Local anesthesia: not painful and not scary. What effect does general and local anesthesia have on the body?

Local anesthesia (also known as local anesthesia) is the numbing of a specific area of ​​the body in various ways while keeping the patient conscious. Mainly used for minor operations or examinations.

Types of local anesthesia:

• regional (for example, with appendicitis, etc.);
• pudendal (during childbirth or after);
• according to Vishnevsky or case (various methods of application);
• infiltration (injections);
• application (using ointment, gel, etc.);
• superficial (on mucous membranes).

The choice of anesthesia depends on the disease, its severity and the general condition of the patient. It is successfully used in dentistry, ophthalmology, gynecology, gastroenterology, and in surgery for operations (opening boils, suturing wounds, abdominal operations - appendicitis, etc.).

Local anesthesia during surgery differs from general anesthesia by ease of use, a minimum of side effects, a rapid “departure” of the body from the drug and a low likelihood of any consequences after using the anesthetic.

Terminal anesthesia

One of the simplest types of local anesthesia, where the goal is to block receptors by cooling the tissue (rinsing, wetting). Widely used in examining the gastrointestinal tract, dentistry, and ophthalmology.

An anesthetic is moistened onto an area of ​​skin at the site of the operated surface. The effect of such anesthesia lasts from 15 minutes to 2.5 hours, depending on the chosen agent and its dose. The negative consequences from it are minimal.

Regional anesthesia

With this type of anesthesia, a blockade of the nerve plexuses and the nerves themselves in the area of ​​​​the operation is achieved. Regional anesthesia is divided into types:

• Conductor. Often used in dentistry. During conduction anesthesia, the drug is injected with a thin needle near the nerve ganglion or trunk of a peripheral nerve, or less often into the nerve itself. The anesthetic is injected slowly to avoid damaging the nerve or tissue. Contraindications for conduction anesthesia include childhood, inflammation in the area where the needle is inserted, and sensitivity to the drug.
• Epidural. The anesthetic is injected into the epidural space (the area along the spine) through a catheter. The medicine penetrates the roots and nerve endings of the spinal cord, blocking pain impulses. Used during childbirth or caesarean section, appendicitis, operations on the groin area, anesthesia of the chest or abdomen. But with appendicitis, this anesthesia takes time, which sometimes is not available.

Possible consequences, complications: decreased blood pressure, back pain, headache, sometimes intoxication.

• Spinal (spinal). The anesthetic is injected into the subarachnoid space of the spinal cord, the analgesic effect is triggered below the injection site. It is used in surgery for operations on the pelvic area, lower extremities, and appendicitis. Possible complications: decreased blood pressure, bradycardia, insufficient analgesic effect (in particular, with appendicitis). It all depends on how competently the procedure was carried out and what drug was selected. Also, in case of appendicitis, local anesthesia may be contraindicated (in case of peritonitis).

Note: sometimes, instead of using general anesthesia for appendicitis in the initial stage, laparoscopic surgery is possible.

Contraindications for spinal anesthesia: skin diseases at the injection site, arrhythmia, patient refusal, increased intracranial pressure. Complications – meningitis, transverse myelitis, etc.

Infiltration anesthesia

Typically, infiltration anesthesia is used in maxillofacial surgery and dentistry, sometimes for acute appendicitis. When the drug is injected into the soft tissues or periosteum, receptors and small nerves are blocked, after which, for example, teeth are removed absolutely painlessly for the patient. Infiltration anesthesia involves the following methods:

1. direct: the drug is injected into the area required for surgical intervention;
2. indirect: involves the same injection of anesthetic, but into deeper layers of tissue, covering areas adjacent to the operated area.

This type of anesthesia is good because it lasts for about an hour, the effect is achieved quickly, and the solution does not contain a large amount of painkiller. Complications, consequences – rarely allergic reactions to the drug.

Anesthesia according to A. V. Vishnevsky (case)

This is also local infiltration anesthesia. The anesthetic solution (0.25% novocaine) directly begins to act on the nerve fibers, which gives an analgesic effect.

How anesthesia is carried out according to Vishnevsky: a tourniquet is tightened above the operated area, then a solution is injected under pressure in the form of tight novocaine infiltrates until a “lemon peel” appears on top of the skin. Infiltrates “creep” and gradually merge with each other, filling the fascial sheaths. This is how the anesthetic solution begins to affect the nerve fibers. Vishnevsky himself called such anesthesia “the method of creeping infiltration.”

Case anesthesia differs from other types in that there is a constant alternation of a syringe and a scalpel, where the anesthetic is always one step ahead of the knife. In other words, an anesthetic is injected and a shallow incision is made. You need to penetrate deeper - everything repeats itself.

The Vishnevsky method in surgery is used both for minor operations (opening wounds, ulcers) and for serious ones (on the thyroid gland, sometimes with uncomplicated appendicitis, amputation of limbs and other complex operations that cannot be performed on people with a contraindication to general anesthesia). Contraindications: intolerance to novocaine, dysfunction of the liver, kidneys, respiratory or cardiovascular systems.

Pudendal anesthesia

Used in obstetrics for suturing damaged soft tissues after childbirth. It is done by inserting a needle 7-8 cm deep on both sides between the posterior commissure and the ischial tuberosity. Together with infiltration it gives an even greater effect, so instead of general anesthesia in such cases, operations have long been performed under local anesthesia.

Application anesthesia

The anesthetic drug is applied to the surface of the skin or mucous membrane without the use of injections. Ointment (often Anestezin ointment), gel, cream, aerosol - this set of anesthetics gives the doctor a choice of which painkiller to use. Disadvantages of topical anesthesia: it does not have a deep effect (only 2-3 mm in depth).

It is used to ensure painlessness of subsequent injections (especially in dentistry). It is done at the request of patients who are afraid of pain: a gel (ointment) is applied to the gums or the skin or mucous membrane is sprayed with an aerosol. When the anesthetic takes effect, a deeper anesthetic injection is given. A side effect of topical anesthesia is a possible allergic reaction to an aerosol, ointment, gel, cream, etc. In this case, other methods are necessary.

Anesthesia for blepharoplasty

Local anesthesia is also used for some plastic surgery operations. For example, with blepharoplasty - correction of the upper or lower eyelid. Before correction, the patient is first given a sedative intravenously, which dulls the perception of what is happening during the operation. Next, injections are made around the eyes at the points marked by the surgeon and surgery is performed. After the operation, decongestant ointment is recommended for the eyelids.

For laser blepharoplasty (eyelid smoothing), surface anesthesia is also used: ointment (gel) is applied to the eyelids and treated with laser. At the end, burn ointment or antibiotic ointment is applied.

The patient may also request general anesthesia for blepharoplasty if he experiences a whole set of negative emotions and fear of the upcoming operation. But if possible, it is better to do it under local anesthesia. Contraindications for such an operation are diabetes, cancer, poor blood clotting.

Anesthetic drugs

Local anesthetic drugs are divided into types:

1. Esters. Novocaine, dicaine, chloroprocaine and others. They must be administered carefully: side effects are likely (Quincke's edema, weakness, vomiting, dizziness). Complications are possible mainly local: hematoma, burning, inflammation.
2. Amides. Articaine, lidocaine, trimecaine, etc. These types of drugs have virtually no side effects. Consequences and complications are practically excluded here, although a decrease in pressure or disorders of the central nervous system are possible only in case of an overdose.

One of the most common anesthetics is lidocaine. The drug is effective, long-acting, successfully used in surgery, but consequences and complications from it are possible. Their types:

• rarely - a reaction to lidocaine in the form of a rash;
• swelling;
• difficulty breathing;
• rapid pulse;
• conjunctivitis, runny nose;
• dizziness;
• vomiting, nausea;
• visual impairment;
• Quincke's edema.

