Introduction.
CARE FOR PATIENTS AFTER ANESTHESIA
Anesthesia(ancient Greek Να′ρκωσις - numbness, numbness; synonyms: general anesthesia, general anesthesia) - an artificially induced reversible state of inhibition of the central nervous system, which causes loss of consciousness, sleep, amnesia, pain relief, relaxation of skeletal muscles and loss of control over some reflexes. All this occurs with the introduction of one or more general anesthetics, the optimal dose and combination of which is selected by the anesthesiologist, taking into account the individual characteristics of the particular patient and depending on the type of medical procedure.
From the moment the patient enters the ward from the operating room, the postoperative period begins, which continues until discharge from the hospital. In this period nurse must be especially careful. An experienced, observant nurse is the doctor’s closest assistant; the success of treatment often depends on her. In the postoperative period, everything should be aimed at restoring the patient’s physiological functions, normal healing of the surgical wound, and preventing possible complications.
Depending on the general condition of the person being operated on, the type of anesthesia, and the characteristics of the operation, the ward nurse ensures the desired position of the patient in bed (raises the foot or head end of a functional bed; if the bed is an ordinary one, then takes care of the headrest, bolster under the legs, etc.).
The room where the patient is admitted from the operating room must be ventilated. Bright light in the room is unacceptable. The bed must be placed in such a way that it is possible to approach the patient from any side. Each patient receives special permission from the doctor to change the regimen: different terms allowed to sit down and stand up.
Basically, after non-cavitary operations of moderate severity, if the patient feels well, he can get up near the bed the next day. The nurse should monitor the patient’s first rise from bed and not allow him to leave the room on his own.
Care and monitoring of the patient after local anesthesia
It should be borne in mind that some patients have increased sensitivity to novocaine, and therefore, after surgery under local anesthesia, they may experience general disorders: weakness, drop in blood pressure, tachycardia, vomiting, cyanosis.
Cyanosis - the most important sign hypoxia, but its absence does not mean that the patient does not have hypoxia.
Only careful monitoring of the patient’s condition allows one to recognize incipient hypoxia in time. If oxygen starvation is accompanied by carbon dioxide retention (and this happens very often), then the signs of hypoxia change. Even with significant oxygen deprivation, blood pressure may remain high and the skin may remain pink.
Cyanosis- bluish coloration of the skin, mucous membranes and nails - appears when every 100 ml of blood contains more than 5 g% of reduced (i.e., not associated with oxygen) hemoglobin. Cyanosis is best determined by the color of the ear, lips, nails and the color of the blood itself. The content of reduced hemoglobin may vary. In anemic patients who have only 5 g% hemoglobin, cyanosis does not occur with the most severe hypoxia. On the contrary, in plethoric patients, cyanosis appears with the slightest lack of oxygen. Cyanosis can be not only due to a lack of oxygen in the lungs, but also due to acute cardiac weakness, in particular cardiac arrest. If cyanosis appears, you should immediately check the pulse and listen to heart sounds.
Arterial pulse- one of the main performance indicators of cardio-vascular system. They are examined in places where the arteries are located superficially and are accessible to direct palpation.
More often, the pulse is examined in adults at the radial artery. For diagnostic purposes, the pulse is determined in the temporal, femoral, brachial, popliteal, posterior tibial and other arteries. To count your pulse, you can use automatic blood pressure meters with pulse indicators.
It is better to determine your pulse in the morning, before eating. The patient should be calm and not talk while counting the pulse.
When body temperature rises by 1 °C, the pulse increases in adults by 8–10 beats per minute.
Pulse voltage depends on blood pressure and is determined by the force that must be applied until the pulse disappears. At normal pressure, the artery is compressed with moderate force, so the normal pulse is of moderate (satisfactory) tension. With high pressure, the artery is compressed by strong pressure - this pulse is called tense. It is important not to make a mistake, since the artery itself can be sclerotic. In this case, it is necessary to measure the pressure and verify the assumption that has arisen.
If the artery is sclerotic or the pulse is difficult to palpate, measure the pulse on the carotid artery: feel the groove between the larynx and the lateral muscles with your fingers and press lightly.
At low pressure, the artery is easily compressed, and the tension of the pulse is called soft (relaxed).
