Did your attending physician tell you that only surgery will help you?
For many patients this sounds like a death sentence. From practice, many anesthesiologists will confidently say that most patients are not so much afraid of the operation itself as of the upcoming anesthesia.
And what frightens people, first of all, is the inability to control what is happening during anesthesia and the unknown: how anesthesia works, are there any unpleasant sensations during anesthesia, how will the patient wake up, what are the consequences...
Let's try to debunk the most common fears of patients about anesthesia:
MYTH #1 “I will wake up during surgery.”
The roots of this misconception go far back. The fact is that more than a hundred years ago, the technique of “manual” (mask) ether anesthesia was actively practiced. During the operation, a kind of modern mask with a napkin was applied to the patient’s face and liquid ether was dripped. The patient breathed on his own, the ether vapors were inhaled by the patient and, as a result, sleep occurred. Even the most distant person from medicine understands that it is very difficult to select the dosage of anesthetic necessary for sleep, and not causing dangerous side effects, with this method. Therefore, in order to avoid the toxic effects of anesthesia, anesthesia was carried out at a superficial level and the patient could periodically “wake up”... The modern approach to general anesthesia has changed radically. Dosages of drugs are clearly selected for each patient (taking into account age, gender, weight, concomitant diseases, type of operation) , automatic dosing systems are used (in artificial ventilation devices, intravenous automatic dosing devices). Therefore, there is simply no possibility for the patient to wake up during the operation...
The myth is supported by the fact that at the end of the operation (when no painful manipulations are performed, bandages are applied, etc.), the anesthesiologist begins to “release” the patient from sleep, so some patients, hearing conversations around them, think that they woke up during the operation...
Recommendations for preparing for anesthesia:
- Stop smoking at least a few days before surgery - this way you will significantly reduce the risk of respiratory complications during surgery
- do not drink alcohol for several weeks before surgery
- exclude the use of new or “controversial” products, so as not to disrupt the gastrointestinal tract
- inform the anesthesiologist about the slightest deviations in health: dizziness, pain, weakness, anxiety, etc.
How does a patient recover from anesthesia?
- After the anesthesia ends, the patient regains consciousness - reaction, sensitivity, and muscle function are restored.
- In the first hours after surgery, the person is under the strict supervision of an anesthesiologist and other specialists.
- At first, the patient is given an anesthetic to smoothly exit the state of drug-induced sleep and dull the pain.
- To restore blood volume, infusion therapy with electrolyte solutions is performed.
- As a rule, already on the second day after surgery, the patient is transferred to a specialized department, where doctors continue to monitor him.
- Side effects of recovery from anesthesia may include dizziness, headache, and mild nausea. But in general, the condition is tolerable, especially against the backdrop of positive emotions from the transformation.
MYTH No. 2 “There will be hallucinations.”
Often, people who underwent anesthesia in the 70-80s of the last century remember them with horror. This is due to the fact that during and after anesthesia, many of them had nightmares, hallucinations, and disturbed sleep. It was objective! All the symptoms described were a side effect of one of the anesthetics - the drug is very good in terms of its qualities in terms of pain relief and safety for the patient, but it has these features. It is possible to smooth out the negative effects of this drug by using complex anesthesia (a combination of several anesthetics).
Today, qualitatively different anesthesia drugs are widely used, which provide a soft fall asleep, smooth sleep and peaceful awakening . Very often, within the first half hour after anesthesia, the patient states that “it was as if nothing had happened...”
Before surgery
Natalya Kozhina, AiF.ru: Vladimir Vitalievich, during anesthesia the patient is entirely dependent on the anesthesiologist. Is it possible to assess the degree of competence of a specialist before surgery?
Vladimir Kulabukhov : By and large, no. But the existing system of certification of doctors says that if an anesthesiologist is admitted to perform this manipulation by a medical institution, then he knows all the methods of anesthesia necessary for a particular situation. In general, an anesthesiologist, like any doctor who will treat a patient, is appointed by the head of the department.
Question and answer What is the probability of not waking up after anesthesia?