Indications for local anesthesia

If it is necessary to perform a minor operation, doctors often advise solving the problem under local anesthesia in order to prevent some negative consequences. But there is also a whole set of specific indications for it:

• The operation is minor and can be performed under local anesthesia;
• patient refusal of general anesthesia;
• people (usually elderly) with diseases for which general anesthesia is contraindicated.

Contraindications

There are reasons when you cannot operate with local anesthesia (negative consequences and complications may occur). Types of contraindications:

• internal bleeding;
• drug intolerance;
• scars, skin diseases that impede infiltration;
• age under 10 years;
• mental disorders.

Under such conditions, patients are indicated exclusively for general anesthesia.

Choosing a pain relief method

An anesthesiologist is responsible for the anesthesia process. He, together with the surgeon and the patient, decides what type of anesthesia will be used for each patient individually.

The choice of anesthesia method for a particular surgical procedure is influenced by many factors. Firstly, of course, the anesthesiologist takes into account the scope of the intervention planned by the surgeon. It is clear that now no one performs appendicitis removal under local anesthesia, but the removal of a mole, for example, does not require deep medicated sleep.

Secondly, the choice of anesthesia method is influenced by the patient’s condition. If the patient is in serious condition and any complications of surgery or anesthesia are expected,

Thirdly, the anesthesiologist takes into account the experience and qualifications of the surgeon in order to know approximately what direction the operation will take. In addition, the anesthesiologist, if given the opportunity to choose one or another method of pain relief, will always choose the one that he himself is better at.

If the situation allows, the patient can choose the method of anesthesia. For example, during a caesarean section, a woman may choose spinal anesthesia in order to be conscious when her baby is born, while other women prefer to fall asleep in order to more easily endure this period of excitement.

What you need to know if you are undergoing local anesthesia or anesthesia

It is very important for the patient to establish contact with the anesthesiologist. Carrying out his instructions for the patient and correct patient behavior greatly facilitates the process of pain relief and improves the prospects for treatment.

Before the operation, the doctor will ask you about previous surgical interventions, so try in advance, if possible, to tell in chronological order what operations were performed and for what reason. What type of anesthesia was used and how did you tolerate it?

Before surgery, remember the diseases you have had throughout your life. Don't forget to mention any chronic diseases you have at the time of surgery.

If you are taking any medications, tell your doctor their name and, if possible, their dosage.

The doctor will ask you about the blood pressure numbers that are usually typical for you.

In addition to all of the above, the anesthesiologist may ask additional questions and order additional tests in order to finally decide on the choice of pain relief method.

Local anesthesia

What is it: Local anesthesia usually does not require the presence of an anesthesiologist. Surgeons are fluent in this anesthesia technique. The area of ​​the body where the intervention will be performed is anesthetized layer by layer with a solution of local anesthetic.

When used: usually for minor operations, for example, removal of a mole, papilloma, surgery for a non-strangulated hernia, elimination of phimosis or testicular hydrocele

What the patient needs to know: with local anesthesia there is always a risk of insufficient pain relief, but often patients, especially impressionable individuals, already in anticipation of pain, say that they feel everything that the surgeon does, although in fact, if you distract the patient and pinch the skin, where the operation will be performed, he will not even feel it.

If you feel any discomfort or pain, do not panic. Ask your doctor to stop for a while and add pain relief. A tactful approach to a health care worker is a guarantee of courteous treatment of the patient.

Spinal anesthesia

What is it: during spinal anesthesia, a local anesthetic solution is injected directly into the space between the membranes of the spinal cord. This is done under local anesthesia of the skin and underlying tissues in the lumbar region, so that the patient during spinal anesthesia feels only one injection, like dental anesthesia. After intraspinal administration of the anesthetic, the lower torso and lower extremities lose pain sensitivity.

When used: spinal anesthesia is successfully used during operations for varicose veins of the legs, during surgical interventions in urology, gynecology, and traumatology. The attitude of anesthesiologists and obstetricians-gynecologists towards pain relief during labor using spinal anesthesia is ambiguous.

What the patient needs to know: After a standard interview, the anesthesiologist asks the patient to lie on his side with his legs adducted to his stomach or, more often, to sit on the operating table with his back arched, like a cat. It is very important to maintain the given position, as this is necessary for the correct progress of the procedure. Spinal anesthesia with good local anesthesia is almost painless.

Epidural anesthesia

What is it: with epidural anesthesia, a catheter is inserted into the space between the spinal cord and the spinal canal - a thin tube through which a local anesthetic solution and even narcotic painkillers can be injected.

When used: In Western countries, epidural anesthesia is used to relieve pain during labor. In our country, this method of labor pain relief has not yet become widespread. Typically, this type of anesthesia is used for long-term gynecological or urological operations.

What the patient needs to know: epidural anesthesia is carried out after a standard interview and examination of the patient, during which the absence or presence of contraindications to this type of anesthesia is determined. After inserting the catheter, the end through which medications will be administered is usually placed on the patient's shoulder for convenience. As needed, the doctor will be able to add the necessary medications.

Mask anesthesia

What is it: sleep during anesthesia is maintained using a special gas, which is supplied through a mask applied directly to the patient’s face.

When used: for surgical interventions that take a relatively short time, for example, reduction of a fracture or dislocation, opening of a subcutaneous abscess.

What the patient needs to know: during mask anesthesia, it is important to work harmoniously with the doctor, breathe as he asks, follow the commands he says, and answer the questions asked by the doctor. With adequate contact between the anesthesiologist and the patient, mask anesthesia allows you to quickly put the patient to sleep and also quickly wake him up.

Intravenous anesthesia

What is it: drugs that cause pain relief and induce a state of medicated sleep are injected into a vein. This also allows you to most often achieve a quick effect.

When to use: Intravenous anesthesia can be used for various operations. Often, intravenous anesthesia as the only method of pain relief is used to terminate pregnancy, during hysteroscopy, in so-called “minor” surgery, and during some urological operations.

What the patient needs to know: Since all drugs that provide pain relief will be injected into a vein, it is imperative to discuss with the doctor any allergic reactions to any substances in the past.

Multicomponent general anesthesia with muscle relaxation

What is it: this anesthesia is called multicomponent because with this type of anesthesia, drugs for pain relief and sleep are administered both intravenously and in the form of gases through the airways. This allows you to achieve the most adequate pain relief.

When used: this type of anesthesia is absolutely indicated for patients with severe pathology. In addition, all “major” operations are performed only under multicomponent anesthesia. Currently, under this type of anesthesia, they operate on the organs of the abdominal cavity, chest, and carry out long-term operations on the organs of the retroperitoneal space. If the patient does not want to be conscious during the operation, this anesthesia can be used at his request and in the absence of contraindications.

What the patient needs to know: the survey conducted by the anesthesiologist must be approached very responsibly. Do not hide any information regarding your health from your doctor. It is important to follow the doctor’s commands and respond adequately to them. After such general anesthesia, nausea and slight dizziness are possible. Any concerns should be reported to your doctor. After the operation, the anesthesiologist, together with the surgeon, will make the necessary appointments. You are prohibited from eating or drinking for two hours after surgery.

Drugs used:

Local - anesthesia, achieved by the action of an anesthetic substance on the nerve endings and trunks at the site of surgery.

Local anesthesia is typically used in outpatient settings for minor surgeries or diagnostic tests. Local anesthesia is used if there are contraindications to general anesthesia (anesthesia).

Methods of local anesthesia.

Superficial anesthesia involves applying anesthetics to the skin or mucous membranes and cooling. For this, chloroethyl and local anesthetic substances are used (1-5% solutions of cocaine, 10% solution of novocaine, 0.25-3% solutions of dicaine, 2-5% solutions of lidocaine and trimecaine and others).

Infiltration anesthesia. With a thin needle, a 0.25-0.5% solution of novocaine (or other more modern anesthetics) is injected into the soft tissues, resulting in the tissue in the area of ​​​​operation becoming saturated with a solution of local anesthetic and blocking the conduction of nerve impulses. With infiltration anesthesia, not only pain relief is achieved, but also another goal - hydraulic tissue preparation, which greatly facilitates the surgeon’s manipulations and reduces blood loss.