An empty, relaxed pulse is called a small filamentous pulse. Thermometry. As a rule, thermometry is carried out 2 times a day - in the morning on an empty stomach (between 6 and 8 am) and in the evening (between 16-18 o'clock) before the last meal. During the indicated hours, you can judge the maximum and minimum temperatures. If you need a more accurate idea of the daily temperature, you can measure it every 2–3 hours. The duration of temperature measurement with a maximum thermometer is at least 10 minutes.
When performing thermometry, the patient must lie or sit.
Locations for measuring body temperature:
Armpits;
Oral cavity (under the tongue);
Inguinal folds (in children);
Rectum (weakened patients).
Care and monitoring of the patient after general anesthesia
The post-anesthesia period is no less important than the anesthesia itself. Most possible complications after anesthesia can be prevented by proper patient care and pedantic compliance with doctor's orders. A very important stage of the post-anesthesia period is transporting the patient from the operating room to the ward. It is safer and better for the patient if he is taken from the operating room to the ward on a bed. Repeated transfers from a table to a gurney, etc. can cause breathing problems, cardiac activity, vomiting, and unnecessary pain.
After anesthesia, the patient is placed in a warm bed on his back with his head turned or on his side (to prevent the tongue from retracting) for 4–5 hours without a pillow, covered with heating pads. The patient should not be woken up.
Immediately after surgery, it is advisable to place a rubber ice pack on the area of the surgical wound for 2 hours. The application of gravity and cold to the operated area leads to compression and narrowing of small blood vessels and prevents the accumulation of blood in the tissues of the surgical wound. Cold soothes pain, prevents a number of complications, and reduces metabolic processes, making it easier for tissues to tolerate circulatory failure caused by surgery. Until the patient wakes up and regains consciousness, the nurse should remain near him constantly, monitoring his general condition, appearance, blood pressure, pulse, and breathing.
Transporting the patient from the operating room. The delivery of the patient from the operating room to the recovery room is carried out under the guidance of an anesthesiologist or nurse in the recovery room. Care must be taken not to cause additional injury, not to displace the applied bandage, or to break the plaster cast. From the operating table the patient is transferred to a gurney and transported to the recovery room. The gurney with the stretcher is placed with the head end at a right angle to the foot end of the bed. The patient is picked up and transferred to the bed. The patient can also be placed in another position: the foot end of the stretcher is placed at the head end of the bed and the patient is transferred to the bed.
Preparing the room and bed. Currently, after particularly complex operations under general anesthesia, patients are placed in the intensive care unit for 2–4 days. Subsequently, depending on their condition, they are transferred to the postoperative or general ward. The ward for postoperative patients should not be large (maximum for 2–3 people). The ward must have a centralized oxygen supply and the entire set of instruments, devices and medications for resuscitation.
Typically, functional beds are used to give the patient a comfortable position. The bed is covered with clean linen, and oilcloth is placed under the sheet. Before putting the patient to bed, the bed is warmed with heating pads.
Caring for a patient who vomits after anesthesia
In the first 2–3 hours after anesthesia, the patient is not allowed to drink or eat.
Help with nausea and vomiting
Vomiting is a complex reflex act that leads to the eruption of the contents of the stomach and intestines through the mouth. In most cases, it is a protective reaction of the body aimed at removing toxic or irritating substances from it.
If the patient starts vomiting:
1. Sit the patient down, cover his chest with a towel or oilcloth, bring a clean tray, basin or bucket to his mouth, you can use vomit bags.
2. Remove dentures.
3. If the patient is weak or is prohibited from sitting, position the patient so that his head is lower than his body. Turn his head to the side so that the patient does not choke on vomit, and bring a tray or basin to the corner of his mouth. You can also place a towel folded several times or a diaper to protect the pillow and linen from contamination.
4. Stay near the patient while vomiting. Place the unconscious patient on his side, not on his back! It is necessary to insert a mouth dilator into his mouth so that during vomiting with closed lips, aspiration of vomit does not occur. After vomiting, immediately remove the container with vomit from the room so that a specific smell does not remain in the room. Allow the patient to rinse with warm water and wipe his mouth. In very weakened patients, each time after vomiting, it is necessary to wipe the oral cavity with a gauze cloth moistened with water or one of the disinfectant solutions (solution boric acid, light solution of potassium permanganate, 2% solution of sodium bicarbonate, etc.).
Vomiting "coffee grounds" indicates gastric bleeding.
Anesthesia(pain relief) is a series of procedures designed to relieve the patient of pain. Anesthesia is performed by an anesthesiologist, but in some cases by a surgeon or dentist. The type of anesthesia is selected primarily depending on the type of operation (diagnostic procedure), the patient's health status and existing diseases.