— It turns out that I cannot say to an anesthesiologist who does not inspire confidence in me: “Sorry, I don’t like you, I want another specialist”?
— According to the healthcare law, any person has the right to choose their attending physician. But at the beginning, the anesthesiologist is not the attending physician, although at the time of the operation itself, responsibility is distributed between him and the surgeon. Of course, you can ask another specialist, but to categorically state: “I don’t want this anesthesiologist, but I want this one,” is probably not entirely correct. Although legally there is such a possibility.
— Do we have enough anesthesiologists today?
— Unfortunately, the shortage of specialists in the field of anesthesiology and resuscitation - we have a single specialty - is approximately 50%. This is due to enormous physical and psychological stress and low wages. People do not go into this specialty, plus everything else, because the role and place of the doctor in our society has been significantly diminished in recent years.
MYTH No. 4 “Memory deteriorates, headaches hurt.”
Of course, during anesthesia, drugs are used that directly affect the nervous system and higher nervous activity. The degree of influence depends on the amount (dose), duration of action (15-minute operation and 9-hour operation are slightly different), frequency of anesthesia (1-2 anesthesia in a lifetime and a dozen anesthesia in a year). Short-term forgetfulness can naturally occur if a person has undergone several difficult operations or long-term anesthesia in a short period of time. However, in this situation it is difficult to say whether these phenomena are associated with anesthesia, or with the general severity of the body’s diseases. In this matter, we can draw an analogy with drinking alcohol - every time you drink alcohol, you don’t think about memory loss?
It is extremely rare that headaches occur after anesthesia. As a rule, persistent headaches can occur after spinal anesthesia. However, there are prerequisites for these headaches - the patient’s initial asthenic state, vegetative-vascular dystonia, a tendency to migraines, low blood pressure. And even in such patients, strict adherence to bed rest for 24 hours after spinal anesthesia, adherence to the drinking regime allows in 90% of cases to avoid the appearance of headaches .
MYTH No. 5 “Anesthesia does not work on a drunk person.”
Anesthesia affects any living person! The only question is choosing the right combination of drugs and their dosages. Alcohol intake affects anesthesia in two ways. Chronic alcohol intake in the early stages leads to constant “combat readiness” of the liver, therefore the activity of its enzymes that destroy molecules of both alcohol and many anesthetics increases and large doses of anesthesia drugs are needed to achieve the desired depth of anesthesia. With prolonged alcoholism, patients develop cirrhosis of the liver and the detoxification capacity of the liver drops sharply - as a result of this, much smaller doses of anesthetics are needed.
During acute intoxication, the effect of many anesthetics is enhanced, and some are modified. Therefore, you probably shouldn’t drink alcohol before going under anesthesia...
MYTH No. 6 “I will die from anesthesia.”
Anesthesia is primarily aimed at protecting the patient from surgical aggression, ensuring comfort, safety and monitoring vital processes in the patient’s body.
Of course, there are cases of patient death on the operating table - they are associated with the severity of the disease, injury, bleeding, concomitant diseases, but not with anesthesia.
Before the operation, the anesthesiologist carefully examines the patient, finds out information about all chronic diseases, characteristics of the body - thanks to this, the doctor can select the safest combination of anesthetics. The intake of all medications on the eve of anesthesia must be agreed upon with the anesthesiologist - this will eliminate the negative influence of drugs and anesthetics on each other. Preparation for anesthesia is also important - it is strictly forbidden to take food or liquid at least 6 hours before surgery. Violation of this principle can lead to vomiting during anesthesia and aspiration (entry of stomach contents into the respiratory tract). And then problems may arise...
WHY IS GENERAL ANESTHESIA PREFERABLE FOR PLASTIC OPERATIONS?
General anesthesia is the same anesthesia. It can be provided in different ways: by intravenous administration of drugs, by inhalation of inhalational anesthetics, or a combination of these methods.
There is such a thing as intravenous sedation. This is a medicated sleep while the surgeon performs the operation under local anesthesia. This type of anesthesia is used if a minor operation lasting up to an hour is planned, and the patient is afraid.