Regional anesthesia - the anesthetic is injected in close proximity to the nerve trunk.

Types of regional anesthesia:
Conduction - an anesthetic is injected near a nerve ganglion, nerve plexus or peripheral nerve trunk (for example, during tooth extraction).
Spinal (synonyms: lumbar, subdural anesthesia, subarachnoid anesthesia) is based on the introduction of an anesthetic into the subarachnoid space of the spinal cord. In this case, the sensitivity and function of organs receiving innervation below the injection site are temporarily lost. Similar anesthesia is used for operations on the stomach, intestines, liver and bile ducts, spleen, pelvic organs, and lower extremities. Contraindications to spinal anesthesia: shock, severe, low blood pressure, severe pathology of internal organs, inflammatory skin diseases at the site of the intended injection of the drug, spinal deformities, etc.
Epidural - anesthetics (lidocaine, bupivacaine, ropivacaine) are injected into the epidural space of the spine through a special catheter. Such anesthesia is practically safely used for analgesia of the chest, abdomen, groin area and legs, and is often used during childbirth. The advantage is the use of very small doses of anesthetics, rare side effects (nausea, decreased blood pressure, etc.)
Intravascular - intravenous anesthesia, which is used for operations on the limbs, when the anesthetic is injected into the limb on which a hemostatic tourniquet is applied. A type of intravascular anesthesia is.

Contraindications to local anesthesia:
- intolerance to local anesthetics;
- mental disorders of the patient;
- tissue damage (rough scars, severe inflammation that prevents the implementation of infiltration anesthesia, bleeding).

Local anesthesia begins with (preparatory treatment, when the patient is injected with a 1-2% solution of promedol, 0.1% solution of atropine, 0.25% solution of droperidol or tranquilizers.

Complications of local anesthesia are extremely rare. There may be: agitation, hand tremors, allergic reactions, pallor, sweating, hypotension, decreased blood pressure, etc. A preliminary conversation with the patient (clarification of drug intolerance), careful adherence to the dosage and anesthesia technique helps to avoid complications.

Intravenous anesthesia.
Intravenous administration of drugs provides physiological sleep and good pain relief, eliminates feelings and fear. Such anesthesia is used for short, low-traumatic operations to ensure maximum patient comfort. Sometimes intravenous anesthesia is part of complex anesthesia (including masking while maintaining spontaneous breathing or transferring to artificial ventilation).

Local anesthesia– a science that studies methods of protecting the body from the effects of surgical trauma by influencing the peripheral structures of the nervous system. In this case, the nerve fibers conducting pain (nociceptive) impulses can be blocked both directly in the area of ​​​​the operation (terminal, infiltration anesthesia), and on the way to the spinal cord - regional anesthesia (conductor, epidural and spinal anesthesia), at the level of the spinal roots brain Intraosseous and intravenous regional anesthesia are currently used extremely rarely. These two methods are similar in their essence and method of execution. They can be used for operations on the limbs. A tourniquet is applied to the limb, and an anesthetic solution is injected either intravenously or into bones with a spongy structure (femoral, humeral or tibial condyles, individual bones of the foot or hand). For intraosseous administration, special needles with a mandrel are used. Blockade of pain impulses can be caused not only by pharmacological substances, but also by physical factors:

• Cold (surface freezing using chloroethyl).
• Electroanalgesia.
• Electroacupuncture.

General anesthesia(synonymous with general anesthesia) is a condition caused by pharmacological agents and characterized by loss of consciousness, suppression of reflex functions and reactions to external stimuli, which allows surgical interventions to be performed without dangerous consequences for the body and with complete amnesia during the operation. The term “general anesthesia” more fully than the term “anesthesia” reflects the essence of the state that must be achieved to safely perform a surgical operation. In this case, the main thing is to eliminate the reaction to painful stimuli, and depression of consciousness is of less importance. In addition, the concept of “general anesthesia” is more comprehensive, since it also includes combined methods.

History of the development of local and general anesthesia

Opened at the beginning of the 19th century. effective methods of surgical anesthesia were preceded by a centuries-old period of ineffective searches for means and methods of eliminating the excruciating feeling of pain that occurs during injuries, operations and diseases.

Real prerequisites for the development of effective methods of pain relief began to take shape at the end of the 18th century. Among the many discoveries of that period was Hickman's study in 1824 of the narcotic effects of nitrous oxide, diethyl ether and carbon dioxide, he wrote: “The destruction of sensitivity is possible through the methodical inhalation of known gases and thus the most dangerous operations can be performed painlessly.”

The development of local anesthesia was prompted by the introduction of the syringe into medical practice (Wood, Pravets, 1845) and the discovery of the local anesthetic properties of cocaine. In 1905, Eingor studied the chemical structure of cocaine and synthesized novocaine. In 1923–1928 A.V. Vishnevsky created an original method of local anesthesia with novocaine, which became widespread in Russia and abroad. After novocaine was synthesized, which is several times less toxic than cocaine, the possibility of using infiltration and conduction anesthesia increased significantly. Rapidly accumulating experience has shown that under local anesthesia it is possible to perform not only small, but also medium-sized and complex operations, including almost all interventions on the abdominal organs.

In the development and promotion of conduction anesthesia, much credit goes to the famous domestic surgeon V.F. Voino-Yasenetsky, who studied the method for many years and presented the main results of his work in 1915 in his doctoral dissertation. In the 20–30s, differences in the approach to anesthesiological support for operations of domestic and foreign surgeons clearly emerged. While local infiltration anesthesia has become the predominant method in our country, surgeons in Western Europe and the United States for medium and large volume operations preferred general anesthesia, for which specially trained medical personnel were involved. These features in the approach to the choice of anesthesia remain to this day. October 16, 1846. On this day, at Massachusetts General Hospital, dentist William P. Morton euthanized a young man undergoing surgery for a submandibular vascular tumor by surgeon John C. Warren with sulfuric ether. During the operation, the patient was unconscious, did not respond to pain, and after the end of the intervention he began to wake up. It was then that Warren uttered his famous phrase: Gentlemen, this is not a trick!

The positive experience of the participation of anesthesiologists in the provision of resuscitation care was so convincing that on August 19, 1969, the Ministry of Health issued order No. 605 “On improving anesthesiology and resuscitation services in the country,” in accordance with which anesthesiology departments were transformed into anesthesiology and resuscitation departments , and anesthesiologists became anesthesiologists-resuscitators.

Types and methods of local and general anesthesia.

Types of local anesthesia:
a) superficial (terminal),
b) infiltration,
c) regional (conductive). stem, plexus, intraosseous, intravenous, intra-arterial, ganglion (zpidural and subarachnoid anesthesia),
d) novocaine blockades.

1. Terminal anesthesia. The simplest method of local anesthesia. At the same time, Dicaine and Pyromecaine are currently used. Intended for certain operations on mucous membranes and for carrying out certain diagnostic procedures, for example in ophthalmology, otorhinolaryngology, and in the study of the gastrointestinal tract. The anesthetic solution is applied to the mucous membranes by lubrication, instillation, and spraying. In recent years, when performing terminal anesthesia, preference is given to less toxic and fairly effective drugs of the amide group, in particular lidocaine, trimecaine, using 5%-10% solutions.

2. Local infiltration anesthesia. The method of infiltration anesthesia, the creeping infiltrate method, using a 0.25% solution of novocaine or trimecaine, has become widespread in surgical practice over the last 60-70 years. This method was developed at the beginning of the 20th century. Its peculiarity is that after anesthesia of the skin and subcutaneous fatty tissue, the anesthetic is injected in large quantities into the corresponding fascial spaces in the area of ​​​​the operation. In this way, a tight infiltrate is formed, which, due to the high hydrostatic pressure in it, spreads over a considerable distance along the interfascial channels, washing the nerves and vessels passing through them. The low concentration of the solution and its removal as it flows into the wound virtually eliminates the risk of intoxication, despite the large volume of the drug.