Epidural anesthesia
Epidural anesthesia involves delivering an anesthetic into the epidural space using a thin polyethylene catheter with a diameter of approximately 1 mm. Epidural and spinal anesthesia belong to the so-called group. central blockades. This is very efficient technique, providing a deep and long-lasting blockade without the use of general anesthesia. Epidural anesthesia is also one of the most effective forms of pain treatment, including post-operative pain.
Epidural anesthesia is the most popular pain relief during childbirth. Its advantage is that the woman in labor does not feel painful contractions, so she can rest, calm down and concentrate on childbirth, and with a caesarean section the woman remains conscious and the pain after childbirth is reduced.
Indications for the use of epidural anesthesia
surgery on the lower extremities, especially if they are very painful, eg hip replacement, knee surgery;
operations on blood vessels - coronary bypass surgery of the vessels of the thighs, aortic aneurysm. Allows for long-term treatment of postoperative pain, rapid re-operation if the first one fails, fights thrombus formation;
removal operations varicose veins veins of the lower extremities;
operations on abdominal cavity- usually together with weak general anesthesia;
major operations on the chest (thoracic surgery, i.e. lung surgery, cardiac surgery);
urological operations, especially in the area of the lower urinary tract;
combating postoperative pain;
Today, epidural anesthesia is the most advanced and effective method managing pain after surgery or during childbirth.
Complications and contraindications for epidural anesthesia
Every anesthesia carries a risk of complications. Correct preparation of the patient and experience of the anesthesiologist will help to avoid them.
Contraindications to epidural anesthesia:
lack of patient consent;
infection at the puncture site - microorganisms can enter the cerebrospinal fluid;
bleeding disorders;
infection of the body;
some neurological diseases;
disturbances in the water-electrolyte balance of the body;
unstabilized arterial hypertension;
heavy birth defects hearts;
unstabilized coronary heart disease;
serious changes in the vertebrae in the lumbar region.
Side effects of epidural anesthesia:
back pain at the injection site; pass within 2-3 days;
“patchwork” pain relief - some areas of the skin may remain unpainful;
in this case, the patient is given another portion of anesthetic or a strong analgesic, sometimes general anesthesia is used;
nausea, vomiting;
delay and complication of urination;
point headache - appears due to puncture of the dura mater and leakage of cerebrospinal fluid into the epidural space;
hematoma in the area of injection of the anesthetic, with accompanying neurological disorders - in practice, a complication is very rare, but serious;
inflammation of the brain and spinal membranes. Spot headache should only occur during spinal anesthesia, since only in this case the anesthesiologist intentionally punctures the dura to inject anesthetic into the subdural space located behind the dura. At With epidural anesthesia, headaches do not appear because the dura remains intact. Point headache occurs with varying frequency, more often in young people and women in labor; appears within 24-48 hours after anesthesia and lasts 2-3 days, after which it disappears on its own. The cause of pinpoint headache is the use of thick puncture needles - the thinner the needle, the less likely this complication is. Analgesics are used to treat point headaches. The patient must lie down. In some cases, an epidural patch is made from the patient's own blood. Some anesthesiologists recommend lying quietly for several hours after surgery and anesthesia.
Postoperative pain
Epidural anesthesia is used not only during surgery, but also after surgery for reducing pain. After the catheter is placed, the patient returns to the department after surgery. Thanks to this, he is provided with comfort in the form of painlessness in the operated area. The anesthetic is supplied to the epidural space even 24 hours after surgery.
The selection of the appropriate anesthetic agent depends on the individual patient, his clinical condition and the planned operation.
It is very important that the patient is monitored not only by an anesthesiologist, but also by a competent nurse. This type of anesthesia is safe; complications, if they appear, most often disappear on their own. Thanks to this anesthesia, part of the operation can be performed without general anesthesia; it is widely used during childbirth and in the fight against pain after surgery.
Epidural anesthesia
Epidural anesthesia- also conduction anesthesia - is achieved by spreading an anesthetic solution (dicaine, trimecaine) between the layers of the dura mater. Preparation, equipment, and position of the patient are the same as for spinal anesthesia.
Spinal anesthesia
Spinal anesthesia- This is a type of central block where a regional anesthetic drug is injected into the area immediately adjacent to the spinal cord (the dural sac; directly into the cerebrospinal fluid).
