Fear of pain is one of the most ancient and frightening. The pain can lead to loss of consciousness, reason and can lead to death from pain shock. The issue of pain relief before humanity arose at the very moment when various manipulations with the body, skin, and organs began to be carried out. And if many years ago the anesthesia was "domestic" (distracted, allowed to shout, given a lethal dose of alcohol), nowadays medicine has stepped forward so much that there are a lot of methods of pain relief and it’s easier to transfer a new method of anesthesia with every new discovery, and side he has less and less effects.
Types of Anesthesia
For a better understanding, consider the main methods of anesthesia.
1) Local anesthesia.
From the name it is clear that the zone of its action is determined locally. The person remains conscious, and there are few side effects and undesirable consequences for this type of anesthesia. Most commonly used:
- Superficial (application) - used in medicine (dentistry, otorhinolaryngology, cosmetology, gynecology), when you need to anesthetize a small area of the skin. The sensitivity of the site is lost, the patient feels numb. The anesthetic may be in the form of a gel, aerosol, spray or solution.
- Infiltration - the introduction of a drug that blocks nerve impulses is performed subcutaneously, injection.
- Conduction - the drug is injected into the paraneural space, which causes a blockade of impulses along the large nerve trunk. This is a more serious type of local anesthesia, it is used in operations on the extremities, thyroid gland and so on.
- Spinal - Anesthetic is injected into the cerebrospinal fluid using a thin needle. The sensitivity of the lower segment of the abdomen and limbs is lost. It is used during operations in the lumbar spine, legs, etc.
- Epidural - anesthesia, widely used in childbirth and cesarean section. The difference from the spinal one is that the catheter is inserted into the epidural space, and the impulses are not blocked at the level of the roots of the spinal nerves, but the nerve endings of the spinal cord are completely blocked.
2) General anesthesia.
During general anesthesia, the central nervous system is completely inhibited, the person is unconscious, the skeletal muscles are relaxed, and pain sensitivity is absent. General anesthesia requires a careful selection of drugs by an anesthetist, recovery from it is more difficult, an artificial lung ventilation apparatus is often required to restore breathing after general anesthesia. Types of general anesthesia:
- inhalation - anesthetics are administered through the respiratory tract, mask, endotracheal, endobronchial devices are used;
- non-inhalation - administration occurs intravenously, intramuscularly (depending on the number of drugs administered and their combinations - mononarcosis, mixed anesthesia, combined anesthesia).
For patient safety and global anesthesia, a combination of inhaled analgesia and non-inhalation analgesia is sometimes used.
Let us consider in more detail one of the most common types of non-inhalation anesthesia - total intravenous anesthesia, what is it, how is it carried out, etc.
Alternative inhalation anesthesia
In short, TBBA is a type of general anesthesia that is used for operations during which muscle relaxation is not required. A feature of this method is the combination of several drugs in lower doses than if each of them was needed separately. Thus, the negative side effect on the body from each drug is reduced. Anesthetics in TBVA are supplemented with tranquilizers, antipsychotics, hypnotics, analgesics, as a result, a combination of several drugs enhances the effect of anesthesia.
Why TVVA?
It is necessary to focus on total intravenous anesthesia, because it is in Russia that the inhalation type of anesthesia cannot yet be widely used. The reason is the lack of modern anesthetics and low-flow anesthetic drugs. Intravenous administration of anesthetics helps to ease the withdrawal from anesthesia, adjust the dosage.
Method Advantages
- To carry out such anesthesia is just technically.
- Reliability, anesthetic can be administered intravenously in fractions.
- Introduction to sleep occurs quickly, almost instantly.
- Physiological sleep.
- Thanks to the joint action with tranquilizers, the patient does not have an excitation phase (there are no fears and anxieties).
- An individual approach to each patient - you can calculate the effective chemical structure of the anesthetic in each individual case.
Books about TVVA
Smith’s book, Total Intravenous Anesthesia, is a good quality benchmark for anesthetists. Until the advent of the Russian-language edition, there were no such books in Russian medicine.
In his book, Smith, co-authored with White, examined in detail and competently the following topics:
- total intravenous anesthesia - concept, technique, its scientific basis;
- a history of intravenous anesthesia;
- TVBA methods;
- pharmaceutical analysis of drugs used in this type of anesthesia;
- advantages and disadvantages of TVBA;
- the conduct and effect of TBVA for certain groups of patients;
- monitoring the effects of anesthetics during anesthesia;
- what future awaits intravenous anesthesia.
Preparing for TVVA
Total intravenous anesthesia is one of the simplest types of anesthesia, and preparation for it is also quite primitive. Inspection of the anesthesiologist, bowel movement (or enema) is required. It is better not to eat food before anesthesia (or the day before) so that there is no vomiting reflex. If required, drug preparation is carried out, drugs that stabilize the psychoemotional state are given or administered to the patient.
The selection of anesthetic substance, auxiliary preparations and their dosages are selected individually and individually by an anesthetist. Calculation is always carried out for each specific case.
Technique
In total intravenous anesthesia, two main types of drugs are used: hypnotic and analgesic, so there are several strategies for infusion. For most operations, the technique is as follows: the rate of hypnotic infusion does not change during the operation, and the analgesic is changed depending on the intensity of the surgical intervention (the patient’s reaction is also taken into account). It happens that they act the other way around: the rate of infusion of the analgesic is maintained at a constant level, the introduction of hypnotic change.
The first method has the advantage of quickly awakening the patient at the end of the operation. Therefore, this technique is used more often, however, the pharmacokinetics of drugs should be taken into account and based on the characteristics of the operation and the patient's condition.
Precautionary measures
No matter how simple it seems the use of intravenous anesthesia, you need to be very careful when choosing an anesthesiologist. Unfortunately, not everything is always simple. Qualification of staff, constant monitoring of the patient after the operation, correctly calculated dosages, control of homeostasis systems will help to get out of anesthesia easily and without negative consequences and memories.