It should be noted that infiltration anesthesia should be used in purulent surgery extremely carefully (according to strict indications) due to violations of aseptic norms!, and in oncological practice, ablastic norms!

Using low concentrated anesthetic solutions, 0.25%-0.5% solutions of novocaine or lidocaine are used, while during anesthesia it is safe to use up to 200–400 ml of solution (up to 1 g of dry matter).

Tight infiltration method. In order for the anesthetic to access all receptors, it is necessary to infiltrate the tissue, forming a creeping infiltrate along the course of the upcoming incision, thus only the first injection is painful. Layering, when the skin under the influence of an anesthetic becomes like a “lemon peel”, then the drug is injected into the subcutaneous fat, fascia, muscles, etc. It is important to consider that the fascia is an obstacle to the spread of the anesthetic.

3. Conduction anesthesia or (regional). Conduction is called regional, plexus, epidural and spinal anesthesia, achieved by applying local anesthetic to the nerve plexus. Regional anesthesia is technically more difficult than infiltration anesthesia. It requires precise knowledge of the anatomical and topographical location of the nerve conductor and good practical skills. A feature of conduction anesthesia is the gradual onset of its action (in contrast to infiltration), while first of all anesthesia is achieved in the proximal parts, and then in the distal ones, which is due to the peculiarity of the structure of the nerve fibers.

The main anesthetics for conduction anesthesia: novocaine, lidocaine, trimecaine, bupivocaine.

Small volumes and fairly high concentrations are used (for novocaine and lidocaine, trimecaine - 1-2% solutions, for bupivocaine 0.5-0.75%). The maximum single dose for these anesthetics with the addition of adrenaline (1:200,000 and no more, to avoid tissue necrosis) is 1000 mg, without adrenaline - 600. The local anesthetic is usually administered perineurally in areas specific for each nerve trunk. The effectiveness and safety of conduction anesthesia largely depends on the accuracy of compliance with the general rules of its implementation and on knowledge of the location of the nerve trunks. Endoneural injections should be avoided, as this is fraught with the development of severe neuritis, as well as intravascular injection (risk of general toxic reactions).

Combined methods of pain relief play an important role in modern anesthesiology. The most common combinations are:

Regional conduction anesthesia + intravenous sedation therapy.
(Sedation)
Epidural anesthesia + endotrachial anesthesia.

Effect on the central nervous system: Pharmacodynamic anesthesia (the effect is achieved by the action of pharmacological substances).

By method of drug administration:
Inhalation anesthesia– administration of drugs is carried out through the respiratory tract. Depending on the method of gas administration, mask and endotrachial inhalation anesthesia are distinguished. Non-inhalation anesthesia - drugs are administered not through the respiratory tract, but intravenously (in the vast majority of cases) or intramuscularly.

By the number of drugs used:
Mononarcosis– use of one drug.
Mixed anesthesia– simultaneous use of two or more drugs.
Combined anesthesia - the use of various narcotic drugs depending on the need (muscle relaxants, analgesics, ganglion blockers).

For use at different stages of the operation:
Introductory– short-term, without an excitation phase, used to reduce the time of falling asleep and to save narcotic substances.
Supporting (main) applies throughout the entire operation.
Basic– superficial, in which drugs are administered that reduce the consumption of the main product.

Types and methods of general anesthesia

Today there are the following types of general anesthesia.
Inhalation(by inhalation through a face mask), (endotrachial with or without the use of muscle relaxants);
Non-inhalation– intravenous (through an intravenous catheter);
Combined.

General anesthesia should mean targeted measures of medication or hardware aimed at preventing or weakening certain general pathophysiological reactions caused by surgical trauma or surgical disease.

Mask or inhalation type of general anesthesia– the most common type of anesthesia. It is achieved by introducing gaseous narcotic substances into the body. Actually, only that method can be called inhalation when the patient inhales the drugs while maintaining spontaneous (independent) breathing. The entry of inhalational anesthetics into the blood and their distribution in tissues depends on the condition of the lungs and the blood circulation in general.

In this case, it is customary to distinguish between two phases: pulmonary and circulatory. Of particular importance is the ability of the anesthetic to dissolve in the blood. The time of induction of anesthesia and the rate of awakening depend on the solubility coefficient. As can be seen from the statistical data, cyclopropane and nitrous oxide have the lowest solubility coefficient, therefore they are absorbed in the blood in minimal quantities and quickly give a narcotic effect, awakening also occurs quickly. Anesthetics with a high solubility coefficient (methoxyflurane, diethyl ether, chloroform, etc.) slowly saturate the body tissues and therefore cause a prolonged induction with an increase in the period of awakening.

Features of the technique of masked general anesthesia and the clinical course are largely determined by the pharmacodynamics of the drugs used. Inhalational anesthetics, depending on their physical state, are divided into two groups - liquid and gaseous. This group includes ether, chloroform, fluorothane, methoxyflurane, ethane, trichlorethylene.

Endotracheal method of general anesthesia. The endotracheal method best meets the requirements of modern multicomponent anesthesia. For the first time, the endotracheal method of anesthesia with ether was used in an experiment in 1847 by N. I. Pirogov. The first laryngoscope to facilitate tracheal intubation and laryngological practice was invented in 1855 by M. Garcia.

Currently, the endotracheal method of anesthesia is the main one in most areas of surgery. The widespread use of endotracheal general anesthesia is associated with its following advantages:

1. Ensuring free patency of the respiratory tract, regardless of the surgical position of the patient, the possibility of systematic aspiration of bronchial mucous secretions and pathological secretions from the respiratory tract, reliable isolation of the patient’s gastrointestinal tract from the respiratory tract, which prevents aspiration during anesthesia and surgery with the development of severe respiratory damage paths with aggressive gastric contents (Mendelssohn syndrome)

2. Optimal conditions for mechanical ventilation, reducing dead space, which ensures adequate gas exchange, oxygen transport and its utilization by the patient’s organs and tissues with stable hemodynamics. 3.

The use of muscle relaxants, which allows the patient to operate under conditions of complete immobilization and superficial anesthesia, which in most cases eliminates the toxic effect of some anesthetics.

The disadvantages of the endotracheal method include its relative complexity.

Muscle relaxants(curare-like substances) are used to relax muscles during anesthesia, which makes it possible to reduce the dose of anesthetic and the depth of anesthesia, for mechanical ventilation, to relieve a convulsive state (hypertonicity), etc. It should be remembered that the administration of muscle relaxants necessarily leads to the cessation of the work of the respiratory muscles and cessation of independent (spontaneous) breathing, which requires mechanical ventilation.

Studies of the physiology of neuromuscular conduction and pharmacology of neuromuscular blockers in the last decade have shown that the effect occurs in two ways (blockade of the end plate of cholinergic receptors due to their binding by muscle relaxants with a depolarizing effect Francois J. et al., 1984), single-phase relaxants (tubocurarine, pancuronium, etc.). The use of biphasic muscle relaxants (persistent antidepolarization of the potential of the cell membranes of the motor nerve occurs, the drug ditilin and listenone, myorelaxin, etc.). The drugs have a long-term effect (up to 30-40 minutes). The antagonist of this group is prozerin.

Non-inhalation (intravenous) methods of general anesthesia. Traditionally, other methods are understood as intravenous (the most common), as well as rectal, intramuscular, and oral. Currently, non-drug electrostimulation methods of anesthesia are successfully used - central electrostimulation anesthesia, electroneedle analgesia (regional), ataralgesia, central analgesia, neuroleptanalgesia. This trend is due to both practical considerations (reducing the toxicity of anesthesia for patients and operating room personnel) and an important theoretical premise - achieving effective and safe general anesthesia for the patient through the combined use of its various components with selective action.

