I had written this article a long time back, for bringing awareness about anaesthesia among patients...thought of sharing it for all those who wonder what anaesthesia actually is...
Q
1: What is Anaesthesia?
A : Anaesthesia is a word
derived from the Greek, meaning 'without sensation'. Anaesthesia is given to
patients who are undergoing painful procedures such as surgery. By means of
various drugs, all sensations (including pain sensation) of a part or whole of
body are temporarily and reversibly blocked.
Q
2 : Who are
anaesthetists?
A
: Anaesthetists are fully trained medical doctors who have had training in
anaesthesia. The anaesthetists work in partnership with the surgeon, providing
a team approach to surgical care.
Q 3: Are there different types of
Anaesthesia?
A
: There are four types of anaesthesia:
1.
General
Anaesthesia -
This is a state of deep unconsciousness, where you are free of all sensation,
including pain, during the operation. In this type of anaesthesia, you will be
in a controlled state of unconsciousness, with muscles paralysed reversibly,
and in a state of amnesia (loss of memory). Your respiration will be controlled
by a ventilator by means of a tube which the anaesthetist introduces inside
your trachea after you have become unconscious. Anaesthesia is usually started
by an injection of medicine into a vein. Sometimes, a mixture of gases
can be breathed in to give the same effect. Your anaesthetist will stay with
you, monitoring your vital functions, (heart rate, blood pressure and oxygen
levels in your blood) and maintaining the correct level of unconsciousness. The
process of anaesthesia will be reversed at the end of the operation. After
reversal, you will be fully awake, with complete muscle power, but without any
memory of the operation or any pain.
2.
Regional
Anaesthesia -
This is a technique where a local anaesthetic drug is used, to numb a group of
nerves, and make a large part of the body, such as the legs, numb and pain
free. This is achieved by injecting an anaesthetic drug inside your spinal
canal (space around your spinal cord, inside the vertebral column). This
technique is known as ‘Spinal Anaesthesia’. When the drug is injected in the
outermost layer around spinal cord, in a space called epidural space, it is known
as ‘Epidural Anaesthesia’.This can be used on its own, or with sedation or a
general anaesthetic. This type of Anaesthesia is useful for operations on lower
limbs or lower part of abdomen. The numbness wears off sometime after the
operation, when other forms of pain relief are used. As with a general
anaesthetic, you anaesthetist will be monitoring you continuously.
3.
Local
Anaesthesia -
Here the local anaesthetic drug is injected near a few nerves, or into the site
of the operation. As with regional anaesthesia, the painful sensation is
removed, but there may be some sensation of pressure or movement. For e.g, eye
surgeries are generally performed under local Anaesthesia.
4.
Sedation - This is where a sedative drug is
used to make you sleepy and comfortable during surgery. You may not remember
much of what happens at this time, although your anaesthetist will be able to
talk to you to confirm you are comfortable. Sedation is used during procedures
that are uncomfortable rather than painful. Sedation can be administered in
combination with other techniques and by trained doctors other than
anaesthetists.
The
anaesthetist chooses the type of anaesthetic, but your wishes will always be
taken into account. Nothing will be done without your agreement.
Q 4: What is pre-anaesthetic check
up? Why is it necessary?
A
: A pre-anaesthetic check up is your health assessment conducted by the
anaesthetist prior to your scheduled surgery. The anaesthetist determines your
fitness for surgery, for your safety. You will be asked about presence of any
chronic health problem, such as Diabetes, high blood pressure, heart disease, asthama,
tuberculosis. You will be asked if you have previously undergone any surgery,
and the previous anaesthesia details. You will be asked about smoking and
alcohol intake, medicines you are taking, any allergies to medicines you have
had, and whether you have received a blood transfusion before. The anaesthetist
will record your heart rate, your blood pressure. He will go through the
necessary blood investigations to see whether they are in the normal range.
This will also allow the anaesthetist to plan the anaesthetic to suit your
health, and the needs of surgery.
Q 5:What is monitoring?
A
: The anaesthetist constantly looks after your
body’s function during the anaesthetic. This “monitoring” usually includes
using special machines, which measures blood pressure, the heart rate (ECG),
and the amount of oxygen in your blood. Depending upon the requirement as
dictated by the surgery, the anaesthetist may use other monitors such as those
for measuring the amount of carbon dioxide in your exhaled gas, your level of
unconsciousness, the degree of your muscle relaxation etc.
Q 6: What can I do to prepare myself
for an anaesthetic?
A
: Following measures should be taken by the patient to ensure a safe
anaesthesia :
1.