The effect of this medicine is a reversible blockade of the transmission of excitation in nerve endings, resulting in tactile, motor and sympathetic blockade. The space of tactile blockade is determined by dermatomes, corresponding to the areas of the skin where the nerves from the spinal cord reach. Tactile blockade of touch is determined based on the patient’s reaction to pathogens - temperature changes (heat, cold), sensation of touch and pain. Motor blockade is based on inhibition of conduction in motor nerves. Sympathetic blockade is associated with a deterioration in conduction in the fibers of the sympathetic nervous system.
With such anesthesia, the patient does not feel anything: there is no tactile, temperature or pain sensitivity. The patient's legs seem to be paralyzed, he cannot move them, but he feels a pleasant warmth in them.
The safety of this kind of anesthesia lies in the fact that the nerve structures are not destroyed by the needle, but are moved apart. This anesthesia is performed only in the lumbar region. A puncture at the lumbar level, no higher than the L3 and L4 vertebrae, allows you to avoid accidental puncture of the spinal cord and its consequences (the spinal cord ends higher, and then passes into the so-called cauda equina). Compared to epidural anesthesia, spinal anesthesia is faster. Most often, this method is used for caesarean section and operations in the lower abdominal cavity and perineum.
Unilateral spinal anesthesia.
With unilateral spinal anesthesia, you can numb only one side of the body - for example, the operated leg, while sensitivity in the second leg will be preserved. Anesthesia of this type has a lesser effect on blood circulation (pressure decreases much less frequently than with complete spinal anesthesia).
When administering unilateral anesthesia, the patient must lie on the affected side for approximately 20 minutes to allow the medication to bind to the appropriate nerve structures on the desired side. Unilateral anesthesia is more difficult to perform.
Procedures for spinal anesthesia
Spinal (subdural) blockade is an ideal solution for operations performed below the navel. It is most often used during gynecological and urological operations, surgical operations in the lower abdominal region and orthopedic operations.
An approximate list of operations for which spinal anesthesia can be used:
Surgical and orthopedic operations of the lower extremities.
Arthroscopy of the knee joint.
Transurethral resection of the prostate.
Urological operations in the area of the lower urinary tract.
Lithotripsy (crushing) of urinary stones.
Hernia operations: femoral, inguinal, scrotal.
Operations for varicose veins of the lower extremities.
Operations in the anal area.
Gynecological operations.
Complications during spinal anesthesia
Spinal anesthesia is a safe procedure. Since the puncture is performed only in the lumbar region, it is impossible to damage the spinal cord (it is located higher). The most common undesirable symptoms appear:
low blood pressure is a fairly common complication, but appropriate monitoring of the patient’s condition allows it to be avoided; The decrease in blood pressure is felt most strongly by patients in whom it is elevated;
back pain at the injection site;
pass within 2-3 days;
in this case, the patient is given another portion of anesthetic or a strong analgesic, sometimes general anesthesia is used;
arrhythmia, including bradycardia;
urinary retention;
point headache - appears due to puncture of the dura mater and leakage of cerebrospinal fluid into the epidural space;
hematoma in the area of injection of the anesthetic, with accompanying neurological disorders - in practice, a complication is very rare, but serious. Point headache
can only occur during spinal anesthesia, insofar as only in this case the anesthesiologist deliberately punctures the dura to inject the anesthetic into the subdural space. When anesthesia is performed correctly, the hard shell remains intact and headaches do not appear.
Point headache occurs with varying frequency, more often in young people and women in labor; appears within 24-48 hours after anesthesia and lasts 2-3 days, after which it disappears on its own.
The cause of pinpoint headache is the use of thick puncture needles - the thinner the needle, the less likely this complication is. Analgesics are used to treat point headaches. The patient must lie down. In some cases, an epidural patch is made from the patient's own blood. Some anesthesiologists recommend lying quietly for several hours after surgery and anesthesia.
The selection of the appropriate anesthetic agent depends on the individual patient, his clinical condition and the planned operation.
It is very important that the patient is monitored not only by an anesthesiologist, but also by a competent nurse. This type of anesthesia is safe, helps to avoid general anesthesia, and complications, if they appear, most often disappear on their own.
Complications after pain relief. You can imagine all possible complications of anesthesia and the consequences of anesthesia in the form of three blocks: O , very common, as well as frequently occurring
Very common and common adverse reactions and complications of anesthesia (consequences of anesthesia)
Nausea
This is very common consequence anesthesia, occurring in approximately 30% of cases. Nausea is more common with general than with regional anesthesia. Here are some tips to help reduce your risk of nausea:
Should not be done during the first hours after operation be active - sit up and get out of bed;
Avoid drinking water and food immediately after surgery;
Good pain relief is also important as severe pain can cause nausea, so if you experience pain, tell your healthcare team;
Deep breathing and slowly inhaling air can help reduce the feeling of nausea.