There is reason to assume that in the coming years the listed groups of drugs will be replenished with new drugs.

Among the existing agents, barbiturates most firmly retain their place in practical anesthesiology, the classic representatives are sodium thiopental (pentothal), hexenal (sodium evipan), used for induction and general anesthesia, endoscopic studies. Ultra-short-acting non-barbiturate anesthetic (Propanidide, Sombrevin, used since 1964). Sodium hydroxybuterate (GHB) is used intravenously, intramuscularly, rectally, orally, in monoanesthesia in therapeutic practice.

Drugs used for local and general anesthesia

Drugs used for local anesthesia. The mechanism of action of local anesthetics is as follows: having lipoidotropic, anesthetic molecules are concentrated in the membranes of nerve fibers, while they block the function of sodium channels, preventing the propagation of the action potential. Depending on the chemical structure, local anesthetics are divided into two groups:

• esters of amino acids with amino alcohols (cocaine, dicaine, novocaine).
• amides of the xylidine type (lidocai, trimecaine, pyromecaine).

Drugs used in general anesthesia. Ether (diethyl ether) - belongs to the aliphatic series. It is a colorless, transparent liquid with a boiling point of 35ºС. Under the influence of light and air, it decomposes into toxic aldehydes and peroxides, so it should be stored in a dark glass container, tightly closed. It is highly flammable and its vapors are explosive. The ether has high narcotic and therapeutic activity; at a concentration of 0.2–0.4 g/l, the analgesic stage develops, and at 1.8–2 g/l an overdose occurs. It has a stimulating effect on the sympathetic-adrenal system, reduces cardiac output, increases blood pressure, irritates the mucous membranes and thereby increases the secretion of the salivary glands. Irritates the gastric mucosa, can cause nausea and vomiting in the postoperative period, promotes the development of paresis and at the same time reduces liver function.

Chloroform (trichloromethane) – colorless transparent liquid with a sweetish odor. Boiling point 59–62º C. Under the influence of light and air, it decomposes and halogen-containing acids and phosgene are formed. Store in the same way as ether. Chloroform is 4–5 times stronger than ether, and the breadth of its therapeutic action is small, which makes it possible to quickly overdose. At 1.2–1.5 vol.% general anesthesia occurs, and at 1.6 vol.% cardiac arrest may occur. (due to toxic effects on the myocardium). Increases the tone of the parasympathetic part of the nervous autonomic system, does not irritate the mucous membranes, is not explosive, depresses the vascular and respiratory centers, is hepatotoxic, promotes the formation of necrosis in liver cells. As a result of the toxic effect on the kidneys and liver, chloroform is not widely used in anesthesiological practice.

Ftorotan (halothane, fluotane, narcotan) – a potent halogen-containing anesthetic that is 4–5 times stronger than ether and 50 times stronger than nitrous oxide. It is a clear, colorless liquid with a sweetish odor. Boiling point 50.2º C. Decomposes under the influence of light, stored with a stabilizer. Ftorotan causes a rapid onset of general anesthesia and rapid awakening, is not explosive, does not irritate the mucous membranes, inhibits the secretion of the salivary and bronchial glands, dilates the bronchi, relaxes the striated muscles, does not cause laryngo and bronchospasm. With prolonged anesthesia, it depresses breathing, has a repressive effect on the contractile function of the myocardium, reduces blood pressure, disrupts heart rhythm, inhibits liver and kidney function, and reduces muscle tone. General anesthesia (fluorotane + ether) is called azeotropic, and it is also possible to use fluorotane with nitrous oxide.

Methoxyflurane (pentran, inhalan) – halogen-containing anesthetic – is a colorless, volatile liquid, a mixture (4 vol.%) with air at a temperature of 60º C ignites. At normal room temperature it is not explosive. It has a powerful analgesic effect with minimal toxic effects on the body, stabilizes hemodynamics, does not cause irritation of the mucous membranes, reduces reflex excitability of the larynx, does not reduce blood pressure, and has a vasodilating effect. However, it has a toxic effect on the liver and kidneys.

Etran (enflurane) – fluorinated ether – gives a powerful narcotic effect, stabilizes hemodynamic parameters, does not cause cardiac arrhythmias, does not depress respiration, has a pronounced muscle relaxant effect, and is devoid of hepatotoxic and nephrotoxic properties.

Trichlorethylene (trilene, rotylane) – the narcotic power is 5–10 times higher than that of ether. It decomposes to form a toxic substance (phosgene), so it cannot be used in a semi-closed circuit. It has found application in minor surgical interventions, does not irritate mucous membranes, inhibits laryngeal reflexes, stimulates the vagus nerve, reduces tidal volume, and in high concentrations causes cardiac arrhythmias.

Nitrous oxide – the least toxic general anesthetic. It is a colorless gas, non-flammable, patients are quickly put under anesthesia and quickly awaken, does not have a toxic effect on parenchymal organs, does not irritate the mucous membranes of the respiratory tract, and does not cause hypersecretion. When anesthesia deepens, there is a danger of hypoxia, thus, monoanesthesia with nitrous oxide is indicated for low-traumatic operations and manipulations.

Cyclopropane (trimethylene) – a colorless flammable gas, has a powerful narcotic effect, 7-10 times stronger than nitrous oxide, and is released from the body through the lungs. It has high narcotic activity, does not irritate the mucous membranes, minimally affects the liver and kidneys, rapid onset of anesthesia and rapid awakening, causes muscle relaxation.

Preparing the patient for local general anesthesia

Tasks: a) assessment of the general condition, b) identification of features of the anamnesis associated with anesthesia, c) assessment of clinical and laboratory data, d) determination of the degree of risk of surgery and anesthesia (choice of anesthesia method), e) determination of the nature of the necessary premedication.

A patient who is undergoing planned or emergency surgery is subject to examination by an anesthesiologist-resuscitator to determine his physical and mental condition, assess the degree of risk of anesthesia and conduct the necessary pre-anesthesia preparation and psychotherapeutic conversation.

Along with clarifying complaints and medical history, the nurse anesthetist clarifies a number of issues that are of particular importance in connection with the upcoming operation and general anesthesia: the presence of increased bleeding, allergic reactions, dentures, previous operations, pregnancy, etc.

On the eve of the operation, the anesthesiologist and sister anesthetist visit the patient for a conversation and, in order to clarify any controversial issues, explain to the patient what anesthetic assistance should be provided, the risk of this assistance, etc. In the evening before the operation, the patient receives sleeping pills and sedatives, ( phenobarbital, luminal, seduxen tablets, if the patient has pain, painkillers are prescribed).

Premedication. Administration of medications immediately before surgery in order to reduce the incidence of intra and postoperative complications. Premedication is necessary to solve several problems:

• decreased emotional arousal.
• neurovegetative stabilization.
• creating optimal conditions for the action of anesthetics.
• prevention of allergic reactions to agents used in anesthesia.
• decreased secretion of glands.

Basic drugs For premedication, the following groups of pharmacological substances are used:

• Hypnotics (barbiturates: etaminal sodium, phenobarbital, radedorm, nozepam, tozepam).
• Tranquilizers (diazepam, phenazepam). These drugs have hypnotic, anticonvulsant, hypnotic and amnesic effects, eliminate anxiety and potentiate the effect of anesthetics, and increase the threshold of pain sensitivity. All this makes them the leading means of premedication.
• Neuroleptics (aminazine, droperidol).
• Antihistamines (diphenhydramine, suprastin, tavegil).
• Narcotic analgesics (promedol, morphine, omnopon). Eliminate pain, have a sedative and hypnotic effect, potentiate the effect of anesthetics. ∙ Anticholinergic drugs (atropine, metacin). The drugs block vagal reflexes and inhibit gland secretion.

