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Doctors share about anesthesia and anesthesia during surgery – VnExpress


According to Dr. Luu Kinh Khuong, anesthesia is to relieve pain in a narrow area, while anesthesia makes the patient sleep when the drug acts on the brain.

According to Dr. Luu Kinh Khuong, Head of Department of Anesthesia – Resuscitation, Tam Anh General Hospital in Ho Chi Minh City, anesthesia is a method of anesthesia, giving anesthesia through intravenous or respiratory routes. The drug acts on the central nervous system, causing the patient to lose sensation in the whole body, through the induction of sleep causing a controlled loss of consciousness. Anesthesia is commonly used in major surgery.

There are many ways to anesthetize a patient. In particular, anesthesia through a mask (mask) is the delivery of anesthetic through the patient’s intravenous or respiratory tract. The drug acts on the brain at which time the anesthesiologist will control the patient’s breathing with a mask. Intravenous anesthesia is an intravenous injection, which can be injected intermittently or continuously into a vein through an electric syringe. The patient breathes on his own or is helped with mask breathing with oxygen or intubated and controlled breathing with a ventilator.

Anesthesia is also performed through an endotracheal tube, using an endotracheal tube placed through the mouth or nose into the patient’s trachea. Anesthesia used by inhalation or intravenous anesthetic.

The last is balanced anesthesia, which is commonly used today. The doctor will intubate to control breathing, combine many drugs such as sedation, intravenous anesthetic, respiratory, analgesic, muscle relaxant… to achieve the appropriate anesthesia for surgery. With this method, it brings many benefits to patients thanks to the synergistic effect of the above drugs with the lowest dose but highest efficiency, avoiding drug overdose and reducing side effects when taking high doses of one drug. single drug.

Doctor CCII Luu Kinh Khuong (monitoring Monitor) performed anesthesia during a surgery. Photo: Tam Anh General Hospital.

Meanwhile, anesthesia is an anesthetic method that uses local anesthetics to temporarily inhibit nerve impulse conduction in order to lose the sense of pain but not lose consciousness. The person receiving anesthesia is still awake, able to hear and talk to the doctor. Anesthesia is used in cases of minor surgery, surgery on extremities, used for people who cannot be anesthetized, to help relieve pain after surgery…

Methods of anesthesia with local anesthesia, applied to small surgical areas such as shallow, small, skin wounds, scalp wounds, finger and toe wounds… External anesthetic methods An epidural is an injection of anesthetic into the epidural space to numb the nerve roots. Depending on the surgical site, anesthesia may be given in the thoracic, lumbar or sacral regions. With spinal anesthesia, the doctor will inject anesthetic into the subarachnoid space, the drug dissolves with cerebrospinal fluid and numbs the lumbar spinal cord and nerve roots.

When to choose anesthesia, anesthesia

According to Dr. Luu Kinh Khuong, usually the doctor will advise the patient to use the appropriate method of anesthesia, based on the patient’s current condition; medical history and comorbidities; allergies, asthma, alcoholism, smoking… The doctor also relies on a history of insensitivity such as having an anesthetic complication; results of clinical examination and paraclinical tests; the nature of the surgery such as removing more or less organs; surgical locations such as head, neck, chest, abdomen, limbs… In addition, the type of surgery must also be considered such as cesarean section, plastic surgery or tumor removal; Estimated time of surgery; laparoscopic or open surgery; The patient is in supine, prone, or supine position.

In some cases, instead of anaesthesia, doctors must safely anaesthetize children if they are uncooperative; Anesthesia for adults who are too nervous, afraid, long surgery, surgical sites that need good control of breathing such as the head, face, neck, in the chest… or in some surgeries that require muscle relaxation and respiratory support is required.

The process of performing anesthesia, anesthesia

In anesthesia, with small surgery such as wisdom tooth extraction, mole removal, warts, stitches on the extremities… the anesthetic process does not require much preparation. Particularly for the procedure of epidural or spinal anesthesia, must be carefully prepared.