A sore throat
Its severity can vary from discomfort to severe constant pain that bothers you when talking or swallowing. You may also experience dry mouth. These symptoms may subside within a few hours after surgery, but may persist for two or more days. If the above symptoms do not go away within two days after surgery, contact your doctor. A sore throat is only a consequence, not a complication. anesthesia.
Shiver
Trembling, which is another consequence of anesthesia, poses a certain problem for patients, as it causes them great discomfort, although most often it does not pose any danger to the body and lasts about 20-30 minutes. Trembling can occur either after general anesthesia or as a complication of epidural or spinal anesthesia. You may be able to reduce your risk of shivering somewhat by keeping your body warm before surgery. You need to take care of warm things in advance. Remember that the hospital may be cooler than your home.
Dizziness and lightheadedness
The residual effect of anesthetics may manifest itself in the form of a slight decrease in blood pressure, in addition, dehydration, which is not so uncommon after surgery, can lead to the same effect. A decrease in pressure can cause dizziness, weakness, and faintness.
Headache
There are many reasons that can cause a headache. These are medications used for anesthesia, the operation itself, dehydration and simply unnecessary anxiety for the patient. Most often, the headache goes away a few hours after anesthesia on its own or after taking painkillers. A severe headache can be a complication as spinal anesthesia, and a complication epidural pain relief. The features of its treatment are described in detail in the article " Headache after spinal anesthesia".
Itching is usually a side effect of anesthesia drugs(in particular, morphine), however, itching can also be a manifestation of an allergic reaction, so if it occurs, you must inform your doctor.
Back and lower back pain
During surgery, the patient remains in one constant position on a hard operating table for quite a long time, which can lead to “tired” back and, ultimately, to lower back pain after surgery.
Muscle pain
Most often, muscle pain after anesthesia occurs in young males, most often their occurrence is associated with the use of a drug called ditilin during anesthesia, usually used in emergency surgery, as well as situations where the patient’s stomach is not free from food. Muscle pain is a consequence of anesthesia (general anesthesia), it is symmetrical, most often localized in the neck, shoulders, upper abdomen and lasts approximately 2-3 days after surgery.
Anesthesia maintenance period. It was stated above that maintaining anesthesia with modern means targeted influence does not present significant difficulties. The task of the anesthesiologist during this period is to provide optimal conditions for the operation and at the same time to protect the patient’s body from surgical trauma.
Greatest recognition from general anesthetics, used for superficial anesthesia, received nitrous oxide, fluorotane and their combinations. Superficial ether-oxygen anesthesia is also widely used, often in combination with nitrous oxide. Nitrous oxide with oxygen is often used in a ratio of 3:1.2:1, fluorotane - in a concentration of 0.5-1%, ether - 3-4% by volume. It is appropriate to emphasize here that when choosing a particular drug, the anesthesiologist in each individual case should be guided by arguments of expediency, and not by a template. There is no doubt that an experienced anesthesiologist can successfully perform anesthesia with chloroform, trilene, cyclopropane, using, of course, special evaporators and maintaining anesthesia at a superficial level. However, is this necessary if there are other, less toxic and safer controlled anesthetics?
In addition to general anesthetic During the operation, the anesthesiologist must periodically add analgesics to maintain analgesia and muscle relaxation, most often fentanyl 2 ml (0.1 mg) and muscle relaxants (ditylin 40 mg or tubocurarn 15-30 mg). In addition, during the traumatic stages of the operation, it is necessary to enhance neurovegetative inhibition by adding 2.5-5 mg of droperidol or 5-10 mg of seduxen.
Responsibilities of an anesthesiologist during the maintenance period, anesthesin is constant monitoring of hemodynamics and gas exchange, timely and adequate compensation of blood loss, transfusion of solutions (reopolyglucin) to improve peripheral microcirculation, maintaining the acid-base state and water-electrolyte balance, administering cardiotonic and vascular drugs, if necessary, and monitoring adequacy of artificial lung ventilation. As you can see, the responsibilities of an anesthesiologist even in this relatively calm period emotionally period is more than enough.