Stages of ether anesthesia

Of the proposed classifications of the clinical course of ether anesthesia, the Guedel classification is the most widely used. In our country, this classification is somewhat modified by I. S. Zhorov (1959), who proposed to distinguish the stage of awakening instead of the agonal stage.

First stage – analgesia – begins from the moment of inhalation of ether vapor and lasts on average 3-8 minutes, after which loss of consciousness occurs. This stage is characterized by a gradual darkening of consciousness: loss of orientation, the patient answers questions incorrectly, speech becomes incoherent, and the state is half-asleep. The skin of the face is hyperemic, the pupils are the original size or slightly dilated, and actively react to light. Breathing and pulse are rapid and uneven, blood pressure is slightly increased. Tactile and temperature sensitivity and reflexes are preserved, pain sensitivity is weakened, which allows short-term surgical interventions (rausch anesthesia) to be performed at this time.

Second stage – excitement – ​​begins immediately after loss of consciousness and lasts 1-5 minutes, which depends on the individual characteristics of the patient, as well as the qualifications of the anesthesiologist. The clinical picture is characterized by speech and motor agitation. The skin is sharply hyperemic, the eyelids are closed, the pupils are dilated, the reaction to light remains, involuntary swimming movements of the eyeballs are noted. Breathing is rapid, arrhythmic, blood pressure is increased.

Third stage – surgical (stage of “anesthesia sleep”) – occurs 12-20 minutes after the start of general anesthesia, when, as the body is saturated with ether, inhibition deepens in the cerebral cortex and subcortical structures. Clinically, against the background of deep sleep, loss of all types of sensitivity, muscle relaxation, suppression of reflexes, and decreased breathing are noted. The pulse slows down and blood pressure decreases slightly. The pupil dilates, but (a lively reaction to light remains).

Fourth stage – awakening – occurs after turning off the ether and is characterized by the gradual restoration of reflexes, muscle tone, sensitivity, consciousness in the reverse order. Awakening occurs slowly and, depending on the individual characteristics of the patient, the duration and depth of general anesthesia, lasts from several minutes to several hours. The surgical stage has four levels of depth.

Indications and contraindications for local and general anesthesia

An absolute contraindication to conduction and plexus anesthesia is the presence of tissue contamination in the blockade area, severe hypovolemic conditions, and allergic reactions to the anesthetic.

Along with the methods of regional anesthesia noted above, anesthesia of the fracture area and block of intercostal nerves are often used for pain relief. Fractures of large tubular bones (femur, tibia, humerus) are usually accompanied by the formation of hematomas in the fracture area. Introducing 20-30 ml of 1% or 2% novocaine solution into it after 2-3 minutes. leads to a feeling of “numbness” at the site of injury. Intercostal nerve blockade is carried out at the level of the costal angles and along the posterior or axillary lines. A thin needle 3-5 cm long is inserted towards the rib. Once contact with the bone is achieved, the taut skin is released and the needle is moved to the lower edge of the rib. Having reached the latter, the needle is further advanced to a depth of 3-4 mm and after an aspiration test (risk of damage to the intercostal artery and lungs), 3-5 ml of a 0.5-1% anesthetic solution is injected.

There are no absolute contraindications for general anesthesia. When determining indications, the nature and scope of the proposed intervention should be taken into account, both in outpatient practice and in clinical settings, some surgical interventions can be performed under local anesthesia; in the clinic, the method of epidural anesthesia is often used. Relative contraindications include those situations (in the absence of urgency in the operation) when it is necessary to stabilize the patient’s condition: eliminate hypovolemia, anemia, correct electrolyte disturbances, etc.

Local anesthesia is indicated in all cases where there are no contraindications to its administration and when there are contraindications to all types of general anesthesia.

General anesthesia is indicated in the following cases:

• during operations, including short ones, when it is very problematic or impossible to ensure free patency of the airways.
• patients with a so-called full stomach, when there is always the possibility of regurgitation and aspiration.
• most patients undergoing abdominal surgery.
• patients who have undergone intrathoracic interventions accompanied by unilateral or bilateral surgical pneumothorax.
• during surgical interventions in which it is difficult to control the free patency of the airways due to the position on the operating table (Fowler, Trendelenburg, Overholt, etc. position).
• in cases where during the operation there is a need to use muscle relaxants and mechanical ventilation with intermittent positive pressure, since manual ventilation through the mask of the anesthesia machine is difficult and can cause the gas-narcotic mixture to enter the stomach, which in most cases leads to regurgitation and aspiration.
• during surgery on the head, facial skeleton, neck.
• in most operations using microsurgical techniques (especially long-term ones).
• during operations in patients prone to laryngospasm (long-term cystoscopic examinations and manipulations, hemorrhoidectomy, etc.).
• for most operations in pediatric anesthesiology.

Complications of local and general anesthesia

Complications of local anesthesia. There are no completely safe methods of anesthesia, and regional anesthesia is no exception. Many of the complications (especially severe ones observed when performing central blocks) relate to the period of development and introduction of RA into clinical practice. These complications were associated with insufficient technical equipment, insufficient qualifications of anesthesiologists, and the use of toxic anesthetics. However, there is a risk of complications. Let's look at the most significant of them.

Due to the mechanism of action of central segmental blockade, arterial hypotension is its integral and foreseen component. The severity of hypotension is determined by the level of anesthesia and the implementation of a number of preventive measures. The development of hypotension (a decrease in blood pressure by more than 30%) occurs in 9% of those undergoing surgery and under EA conditions. It occurs more often in patients with reduced compensatory capabilities of the cardiovascular system (elderly and senile age, intoxication, initial hypovolemia).

A very dangerous complication of central RA is the development of total spinal block. It occurs most often as a result of unintentional and undetected puncture of the dura mater during EA and the introduction of large doses of local anesthetic into the subarachnoid space. Profound hypotension, loss of consciousness and respiratory arrest require full resuscitation measures. A similar complication caused by a general toxic effect is possible with accidental intravascular administration of a dose of local anesthetic intended for EA.

Postoperative neurological complications (aseptic meningitis, adhesive arachnoiditis, cauda equina syndrome, interspinous ligamentosis) are rare (0.003%). Prevention of these complications is the use of only disposable spinal needles and careful removal of antiseptic from the puncture site. Infectious meningitis and purulent epiduritis are caused by infection of the subarachnoid or epidural space, most often during catheterization, and require massive antibacterial therapy.

Epidural hematoma. With prolonged motor blockade after EA, it is appropriate to perform computed tomography to exclude epidural hematoma; If it is detected, surgical decompression is necessary.

Cauda equina syndrome associated with injury to the elements of the cauda equina or spinal cord roots during spinal puncture. If paresthesia appears during needle insertion, it is necessary to change its position and ensure their disappearance.

Interspinous ligamentosis associated with traumatic repeated punctures and manifests itself as pain along the spinal column; does not require special treatment and resolves on its own by 5-7 days.

Headache after spinal anesthesia, described by A. Bier, occurs according to various authors with a frequency of 1 to 15%. It occurs more often in young people than in older people, and in women more often than in men. This is not a dangerous, but subjectively extremely unpleasant complication. Headache occurs 6-48 hours (sometimes delayed 3-5 days) after subarachnoid puncture and continues without treatment for 3-7 days. This complication is associated with the slow “leakage” of spinal fluid through the puncture hole in the dura mater, which leads to a decrease in the volume of spinal fluid and a downward displacement of the structures of the central nervous system.

The main factor that influences the development of post-puncture headaches is the size of the puncture needle and the nature of the sharpening. The use of thin, specially sharpened needles minimizes post-puncture headaches.

The main condition for minimizing complications is the highly qualified specialist and strict adherence to all the rules for performing regional anesthesia:

• strict adherence to the surgical principle of atraumaticity during puncture of the subarachnoid and epidural spaces, anesthesia of nerve trunks and plexuses;
• strict adherence to the rules of asepsis and antiseptics;
• use only disposable kits;
• insertion of a spinal needle only through the sheath when performing SA;
• use of local anesthetics with minimal toxicity and in safe concentrations;
• using only official solutions of local anesthetics to avoid contamination of the cerebrospinal fluid and the penetration of preservatives into it;
• strict adherence to the developed protocols for performing RA, taking into account absolute and relative contraindications.