Specifically, patients are examined before surgery, the doctor will explain to them how to cooperate when giving anesthesia. Next, the doctor cleans the area under anesthesia, sedating the patient the night before surgery (if necessary). Patients are also tested for local anesthetic response using an intradermal test, usually in the upper third of the forearm skin.

The procedure of epidural or spinal anesthesia is carefully prepared before it is performed.  Photo: Shutterstock.

The procedure of epidural or spinal anesthesia is carefully prepared before it is performed. Photo: Shutterstock.

Anesthesia will be divided into several stages including pre-anesthesia, induction of anesthesia, maintenance of anesthesia, and awakening. In anaesthesia, the induction and awakening phases are very important, because the patient is transitioning from the waking state to the sedated state and vice versa; There are many physiological fluctuations leading to dangerous complications, if the patient is not closely monitored and handled promptly. Anesthetics, analgesics, and muscle relaxants help the patient to sleep deeply enough, provide good pain relief, and remain completely immobile to avoid adverse reactions.

In the pre-anesthesia stage, before surgery and before starting anesthesia, the doctor will examine the patient’s general condition, assess the blood volume in the patient’s body, and evaluate the function of organs such as the heart, liver and lungs. kidney… through subclinical tests. If stable, the doctor continues to reassure psychologically, explain the patient’s condition and what the patient will experience during surgery, thereby creating confidence in the patient to help the surgery be safe. In addition, patients need to adhere to some regulations such as fasting and drinking before surgery to avoid aspiration accidents to ensure patient safety.

In the induction phase, the patient is given anesthetic, pain reliever, muscle relaxant into the body. At this time, the anesthesia team will closely monitor the patient’s condition to soon handle possible complications such as anesthetic allergy, low blood pressure, arrhythmia, respiratory failure…

When the patient has enough depth of anesthesia for surgery, the doctor will move on to the maintenance phase of anesthesia. During this stage, intravenous anesthetic or respiratory anesthetic can be used to maintain the patient’s deep sleep; pain relievers, muscle relaxants so that the patient does not feel pain, lie still for the doctor to conduct surgery. It is not until the beginning of the concluding phase of surgery, when the surgeon closes the skin, that the anesthesiologist stops the sleeping pills.

After surgery, the patient will be transferred to the recovery or recovery area depending on the condition of the disease, entering the coma phase. Anesthesiologists and recovery nurses will be in charge of monitoring and resuscitating patients after surgery. Young healthy people only need to monitor for two hours, older patients can monitor for 4-6 hours; People with cardiovascular and respiratory diseases can stay in the recovery room for up to 6 hours or more

Patient’s body after anesthesia, anesthesia

General anesthesia will affect the patient’s wakefulness and reflexes in 24 hours. For safety, the patient should not drive a vehicle, operate machinery, or even cook. Patients are also advised not to make important decisions, to sign legal documents; do not use substances that can affect mental health such as alcohol, tobacco and should have a caregiver in the first night after surgery.

The anesthetic process also has risks such as damaging the lips, teeth, pharynx, hoarseness… If the anesthesia is too shallow, the patient may wake up during surgery. Both anesthesia and anaesthesia have cardiovascular, respiratory, neurological, anaphylactoid, and anaphylaxis complications… Compared with anesthesia, anesthesia has a number of advantages, but it is also important to note possible complications. Common side effects of this method include anesthetic poisoning, limb weakness, nerve damage, low back pain, urinary retention, headache.

The Center for Anesthesia - Resuscitation of Tam Anh General Hospital is equipped with modern machinery.  Photo: Tam Anh General Hospital.

The Center for Anesthesia – Resuscitation of Tam Anh General Hospital is equipped with modern machinery. Photo: Tam Anh General Hospital.

With safety criteria in anesthesia, Tam Anh General Hospital has established the Center for Anesthesia – Resuscitation, pain treatment and palliative care to serve anesthesia, resuscitation and pain relief techniques for patients. sick. The hospital also develops an anesthetic and anesthetic process and a specific protocol for each disease, with a team of leading experts and doctors, and modern equipment and machinery to support the process of anesthesia and anesthesia. , ensuring patient safety during surgery.

Ha Thanh

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