Withdrawal period anesthesia(immediate post-anesthesia period) is one of the critical periods of anesthesia. Unfortunately, there are many sad observations when simple operations that proceeded smoothly against the background of adequate anesthesia ended in death due to mistakes made by the anesthesiologist during this period. Most often this is due to inadequate ventilation of the lungs and the development of hypoxia and hypoxia, the main reason for which is the premature transfer of patients to spontaneous breathing.
In order to avoid of this dangerous and frequent complication, the anesthesiologist must clearly ensure that the patient has restored adequate independent breathing, using a set of instrumental and clinical tests for this. Help can be provided, in particular, by measuring respiratory and minute breathing volumes with a volumeter, which in adults should not be less than 400-500 ml and 8-10 l, respectively. Of the clinical tests, the patient’s ability to raise his head on command and hold it in this position for several seconds is very valuable. More information will give the anesthesiologist observation of the movements of the chest: they should be rhythmic and deep, with the participation of all intercostal muscles in the act of breathing. There is another test: the patient’s ability to take a deep breath and hold his breath for a few seconds, which also indicates sufficient restoration of spontaneous breathing. On the contrary, shallow, irregular breathing, paradoxical rocking movements of the chest and diaphragm, retraction (“diving”) of the trachea with each breath, flaring of the wings of the nose, cyanosis of the mucous membranes and skin indicate inadequacy of spontaneous breathing and require continued artificial ventilation.
Tracheal extubation should be carried out only when there is no doubt about the complete restoration of spontaneous breathing. IN otherwise it is necessary to carry out continued artificial ventilation either in the operating room (if there are no other operations and appropriate premises), or in the awakening room (anesthesia room), or in the intensive care unit. The patient can be transferred to the ward only after an average of 2 hours after the end of anesthesia and extubation. Before this, the patient must remain under the active supervision of an anesthesiologist and nurse anesthetist, who must do everything necessary for the speedy normalization and stabilization of the functions of vital organs and systems.
One more thing should be said important tactical detail, which, unfortunately, not all anesthesiologists take into account. It just so happened that the quality of an anesthesiologist’s work was often assessed by others by the ability of a patient with the last stitch to open his eyes, show his tongue, and recognize the surgeon and anesthesiologist. In other words, the apsstsnolognichesky benefit with the end of the operation was considered completed. Unfortunately, many anesthesiologists, trying to show their “art,” administered respiratory analeptics, antidotes, analgesics and relaxants, regardless of their negative effects. side effects, and most importantly, not taking into account the fact that after a traumatic operation, the patient’s pain sensitivity was already restored on the operating table and pain arose, nullifying all efforts to adequately restore spontaneous breathing, hemodynamics and serving as a source of pathological reactions on the part of vital organs and systems. With the indicated pathological symptoms, with peripheral acrocyanosis, patients trembling, agitated and groaning in pain were transferred from the operating room to the intensive care unit, where the same anesthesiologist or resuscitation specialists again began active intensive measures to combat pain, trembling, agitation, respiratory and hemodynamic disturbances. Usually, only after a few hours the patients were able to be brought out of this pathological condition which could and should have been avoided.
Competent anesthesiologist never makes such mistakes. He understands that the patient needs a gradual, smooth recovery from anesthesia while maintaining analgesia and some mental calm for several days after the operation. We specifically focused on this fundamental position with the hope that many students, having become surgeons, will be able to correctly evaluate the tactics of anesthesiologists during the period of removing a patient from a narcotic state.
Coming out of anesthesia after surgery worries many people more than the progress of the surgery itself. After all, during it a person does not feel anything, but after the anesthesia wears off, unpleasant sensations arise. And they are associated not only with the return of sensitivity in the area of surgical intervention: in addition to pain, the patient sometimes experiences a lot of painful symptoms that can last for several hours.
Features of local anesthesia
Local anesthesia is understood as temporary anesthesia of a small area of the body due to the effect of external drugs on it or injection of a medicinal solution. In the definition one can immediately see a large classification of species local anesthesia: superficial and internal. The latter, in turn, is divided into several more subtypes depending on the area of influence (epidural, conduction, spinal, infiltration).
Local anesthesia has found application in almost all areas of medicine, but the most a shining example is dentistry. Today, almost all manipulations are performed with anesthesia. And if previously the patient had to endure 10-20 minutes while the doctor drills the tooth, cleans the canals, puts a filling, now everything painful sensations are reduced to a second tingling sensation from the insertion of a thin needle.