Performing any method of regional anesthesia is permissible only in operating rooms with mandatory monitoring of the patient’s functional state and compliance with all safety rules adopted in modern clinical anesthesiology.

Complications of general anesthesia. When carrying out modern combined anesthesia, complications are extremely rare, mainly in the first 15 minutes of anesthesia (induction period), during the patient’s awakening and in the post-anesthesia period, being in most cases the result of errors by the anesthesiologist. There are respiratory, cardiovascular and neurological complications.

Respiratory complications include apnea, bronchiolospasm, laryngospasm, inadequate restoration of spontaneous breathing, and recurarization. Apnea (cessation of breathing) is caused by hyperventilation, reflex irritation of the pharynx, larynx, root of the lung, mesentery, bronchiolospasm, the action of muscle relaxants, overdose of drugs that depress the central nervous system. (morphine, barbiturates, etc.), neurological complications (increased intracranial pressure), etc. Bronchiolospasm (total or partial) can occur in persons with chronic pulmonary pathology (tumors, bronchial asthma) and prone to allergic reactions. Laryngospasm develops when secretions accumulate in the larynx, as a result of exposure to concentrated vapors of general inhalational anesthetics, soda lime dust, trauma with a laryngoscope, rough intubation (against the background of superficial anesthesia).

Inadequate restoration of spontaneous breathing is observed after general anesthesia against the background of total myoplegia and is associated with an overdose of muscle relaxants or general anesthetics, hyperventilation, hypokalemia, extensive surgical trauma, and the general serious condition of the patient. Recurarization is stopping breathing after it has completely recovered in the patient. As a rule, this complication appears when the dosage of proserin is insufficient, after the use of anti-depolarizing relaxants.

Cardiovascular complications include arrhythmias, bradycardia, and cardiac arrest. Arrhythmias develop in the presence of hypoxia, hypercapnia, irritation of the trachea with an endotracheal tube, and the administration of certain drugs (adrenaline, cyclopropane). Bradycardia is caused by irritation of the vagus nerve during operations, the introduction of vagotonic substances (proserin - to restore spontaneous breathing). Cardiac arrest can occur with severe irritation of reflexogenic zones, due to massive blood loss, hypoxia, hypercapnia, hyperkalemia.

Neurological complications include tremors upon awakening, hyperthermia, convulsions, muscle pain, regurgitation, and vomiting. Trembling occurs when the temperature in the operating room is low, there is heavy blood loss, or prolonged open-chest or abdominal surgery. Hyperthermia can be observed in the postoperative period due to a rise in the patient’s already elevated temperature, the use of drugs that disrupt normal sweating (atropine); due to an excessive reaction after warming the patient when performing operations under conditions of general hypothermia or with the development of a pyrogenic reaction to intravenous administration of solutions.

Convulsions are a sign of overexcitation of the central nervous system. - may be caused by hyperventilation, hypercapnia, overdose or rapid administration of general anesthetics, observed in diseases of the central nervous system. (brain tumor, epilepsy, meningitis). Muscle pain is observed when depolarizing relaxants (ditilin) ​​are used for myoplegia after short-term general anesthesia. With spontaneous and artificial ventilation of the lungs, aspiration or injection of fluid into the trachea is possible as a result of regurgitation of the contents of the gastrointestinal tract with intestinal obstruction and heavy gastrointestinal bleeding. Vomiting often develops during inadequate premedication, increased sensitivity of some patients to morphine, or severe tracheal intubation in an inadequately anesthetized patient. There is a category of patients in whom vomiting occurs for no apparent reason.

Features of local and general anesthesia in children

Features of local anesthesia. Local anesthesia is one of the most common procedures in pediatric medical practice, and local anesthetics are among the most commonly used medications. This is a powerful tactical tool in the surgeon’s arsenal, without which most modern treatment protocols are impossible.

The issue of local anesthesia becomes especially acute in children under 4 years of age. To date, we do not have effective and safe local anesthetics for this age group. As clinical experience shows, the need for local anesthesia arises when treating children 4 years of age and younger. In the practice of most doctors working with children, there are many cases where medical intervention requires pain relief. However, the duration and complexity of the intervention does not always justify putting the child under anesthesia. The most optimal solution in this situation remains the use of injection anesthesia, similar to how this is done in older children, but always taking into account the characteristics of early childhood.

Based on their pharmacological properties, the most effective drugs in dentistry today are anesthetics based on articaine and mepivacaine. This has been proven by clinical practice, but their use, as well as proprietary forms containing these anesthetics, is not indicated in children under 4 years of age due to the lack of data on effectiveness and safety. No such studies have been conducted. Therefore, the doctor actually does not have the means to solve the clinical problem assigned to him. However, in real clinical practice, children under 4 years of age, during dental treatment, are given local anesthesia with drugs based on articaine and mepivacaine. Despite the lack of official statistics on this issue, analysis of the frequency and structure of complications during local anesthesia in children under 4 years of age indicates the accumulated positive experience of our and foreign specialists.

There is no doubt that local anesthesia in pediatric surgery is an indispensable procedure. It should also be recognized that the risk of complications with local anesthesia in childhood is higher, but their structure will be different. Our experience and the experience of our colleagues indicates that the most common type of complications are toxic reactions. They belong to the group of predictable complications, therefore, the doctor’s special attention should be paid to the dose of the anesthetic, the time and technique of its administration.

Features of general anesthesia are caused by the anatomical, physiological and psychological characteristics of the child’s body. At the age of up to 3 years, the most gentle methods of induction of anesthesia are indicated, which, like premedication, are carried out for all children under the age of 12 in a familiar environment, usually in a ward. The child is delivered to the operating room already in a state of narcotic sleep.

With A. o. All narcotic substances can be used in children, but it should be remembered that their narcotic range in a child narrows and, consequently, the likelihood of overdose and respiratory depression increases. In childhood, the thermoregulation system is very imperfect, so within 1-2 hours of surgery, even in older children, body temperature can decrease by 2-4°.

Specific complications of A. o. observed in children include convulsions, the development of which may be associated with hypocalcemia, hypoxia, as well as subglottic edema of the larynx. Prevention of these complications consists of ensuring adequate conditions for artificial ventilation of the lungs during surgery, correcting water and electrolyte disturbances, correctly choosing the size of the endotracheal tube (without sealing cuffs) and maintaining the temperature on the operating table using a warming mattress.

Absolutely everyone knows that anesthesia (narcosis) has its consequences, has an effect on the body that is far from positive, but under certain circumstances it is impossible to do without it.

But does the effect of anesthesia always have a negative impact on health? Or something specific is dangerous, for example, an incorrectly calculated and administered amount of a substance is not entirely clear.

In order to understand this, you need to understand what anesthesia is.

What is it?

According to the definition, anesthesia is a decrease in the sensitivity of the human body as a whole or a separate part of it to external influences, up to a complete loss of control and awareness of what is happening. In simple terms, it is the loss of the ability to feel pain for some time, as well as to be aware of the surrounding reality.

The name itself comes from the Greek word “ἀναισθησία”, which literally means “without feelings”.

What type of anesthesia is there?

There are quite a large number of methods for classifying anesthetic processes in the world, most of which are understandable only to a narrow circle of specialists.

