything is on the go, fleeting phrases. Thank you for the article.
She herself underwent anesthesia twice and both times there was a feeling that she was very cold, woke up and began to chatter her teeth, and even a severe allergy began in the form of urticaria, the spots then increased and merged into a single whole (as I understand it, edema began). For some reason, the article does not say about such reactions of the body, maybe it is individual. And the head was in order for several months, the memory was noticeably reduced. And how does this affect children, and if a child has neurological problems, what are the consequences of anesthesia in such children?
04/13/2006 03:34:26 PM, RybkaMy child has had three anesthesias and I really want to know how this will affect his development and psyche. But no one can answer this question for me. Hoping to find out in this article. But only general phrases that there is nothing harmful in anesthesia. But in general, the article is useful for general development and for parents.
A note on management. Why is this article placed under the heading "Automobile"? Of course, some connection can be traced, but after a "meeting" with a car for anesthesia, it is usually quite problematic to prepare for anesthesia for three days ;-(
For some reason, the article, and most of the materials on this topic, do not talk about the effect of anesthesia on the human psyche, and even more so - the child. A lot of people say that anesthesia is not only "fell and woke up", but rather unpleasant "glitches" - flying along the corridor, different voices, a feeling of dying, etc. A familiar anesthetist said that these side effects do not occur when using the latest generation of drugs, such as recofol.
Mikhnina A.A.
With the development of modern society, the advent of high technologies and their penetration into medicine in particular, it has become popular to demand from medical procedures not only getting rid of the disease, but also a minimum of discomfort during their implementation. To eliminate pain and psychological stress associated with its expectation, modern medicine is ready to offer us the use of anesthesia in a variety of forms - from simple local anesthesia to deep medical sleep (narcosis). When carrying out extensive operations for the treatment of serious diseases, the need for anesthesia is obvious.
However, there are other situations: we want to give birth without pain, treat teeth without fear, and improve our appearance without discomfort. However, there are no completely safe medical interventions and drugs.
And here it is very important to measure the risk with the actual need. In addition to the risk of complications from the medical procedure itself or exacerbation of the disease due to intervention in the body, one must also not forget about the existing risk of adverse effects from anesthesia. It is especially important to remember this when it comes to our children, for whom we, the parents, make decisions regarding their health.
Most recently, on a parenting forum, I read a message from a mom who was doing her 1.5-year-old child an operation to dissect the hyoid frenulum under general anesthesia. To be honest, I was somewhat discouraged by such frivolity - anesthesia for a child, since, in my opinion, there is absolutely no need for anesthesia with such a low-traumatic and quick procedure. This is the same as donating blood from a finger under anesthesia! Will it come to your mind? At the same time, many participants in the discussion on this forum also did not see anything shameful in the described situation.
Actually, this case was the reason for conducting a certain study of the issue of the dangers of anesthesia. It became interesting to me whether it is so terrible and dangerous with its consequences, as one sometimes hears. Can anesthesia seriously harm a child?
For help in writing this note, I turned to specialists: a surgeon of the highest category, doctor of medical sciences, professor, employee of the Research Institute of Oncology. prof. N.N. Petrova Mikhnin A.E. and an anesthesiologist-resuscitator of the highest category, an employee of the resuscitation and intensive care unit for newborns at the children's city hospital No. 1 in St. Petersburg, Naumov D.Yu.
What is anesthesia, and why is it necessary?
Anesthesia is local and general. In the second case, it is customary to talk about anesthesia. With local anesthesia, the drug is injected into the tissues directly in the area of medical intervention or into the nerve endings responsible for conducting pain impulses from this area and adjacent (sometimes extensive) areas to the brain. However, it does not have a significant effect on the body as a whole (with the exception of a dangerous case of an allergic reaction to an analgesic). This is how we treat teeth, remove papillomas, and do piercings. Epidural or spinal anesthesia used in childbirth is also local.
General anesthesia (general anesthesia, anesthesia) is a condition caused by pharmacological agents and characterized by a controlled loss of consciousness and loss of sensitivity, suppression of reflex functions and reactions to external stimuli, which allows performing surgical interventions without dangerous consequences for the body and with complete amnesia of the period operations. The term "general anesthesia" more fully than the term "anesthesia", reflects the essence of the state that must be achieved for the safe performance of a surgical operation. The main thing is the elimination of the reaction to painful stimuli, and the oppression of consciousness is of lesser importance. (The common everyday expression "general anesthesia" is incorrect, the equivalent is "butter oil").