How is it carried out?
All types of local anesthesia have their own characteristics, but on average it is something like this: a person is injected with medicine into a specific area. After a few minutes, sensitivity in this area is lost, and doctors can begin manipulation. The patient remains conscious, but he does not feel anything, not even the touch of a cold instrument. The general condition is also stable, although some admit to experiencing mild nausea and dizziness. But doctors attribute this more likely to anxiety than pain relief.
By the way! Sometimes, before inserting a needle, the skin is first numbed with external anesthetics to reduce pain from puncturing soft tissue. The result is a combined local anesthesia. It is used, for example, during epidural anesthesia.
How does anesthesia wear off?
The amount of anesthetic administered and the choice of its type are calculated based on the complexity of the operation and the patient’s physique. But the medicine is always taken with a reserve so that the anesthesia does not suddenly wear off during medical procedures if they require more time. Accordingly, after the end of the operation, the patient has a few more minutes (sometimes even a little more than an hour) for the anesthetic to stop working.
Sensitivity returns gradually, but quite quickly. First, a person begins to feel the touch, and after a minute or two he feels pain at the site of the manipulation. If it was a dental procedure, then the area where the gum was punctured or the hole after the extracted tooth may ache.
When treating caries, as a rule, no pain is felt after the anesthesia wears off. If it was a more complex operation, for example, to remove an ingrown nail, then the operated finger may begin to hurt quite severely because there was a violation of the integrity of the tissue. But these pains can be relieved with analgesics.
Possible complications
Some people are allergic to certain types of medications. Local anesthesia involves the use of Lidocaine, Novocaine, Bupivacaine, etc. And a person may experience a reaction to them in the form of:
These reactions appear immediately after administration of the drug. And if the first two are quite tolerable, then the last three require termination of the operation and hospitalization of the patient. You can find out if you are allergic to anesthetics by first conducting an allergy test.
Some people note certain reactions after the local anesthesia wears off: dizziness or headache, weakness, sleepiness, and fever. But it is impossible to say for sure whether this is an allergy to the medicine or consequences after the operation.
Features of general anesthesia
A more complex type of anesthesia, which involves immersing the patient in a narcotic sleep and completely depriving him of not only sensitivity, but also consciousness. It is difficult for people who have never been exposed to this in their lives to imagine such a condition. Therefore, many people are afraid of their first operation under general anesthesia.
General anesthesia is also successfully used today in all areas of medicine. Moreover, sometimes this is the only chance to perform the operation. In dentistry, this type of pain relief is also used when a person (usually a child) is unable to overcome his fear of going to the dentist.
There are two main types of general anesthesia: inhalation (through a mask) and intravenous. Sometimes combined anesthesia is used. What it will be in a particular case is decided by the doctor, depending on the specifics of the operation and the physiology of the patient.
What is it made up of?
General anesthesia consists of three “components”: drug-induced sleep, analgesia and muscle relaxation. In essence, a person simply falls asleep, but in fact completely different changes occur in his body. During normal sleep, breathing is calm, the body is relaxed, but reflexes are preserved.
And if you prick a person with a pin or simply pat him, he will wake up. And narcotic sleep also implies analgesia - suppression of the body’s autonomic reactions to all types of interventions: punctures, incisions, manipulations with internal organs etc.
The third “component” of general anesthesia – muscle relaxation – is necessary to facilitate the work of surgeons during surgery. Due to the presence of muscle relaxants in the medicinal solution, the patient’s muscles are as relaxed as possible and also cannot reflexively react to interventions (contract, tense).
How is it carried out?
If this is general anesthesia of the inhalation type, then a mask is put on the patient’s nose and mouth, through which a gas-narcotic mixture is supplied. A person is required to breathe evenly and not resist the onset of sleep. Using sensors connected to the body, the anesthesiologist determines when the anesthesia has fully taken effect and signals this to the surgeons.
Intravenous general anesthesia involves the administration of drugs through the skin. This anesthesia is considered deeper and more reliable, while inhalation anesthesia is used for simple operations. If a difficult and lengthy intervention is ahead, then combined anesthesia is used: first intravenous, then a mask is added.
By the way! During general anesthesia, doctors must monitor the main indicators of the body’s vitality, thanks to equipment and external signs. The patient’s skin color, body temperature, heart function, pulse - all this allows you to monitor the course of anesthesia and the person’s condition.
How long does it take to recover from general anesthesia?