Confide
everything to your anaesthetist. Do not hide any health problem or any drug you
are consuming, as this can adversely affect the anaesthetic management.
2.
Do
not eat or drink anything for at least six hours before surgery. This is
important to prevent you from choking while you are unconscious and from
vomiting after you are out of anaesthesia.
3.
Stop
smoking and consuming alcohol at least a month before surgery. This is
important for your post operative recovery.
4.
Glasses
and contact lenses should be removed before surgery, to prevent them getting
damaged by the anaesthetic equipment.
5.
Dentures
or false teeth need to be removed just before the anaesthetic, and the
anaesthetist should be informed about any loose or crowned teeth. This is
because the anaesthetic will relax your neck and mouth, and the anaesthetists
will need to use equipment to help keep you breathing safely.
6.
Follow
the instructions given by the anaesthetist properly, especially regarding your
routine medications. For e.g, the anaesthetist will advise you to take your
antihypertensive medicine with sips of water on morning of surgery, while he
will ask you to omit your diabetes medicine on the morning of surgery. This is
important for your intraoperative safety.
Q 7: Where will I go to sleep? Where
will I wake up?
A
: When it is time for your operation, you will be moved from the ward to the
anaesthetic room next to the operating theatre. It is here that you will have a
cannula, a narrow plastic tube through which injections are made, put into a
vein and you will go to sleep. Occasionally, you may be anaesthetized in theatre.
Usually
you will wake up in the Recovery area, which is near to the theatre. Sometimes,
you will wake up before you get there, but your anaesthetist will only wake you
when it is safe to do so. The Recovery area has specially trained staff to look
after you following you operation, and to make sure that any nausea, pain
or discomfort is treated. The Anaesthetist continues to have a role in keeping
you pain free, and looking after your fluid and drug requirements, on the ward
afterwards.
Q 8: Is Anaesthesia safe?
A
: Yes it is, but all operations and anaesthetics have some risk. The risk
depends on various factors, such as the age of the patient, associated diseases
like heart disease or lung disease, the type of surgery, whether surgery is
emergency or planned, the duration of surgery, the site of surgery (heart and
brain surgeries obviously carry greater risk than surgery of toe). The risks of
a particular procedure to a particular patient will vary, and your anaesthetist
will discuss any risks that are relevant to you before the operation. There are
side effects of having an anaesthetic, such as drowsiness, nausea, muscle
pains, headaches or a sore throat. These symptoms are usually short lived, and
can be relieved by relevant drugs.
Q 9: They say Anaesthesia is safer
now than it was previously. Is it true?
A : Certainly. Anaesthesia has evolved
over years from use of cold ice to cause numbness to a variety of safe and
efficient drugs. Drugs like Thiopentone Sodium, which caused nausea and delayed
recovery have been replaced by Propofol, which is short acting, helping in faster
recovery, as well as non nauseating. Newer and shorter acting muscle relaxants
are now available. Inhalation drugs such as Ether, which was used in the past
and had lots of side effects have now been replaced by newer and safer as well
as more potent drugs like Sevoflurane and Desflurane. Various new pain killers
are now available which can be used alone or in combination for intra operative
and post operative pain relief. Pain killers are now available in various forms
such as skin patches and lollipops. Overall anaesthesia has now become a
pleasant experience. All anaesthetists strive to give their patients a ‘Balanced
Anaesthesia’, which is a combination of Analgesia
(loss of response to pain), Amnesia (loss of memory), Immobility ( loss of
motor reflexes), Hypnosis (loss of consciousness) and skeletal muscle
relaxation.
Q 10: Where else will I require services of an
Anaesthetist?
A
: Apart from surgeries, Anaesthetist is required in the following scenarios-
1.
Labor analgesia – By
giving a drug in the epidural space (mentioned above) anaesthetist can help you
achieve a painless normal delivery. Here you will be able to move both legs but
you will have no sensation, and hence no pain.
2.
Chronic pain – chronic
pain conditions such as cancer pain, neuralgias can be relieved by various
nerve blocks. The anaesthetist injects a nerve ablating agent such as absolute
alcohol around the nerve responsible for causing intractable pain resulting in
permanent irreversible blockede of that nerve resulting in relief from pain.
3.
Diagnostic procedures –
Anaesthetist is required for giving sedation or anaesthesia for children and
un-cooperative patients undergoing diagnostic procedures e.g CT scan, MRI, TEE
etc.
4.
Critical care –
Anaesthetists are trained in management of post operative patients in intensive
care units.
5.
Trauma management –
Anaesthetists are trained in cardio pulmonary resuscitation and emergency
management.