Mikhnin Alexander Evgenievich:“Quite right. The main task of general anesthesia is to prevent such a dangerous state of the body as pain shock, which can lead to death. It is important to qualitatively anesthetize the patient, while he may be conscious (depending on the type of operation performed). This effect is achieved, for example, with epidural anesthesia. Another important task of anesthesia is the complete relaxation of the muscles, facilitating access to the internal organs.
In a situation when it comes to treating a child, the goals of using anesthesia often change priority, and the need to turn off consciousness and immobilize a small patient may come to the fore.
Mikhnin Alexander Evgenievich:“It's all right. But, nevertheless, there is an important rule based on common sense, and which I, as a surgeon, always adhere to in relation to both adult and very young patients. Its essence is that the danger of anesthesia should not exceed the risk of medical manipulation, for which the patient is given anesthesia.
There is an opinion that anesthesia shortens life. However, I read a lot of materials on the websites of medical clinics that preparations for general anesthesia and the technology of their introduction into the body have changed significantly over a long time of their practical use (ether anesthesia was first used in 1846). In the course of clinical research, new drugs have been developed, and anesthesia has now become practically safe. What should be feared during general anesthesia?
Naumov Dmitry Yurievich:“Anesthesia by itself, of course, does not shorten life. Otherwise, many of the patients I know would have already died from its consequences, having been cured of the underlying disease and actually healthy people. The danger of anesthesia really lies, on the one hand, in the toxicity of the drugs used, which was especially important at the dawn of the era of the use of drug anesthesia, when a variety of substances were used, including dangerous ones with their long-term effects, the necessary level of analgesia and relaxation of the body was achieved due to the long-term maintenance of highly toxic drugs. doses of the drug in the patient's blood, and on the other hand, the risks are determined by the skill level of the anesthesiologist.
Most of the negative consequences of anesthesia are connected precisely with the human factor: firstly, and mainly, with the characteristics of the patient's body, which can give an unforeseen reaction, and one must be ready to cope with it; secondly, with the qualifications of the anesthesiologist himself, when he does not fully master modern technologies of combined anesthesia, did not keep track of some vital parameters of the organism of the patient under anesthesia or did not take the necessary measures to maintain them and correct the patient's condition in time, did not notice an allergy to some used medication in a timely manner (this, of course, is criminal extremes).
To date, for general anesthesia, modern drugs are used that do not have long-term effects and are quickly excreted from the body (for example, sevofluorane, remifentanil). Anesthesia is carried out by a combination of various substances and methods of their administration: intravenously, intramuscularly, inhalation, rectally, transnasally. The combined use of two or more drugs is carried out in order to reduce the dose, and, consequently, the toxicity of each of them, to provide all the necessary components of anesthesia due to drugs with selective properties without a deep violation of the central nervous system.
And yet we must not forget that even the safest drugs for providing anesthesia have a certain toxicity to the body. It is no coincidence that anesthesia is also called a medical coma.
This means that some consequences from the use of anesthesia, even modern and well-carried out by a competent and experienced anesthetist, can still be, as well as from any medical procedure. What are they, and with what degree of probability can one or another complication be obtained?
Naumov Dmitry Yurievich: “There are respiratory, cardiovascular and neurological complications of anesthesia, as well as anaphylactic shock.
Respiratory complications include respiratory arrest during the procedure of general anesthesia (apnea) or after recovery from anesthesia after the patient's breathing has fully recovered (recurarization), bronchiolospasm, laryngospasm.
The causes of this type of complications are very different: from mechanical injuries during the procedure of general anesthesia (injuries with a laryngoscope, rough intubation, ingress of various dust, foreign bodies and vomit into the respiratory tract, etc.) to an individual reaction to drugs and the general serious condition of the patient . An increased risk of such complications is in people suffering from diseases of the respiratory system. So, bronchiolospasm (total or partial) can occur in patients with tumors of the bronchi and lungs, bronchial asthma and prone to allergic reactions. Laryngospasm often develops with the accumulation of secretions in the larynx, in particular in patients with pulmonary tuberculosis. (author's note - The frequency of such complications averages 25% (mainly as a result of regurgitation of gastric contents) (1)).
Cardiovascular complications include arrhythmias, bradycardia, cardiac arrest. Most often, they occur with inadequate management of general anesthesia (overdose of certain drugs), insufficient prompt elimination of signs of hypoxia, untimely or ineffective resuscitation measures taken to correct the consequences of a surgical operation performed on the patient (severe irritation of the reflexogenic zones, massive blood loss, etc.) .
A risk factor here is also the presence of a patient's history of diseases of the cardiovascular system. The frequency of such complications averages 1:200 cases in the risk group.