The most widely accepted, “simplified” classification divides anesthesia into the following groups:

1. Local.
2. General.
3. Inhalation.

Local anesthesia

The main types of anesthesia with local effect include:

• Application is a superficial anesthesia applied to a certain area of ​​the skin or mucous membrane from above, while the drug used penetrates the tissue, “dulls” the nerve endings, leading to an almost complete loss of sensitivity - it is used quite widely, for example, in dental treatment and in urology.
• Infiltration - with this type of anesthesia, an injection is given, leading to a complete blockade of nervous activity in a separate area of ​​the body, and, accordingly, to a loss of sensitivity in it.
• Conduction - in this case, an anesthetic is injected into the paraneural area, which entails blocking the transmission of impulses along the fiber of the trunk of a large nerve; anesthesiologists use this type of anesthesia during surgical interventions on the thyroid gland, and for pain relief during gynecological surgical procedures.
• Spinal or spinal - the drug with this method of anesthesia is injected into the cerebrospinal fluid, inside the spinal column, and sensitivity is blocked at the level of the roots of the nerve branches; this type of anesthesia is used for some types of operations on the legs and spine.
• Epidural - the drug is also injected into the spinal column, but using a catheter and into the epidural zone; pain relief occurs by blocking the transmission of impulses by the spinal cord; it is often used as a supplement to general anesthesia and, if necessary, in obstetric practice.

General

In general, the effect of the general type of anesthesia on a person is as follows:

1. Complete reversible inhibition of all activity of the central nervous system.
2. Loss of memory and awareness of what is happening.
3. Complete “insensibility” of the body.
4. Relaxation of all muscle fibers in the body.

The general form of pain relief can be:

• Mononarcotic - only one drug is used.
• Mixed - two or more related remedies are used.
• Combined – doctors use several types of drugs from different groups at the same time.

Inhalation

According to the way in which the effect on the body is carried out, this anesthesia can be:

1. Masked.
2. Endotracheal.
3. Endobronchial.

Quite often used both as an independent form of anesthesia and as a supplement to general anesthesia.

What medications are used?

Some drugs used by anesthesiologists come in different forms and are used to provide different pain-relieving effects on the body.

For local anesthesia

When using anesthesia that has only a local, superficial effect, doctors usually use:

• lidocaine;
• Kamistad;
• tetracaine;
• proxymetacaine;
• inocaine;
• xylocaine.

The drugs are used in the form of:

1. Aerosols.
2. Mazey.
3. Gels.
4. Sprays

When choosing an infiltration method of influencing the body, the following are used:

• novocaine;
• ultracaine;
• lidocaine.

When performing both conduction and spinal anesthesia, the following drugs are selected:

1. Procaine.
2. Bupivacaine.
3. Tetracaine.
4. Lidocaine.

In order for a person to be under epidural anesthesia, the following is used:

• ropivacaine;
• bupivacaine;
• lidocaine.

General

For general intravenous anesthesia of the human body, anesthesiologists usually use:

1. Hexenal.
2. Ketamine.
3. Fentanyl.
4. Sodium hydroxybutyrate.
5. Droperidol.
6. Seduxen.
7. Relanium.
8. Propanidid.
9. Viadryl.
10. Sodium thiopental.

This method is distinguished by a very fast effect on the body, but its effect ceases just as quickly; on average, any such drug keeps you unconscious for 20 to 30 minutes.

Inhalation

There are many drugs for this type of anesthesia, and even more mixtures of them, the compositions and ratios of which are at the discretion of the doctor.

Most often, doctors use the following agents and their mixtures:

• nitrous oxide;
• chloroform;
• xenon;
• propofol;
• fluorothane.

Possible consequences and complications after anesthesia

The most common complication of anesthesia is its overdose, which, unfortunately, is not always noticeable during medical procedures, but almost always leads to sad consequences that appear after surgical treatment, during the rehabilitation of the body.

The potential harm to health is directly dependent on the method by which anesthesia was administered and what drug or combination of drugs was used.

After local anesthesia

Despite the fact that for local anesthesia the dosage is almost always based on the doctor’s question whether it hurts or not, for example, when treating teeth, this method causes minimal harm to the body compared to other methods of pain relief.

The consequences of the application of superficial anesthetics are:

1. Edema.
2. Allergic reaction.
3. Slight dizziness.
4. Feeling nauseous.

Such symptoms can occur both as a result of exceeding the threshold of individual tolerance, and as a result of increased sensitivity to the drug used, an allergy to it.

The same consequences can occur when using the infiltration method of anesthesia. Both of these methods have a very gentle effect on both nervous tissue and the body as a whole, so the range of application of these methods to relieve pain during any procedure is very wide - from cosmetology to not particularly complex small operations, for example, the removal of warts.

With conduction and spinal local anesthesia, everything is quite complicated and dangerous. Among the possible consequences of an incorrectly calculated dose or an incorrectly administered drug, the most common are the following:

• transverse myelitis;
• neuropathy;
• partial or complete paralysis of a major nerve;
• spinal meningitis;
• “anterior horn” syndrome of the spinal cord;
• convulsions.

If the patient is given an epidural anesthesia, an anesthesiologist's mistake can lead to complications such as:

1. Paralysis.
2. Epidural hematoma.
3. Attacks of spasmodic pain in the lower back.
4. Loss or reduction of sensation in general.

When performing local anesthesia, this type of drug injection into the spine is the most risky and dangerous for a sick person.

General

Harm after intravenous general anesthesia may appear quite a long time after the medical procedure. The most common problems that arise after using this type of pain relief include:

• tooth decay;
• a general drop in the activity of the central nervous system, a certain amoebism in reactions and behavior;
• leg cramps;
• the appearance of interruptions in breathing, pauses and snoring during sleep;
• cardiac dysfunction;
• dullness, a sharp decline in intelligence and thinking abilities;
• death of some brain cells.

The most severe consequences of using this type of anesthesia include when the patient does not wake up after surgery, falls into a coma that can last an indefinite amount of time, or dies due to cardiac arrest.

Inhalation

The consequences of delivering painkillers to the lungs include quite a lot of pathologies, but the most common are the following:

1. The impossibility of returning to independent mechanical breathing after the operation for various reasons - from the fact that the brain “forgot” how to do it, to the fact that the muscle tissue is numb and “frozen” and simply does not obey weak nerve signals after “forgetting”.
2. Arrhythmia.
3. Tachycardia.
4. Bradycardia.
5. Partial muscle paralysis.
6. Acute spasmodic periodic pain in the heart.
7. Sudden stoppages of breathing, throat spasms, or convulsions in the lungs.

The worst harm that an error can cause when using this type of anesthesia is cardiac arrest, both during and after the operation.

Video: anesthesia and its consequences.

What do the doctors say?

Any anesthesiologist before surgery must have a very long and meticulous conversation with the patient; unfortunately, sick people often do not take this seriously, literally brushing off the doctor like an annoying fly.

However, the doctor talks to the patient for a reason; the purpose of the conversation is to identify possible side effects or any intolerance to certain components used in anesthesia.

Therefore, the very first thing that doctors always say is that you need to be as attentive and extremely sincere in a conversation with an anesthesiologist, since whether the patient wakes up or not largely depends on this conversation.

Also, when talking with a patient, anesthesiologists literally collect, like a puzzle, the entire life history in order to find out whether any interventions have been performed under anesthesia before, and what the person felt. If the patient cannot say that he was injected, then the doctor asks for details of the disease in order to determine this himself.

Therefore, the second thing the doctor will advise is to remember in as much detail as possible all the details of what the anesthesiologist is asking about, because not everything is reflected in the medical record. For example. Quite often situations arise when a person has a tooth removed, and then vomits for several days.

This, as a rule, indicates intolerance to lidocaine, but there is no such information in the patient’s chart. Or, in childhood, a person suffered from inflammation of the middle ear, but no one contacted a doctor - this will also exclude the use of a number of drugs.

Therefore, the only thing that doctors advise, besides the fact that you shouldn’t stress yourself out before the upcoming operation and anesthesia, is to be extremely attentive and frank with the anesthesiologist, on whose actions half the success of the operation depends. And his actions, in turn, depend on the information he has. This means that the more the doctor knows about the patient, the greater the negative consequences of anesthesia can be avoided.