If the operation lasts more than an hour or the area for surgery is too large and requires a large amount of local anesthetic, the anesthesiologist opts for general anesthesia. For example, it is impossible to perform liposuction of the abdomen only under local anesthesia, since the operation area is large, the dose of the administered anesthetic drug will be toxic, and this is dangerous for the patient’s life.
Of course, even today you can hear here and there about blepharoplasty and even SMAS lifting under local anesthesia, as some kind of know-how. To me, this information or advertising sounds like letters from the last century. What guides surgeons who offer such services? Safety for the patient? Ease of operation for the surgeon? Simply the impossibility of using general anesthesia due to the lack of a license at the clinic? I don't know. I can only say one thing: a high-quality surgical SMAS lifting of the face and neck, which does not include the eyelids and forehead, lasts at least 2-3 hours from the time local anesthesia is performed until the wounds are sutured.
It is not so simple: while conscious, lie motionless on the operating table without disturbing the surgeon. Patients' back, arms, legs become numb, they begin to toss and turn.
I'm not even talking about the sounds that surgical instruments make during an operation, and the smell that coagulated tissue smells of, and we use a coagulator very actively during plastic surgeries.
Then, no one excludes the possibility of periodic pain during the operation and the need to add a local anesthetic. In short, you need to have strong nerves and strong motivation to agree to such an adventure.
What does this advertisement “pressure” on? The patient’s fear of anesthesia, of the unknown. But, gentlemen, we live in the 21st century, anesthesia became safe and super-controlled a long time ago. In the arsenal of modern anesthesiologists there are many drugs for muscle relaxation (muscle relaxation), pain relief and medicinal sleep. They successfully combine all types, depending on the needs of each patient. These drugs have been well studied: their effects, mechanism of action, side effects, which also reduces the risk of complications.
So, what are the most common fears I encounter among patients about anesthesia?
Myth No. 7 “General anesthesia can be replaced with local anesthesia.”
Many patients, and often operating doctors, believe that anesthesia is an unimportant stage of treatment. This is a big misconception. The pain that occurs during surgical aggression is a powerful destructive factor that triggers “emergency defense” processes in the body - the regulation of the heart, breathing, liver, kidneys, and endocrine system changes, stress hormones are released, and a powerful spasm of peripheral vessels occurs. Severe pain during surgery can subsequently lead to quite serious, and sometimes life-threatening complications - kidney failure, liver failure, heart rhythm disturbances, etc. If we add here the presence of underlying chronic diseases and the emotional stress component of the patient being awake during the operation, which local anesthesia does not affect in any way, it becomes clear that an alternative to anesthesia does not always exist.
Local anesthesia as an independent type of anesthesia is possible, but it can be used for superficial operations, in emotionally stable people with unburdened concomitant pathologies, or when the risk of anesthesia significantly exceeds the risks of the operation itself.
Today it is considered the norm of world practice that in patients, especially children, any operation should be performed under general anesthesia (like many unpleasant diagnostic tests - gastroscopy, colonoscopy, etc.). A person does not need to remember either what preceded the operation or what happened during its process. The patient should wake up after completion of the operation without any negative emotions or memories.
Anesthesia: features and nuances
General anesthesia allows the surgeon to perform his work efficiently, and the patient not to experience pain, fear and discomfort.
General anesthesia is characterized by:
- complete loss of consciousness when the patient is put into medicated sleep
- lack of response to surgery and external stimuli
- loss of sensation
- muscle relaxation
These states are achieved through the introduction of anesthetic substances into the body. The choice of specific medications for medicated sleep is the task of the anesthesiologist.
Preparation for anesthesia includes the following steps:
- tests (general and clinical blood tests, urine tests)
- undergoing examinations by specialized doctors (therapist, cardiologist, dentist, gynecologist, etc.)
- undergoing diagnostics of organs and systems (cardiogram, ultrasound of the heart, etc.)
- history taking
- identifying allergic reactions to medications
A few days before the proposed operation, the anesthesiologist studies the research results, talks with the patient, and then selects the type of anesthetic drug and dosage.