Neurological complications include convulsions, muscle pain, trembling on awakening, hyperthermia, regurgitation, and vomiting. The causes of this type of complications are also a reaction to various medications used during surgery, concomitant diseases of the central nervous system (brain tumor, epilepsy, meningitis), and inadequate preoperative preparation. There is a category of patients in whom such an unpleasant and dangerous phenomenon during anesthesia as vomiting, which can lead to airway obstruction, bronchospasm and impaired lung ventilation and hypoxia during surgery, as well as pneumonia in the postoperative period, occurs without any visible reasons.
An extremely dangerous complication during operations performed both under anesthesia and under local anesthesia is anaphylactic shock, which is an individual allergic reaction of the body to medications, manifested by a sharp sudden decrease in blood pressure, disruption of the cardiovascular and respiratory systems. The allergen can be both the narcotic drugs themselves and the drugs and solutions used during the operation. Often this complication ends in death, because. an anaphylactic reaction is difficult and difficult to treat, the basis of therapy is hormonal drugs. (author's note - The frequency of such complications averages 1:10,000 cases. (2))
To exclude the possibility of such a reaction of the body, the anesthesiologist must very carefully study the patient's medical history and information about the presence of allergic reactions to medications, in particular, to various anesthetics, in order to prevent their use. In this case, it is extremely important that the patient himself provides reliable and complete information about himself when answering questions asked by doctors.
Also, it is important to note that anesthesia affects memory. With severe anesthesia, brain function associated with memory deteriorates. Sometimes it's irreversible."
Mikhnin Alexander Evgenievich: “For the safest possible operation and minimizing the risks associated with introducing the patient into a state of anesthesia, it is very important to have a high-quality preoperative preparation of the patient, which includes the correction of disturbances in the activity of various body systems, the removal of exacerbations of chronic diseases, adherence to diet and rest on the eve of the operation. In particular, 4-6 hours before the operation, under anesthesia, it is forbidden to eat and drink to eliminate the risk of vomiting. Compliance with the latter requirement largely lies on the patient's conscience, and he must understand the seriousness of the possible consequences of its violation. Preparation for surgery can take from 1 day. up to 1-2 weeks.
Which of the following complications can most often occur in children during anesthesia? Are there any features in comparison with adult patients?
Naumov Dmitry Yurievich: “The specifics of the use of general anesthesia in children is associated with the characteristics of the child's body. So, in newborns, sensitivity to certain drugs is reduced, so their concentration in the blood, compared to adult patients, is sometimes required to be 30% higher. This increases the likelihood of overdose and respiratory depression, and as a consequence of hypoxia. There are a number of drugs that are never used during anesthesia for children.
Oxygen is an integral part of any inhalation anesthesia. However, it is now well known that in preterm infants, hyperoxygenation (100% oxygen) can lead to severe vasoconstriction of immature retinal vessels, causing retrolental fibroplasia and blindness. In the central nervous system, it leads to a violation of thermoregulation and mental functions, a convulsive syndrome. In the lungs, hyperoxia causes inflammation of the airway mucosa and destruction of surfactant. All these features must be known and taken into account by the anesthesiologist.
In childhood, the thermoregulation system is imperfect, therefore, special attention must be paid to maintaining a constant body temperature and avoiding both hypothermia and overheating, which can lead to a very life-threatening complication - hyperthermia (the frequency of this complication is rare, approximately 1: 100,000 cases, the more dangerous it is if it suddenly arises.Usually anesthesiologists are not ready to face such a problem, because in their entire practice they usually did not encounter it). Also among the specific complications of general anesthesia in children are convulsions, the development of which may be associated with hypocalcemia, hypoxia, as well as subglottic edema of the larynx. In the presence of various chronic diseases, the likelihood of certain complications of anesthesia in children, as well as in adults, increases depending on the characteristics of these concomitant diseases. It's all individual."
Mikhnin Alexander Evgenievich: “For elderly and pediatric patients, preparation for surgery under anesthesia must necessarily include a psychological component and complete removal of preoperative emotional stress. In such patients, the nervous system is unstable, and the degree of psychogenic neurological disorders is high, which can cause complications of general anesthesia both from the CNS and the cardiovascular system. The constant presence and psychological support of close relatives for elderly patients and parents for pediatric patients in the period of preparation for surgery and immediately before anesthesia is very important.”
Thus, modern anesthesia is minimally toxic, highly effective and safe enough if it is performed by an experienced anesthesiologist. It can be carried out repeatedly without harm to the health of the patient, unless there are any complications. Their probability in modernly equipped clinics with highly qualified personnel is not so great. Nevertheless, there is always a place for the risk associated with the individual characteristics of each person, as well as the insufficient qualifications of the anesthesiologist, on which the vital activity of the patient’s body completely depends during the operation under anesthesia.
Here is a quote from one very sensible resource onarkoze.ru: “what is the probability of death from anesthesia in the Russian Federation? It is impossible to give an unambiguous answer to this question due to the lack of any plausible statistics. In our country, all the facts of death on the operating table are carefully hushed up and hidden.
By introducing your child into a state of drug-induced sleep, you completely trust his life to an anesthesiologist.
A friend of mine, a cosmetologist at a prestigious aesthetic medicine clinic, who often has to deal with people who prioritize their appearance, and therefore they often resort to the services of plastic surgeons, once said that, even being an adherent of a cult herself, beauty, does not deeply understand such a frivolous readiness of people to plunge into anesthesia without vital evidence. After all, there is always a chance of not getting out of it and dying. Moreover, she determined for herself this probability 50/50, which, of course, from the point of view of statistics is an exaggeration, but from the point of view of the common sense of each of us, perhaps not. After all, life is the most precious thing. Whether it is worth risking it without a clear need, even if the chance of dying is one in a million, everyone decides for himself.
Links:
1. Levichev Eduard Aleksandrovich, dissertation for the degree of candidate of medical sciences. in the specialty "Anesthesiology and Resuscitation" on the topic "Prevention of regurgitation and aspiration during general anesthesia in urgent patients", 2006 - p. 137
2. Vladimir Kochkin, Mom and Baby magazine, No. 2, 2006
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116 thoughts on “Anesthesia for a child”
Imagine the situation: the patient needs to undergo an operation, and pain relief as such does not exist. The patient has, say, an appendicitis, a displaced fracture, or a simple superficial abscess that needs to be opened and cleaned. And there is no anesthesia! Can you imagine yourself in the place of such a patient? Wouldn't want to, right?
But an adult patient, at least, can grit his teeth and endure (if there is no other way out). And the child - in any case. And therefore, it is not at all pathetic to say that the introduction of anesthesia led to a real revolution in medicine and gave a serious impetus to the development of surgery and other related disciplines.
What doctors didn’t come up with in the past in order to still perform a surgical intervention: they gave them alcohol and various narcotic potions, tied them with strong ropes, put a gag in their mouths, tried to use hypnosis and charms, hit the back of the head with a special hammer to “knock out” the patient for a while... And sometimes it really helped. In other cases, it sent the patient to the other world even before the intervention began. But there was no other choice.
Thomas Morton made mankind happy: on October 16, 1846, he first publicly performed successful anesthesia during an operation. And it changed the course of history. A new science has appeared - anesthesiology, which has developed rapidly and today has huge developments.
About local "anesthesia"
In fact, local "anesthesia" does not exist. Anesthesia is only general. Local anesthesia or anesthesia can be used. This is in terms of terminology. And speaking of childhood: almost all operations for children are performed under anesthesia, and you should not ask the doctor for local anesthesia for the child. Yes, it is possible to anesthetize locally and the child will not be hurt at all. But the stress that he will receive from what he sees will lead to worse consequences.
In addition, the child will not lie motionless on the operating table if he is conscious. And so there is a law in pediatrics: the child should not be present at his operation.
The anesthesiologist will take care of 3 main tasks, among many others: the child will not get sick, he will not get stress, his vegetative (automatic) functions (work of the heart, respiration, nervous system, etc.) will also not receive excessive impulses due to injuries and all vital signs will not jump.
Removal of adenoids under local anesthesia
Given the above, you need to understand that children are not recommended to carry out even minor surgical interventions without anesthesia. And this also applies to the adenoids. Local anesthesia will completely eliminate the pain, but the conscious child will be taken away from the mother, fixed (consider tied) and he will see the surgeon working with special instruments in his oral cavity. All this can have very negative psychological consequences in the future.
The pain itself is hard to bear at the moment, but is relatively easy to forget and does not create problems in the future.
In turn, stress may not be noticed at first, but it will manifest itself after a few months or even years. I often communicate with parents who bring their children to our hospital for such operations. And they still talk with horror about their experience in childhood, although more than 20-30 years have passed since then. In this regard, it is better to carry out even such unpleasant procedures as EGD, colonoscopy, etc. in a medical sleep. This also applies. Although here fellow dentists in many cases have learned to eliminate stress with various children's amusements and are relatively successful in doing without anesthesia.
However, in many cases, neither fun nor cartoons help. A light drug-induced sleep will help the child sleep, get medical treatment and go home in a good mood.
About MRI or CT examinations of children under anesthesia
In the vast majority of CT or MRI tomographs work covertly and such examinations are expensive. To obtain a high-quality image, the patient must lie still during the examination. Otherwise, the image will turn out to be of poor quality, it will be very difficult to make a correct diagnosis, and you will still pay money for the visit. And if a CT examination lasts an average of 3-5 minutes, then an MRI scan takes at least 20 minutes. A child of preschool age or with diseases of the central nervous system simply cannot lie motionless for so long. Medical sleep comes to the rescue. However, this is perhaps the biggest fear of parents before agreeing to a picture. But you should not be afraid.
Because what we do during such an examination, from a scientific point of view, is not anesthesia, but only sedation. That is, the dose and amount of drugs is much less than during the operation, because here we turn off only consciousness. The child is asleep, but all his reflexes are working. Even pain sensitivity is preserved. Short-term drugs are introduced: they are quickly and completely excreted from the body. The child wakes up immediately after the examination and after a few hours leads a normal life.
About the dangers of anesthesia for children
The anesthesia procedure already has a whole history of myths, prejudices and unjustified fears. But serious scientific studies show that general anesthesia is safe for children.
Some patients or their parents note temporary mood swings, mental lability, slight memory impairment and absent-mindedness after prolonged anesthesia. But all these side effects disappear within a few days or weeks (in some cases).
Thus, anesthesia has a more gentle effect on the body than the stress resulting from surgery.
About different types of anesthesia
To date, there are many ways to conduct anesthesia for children, even if they have various concomitant diseases. Anesthesia can be combined with local anesthesia, regional anesthesia, etc.
There are a number of drugs that can be used during anesthesia. They differ in their action and price. Sometimes parents ask for the “best” anesthesia for their child, without realizing what they want to get as a result. So, all official preparations enable the anesthesiologist to perform anesthesia and provide the child with adequate pain relief.
But expensive modern drugs are more quickly excreted from the body and have fewer side effects. Speaking superficially, in most cases, after such anesthesia, the child wakes up faster, does not feel hallucinations, starts drinking and eating faster and returns to an active lifestyle faster. But it is not always possible to use such drugs. Only an anesthesiologist can choose the right drugs, the amount and dose of drugs administered.
About anesthesiologists
In many developed countries of the world, anesthesiologists are among the highest paid doctors, and in the United States this profession is in first place in terms of wages among all professions. In fact, it is the most intelligent medical specialty.
In Ukraine, such specialists prepare patients for surgery, provide anesthesia and care in the early postoperative period. In addition, anesthesiologists provide intensive care for all patients treated in intensive care. And if any narrow specialist deals with pathologies of one or several types, the anesthesiologist must navigate in all.
If the patient gets worse in any department of the hospital, the anesthesiologist is called. If an ambulance brings a seriously ill patient to the hospital, the anesthesiologist will be the first to meet him.
If doctors from the maternity hospital meet children who come into this world, then anesthesiologists sometimes have to accompany them to another world. And all because they work with the most seriously ill patients.
About "came, gave an injection and left"
Very often people think this way about the work of an anesthesiologist in the operating room. But in fact, anesthesia for a doctor is an art. Each doctor has his own style in conducting anesthesia. During general anesthesia, many different drugs are administered. It is not only their dose that matters, but also the sequence and order of administration.
During anesthesia, blood loss occurs, blood pressure changes, breathing changes, allergic reactions appear, and other unforeseen side effects and complications. And the task of the anesthesiologist is to keep everything in order, to prevent imbalance and disaster.
Much depends on the work of the anesthesiologist: how well the child will come out of anesthesia, how his postoperative period will pass. Most often, patients learn a lot about their surgeon before trusting him, but know nothing about their anesthetist at all.
conclusions
Today, the development of medicine and anesthesiology, in particular, makes it possible to perform any surgical intervention, unpleasant procedure and manipulation with absolutely no pain and no stress. It is safe and has no long-term negative effects. But it is very important to trust the doctors you need to work with.
You can learn a lot about your doctors through the reviews of other patients. You can come, chat and ask all the necessary questions to the doctor before agreeing to cooperate with him. The law allows you to choose the hospital and the doctor who will perform the surgery and the doctor who will provide anesthesia. Trust will allow you to be more calm, and these days will pass easier, without significant stress and moral overwork.
Pavel Silkovsky,
pediatric anesthetist,
regional children's hospital, Rivne