People sometimes fear for their well-being when they come out of general anesthesia after surgery because it is a complex process. Although, it is difficult for the anesthesiologist, but rather unpleasant for the patient. It's like waking up from a very heavy sleep. In this case, the following sensations may be noted:
If the general anesthesia was light, then the patient after the operation goes to the ward and “wakes up” on his own. After deep anesthesia, a person must be “awakened” by an anesthesiologist. This can happen directly in the operating room, or in the intensive care unit after some time.
By the way! Some people recover from general anesthesia for hours, experiencing the full range of symptoms listed above.
Possible consequences
General anesthesia is stress for the body, which during its action actually balances on the brink of life and death. Yes, everything happens under the control of a medical team, but still breathing almost stops, there are no reflexes, the heart beats very weakly. Therefore, consequences associated with disruption of the normal functioning of the cardiovascular and respiratory systems are not uncommon. This is manifested by a decrease or increase in pressure, spasms of the larynx and bronchi, sputum production, and hiccups.
Is it possible to make recovery from anesthesia easier?
Reduce intensity discomfort It is possible if you prepare properly for the operation. To do this, you need to openly tell your doctor about the illnesses you have suffered and your concerns, follow a diet, and conscientiously take the prescribed medications. If the patient is self-willed in preoperative preparation, eats in secret from doctors, runs around smoking or takes some pills, then this will create problems during surgery. Moreover, they will be associated not only with immersion in and recovery from anesthesia, but also with the course of the operation itself.
It is necessary to follow medical recommendations even after general anesthesia has stopped working. If your doctor allows you to get up and walk, you need to do this to prevent thromboembolism (blockage of the venous vessels). Some people are advised to simply move their legs for the same reason. It is not recommended to grab a book or smartphone immediately after waking up: it is better to rest and think about something good, for example, that everything is behind. And under no circumstances should you ignore the doctor’s instructions, which may vary depending on the type of anesthesia and the operation performed.
If the operation was not accompanied by severe complications and the anesthesiologist’s tactics were correct, the patient should wake up immediately after completion, as soon as the drug is turned off.
If the operation was long and anesthesia was carried out with ether, then the supply is reduced in the second half so that by the end of the operation the anesthesia weakens to a level close to awakening. From the moment the surgeon begins to suture the wound cavity, the supply of the narcotic substance stops completely. Without turning off the device, the oxygen supply is increased to 5-6 liters per minute with the simultaneous opening of the exhalation valve. The beginning of the patient's awakening is determined by the anesthesiologist depending on the progress of the surgical intervention and the characteristics of the course of anesthesia. The skill and experience of the anesthesiologist tells him at what point it is necessary to turn off the device.
Proper management of the patient in the post-anesthesia period is no less important than the anesthesia and surgery itself. Particularly important is the transition from artificial maintenance of the most important functions of the body, which is carried out by an anesthesiologist, to the natural activity of the body after anesthesia. With the correct course of the operation and anesthesia, as well as with the correct recovery from it, by the end of the operation the patient will fully restore active spontaneous breathing. The patient reacts to irritation of the trachea by the tube, consciousness is restored, he complies with the anesthesiologist's request to open his eyes, stick out his tongue, etc. During this period, the patient is allowed to be extubated. If anesthesia was administered through a tube passed through the mouth, then before extubation occurs, it is necessary to prevent biting the tube with the teeth. For this purpose, mouth openers and dental spacers are used. Extubation is most often performed at a certain moment, when the tone of the facial muscles, pharyngeal and laryngeal reflexes are clearly restored and the patient begins to wake up and react to the tube as if it were a foreign body.
Before removing the tube from the trachea, as already mentioned, mucus and sputum should be carefully sucked out from the mouth, endotracheal tube and trachea.
The decision to transfer a patient from the operating room to the ward is determined by his condition.
The anesthesiologist must ensure that breathing is sufficient and that there are no dysfunctions of the cardiovascular system. Respiratory failure most often results from the residual effects of muscle relaxants. Another cause of acute respiratory failure is the accumulation of mucus in the trachea. Suppression of the act of breathing sometimes depends on oxygen starvation (hypoxia) of the brain with low blood pressure and a number of other reasons.
If at the end of the operation the patient’s blood pressure, pulse and breathing are satisfactory, when there is complete confidence that complications will not follow, he can be moved to the postoperative ward. In case of low blood pressure, insufficiently deep breathing with signs of hypoxia, patients should be kept in the operating room, since dealing with complications in the ward always presents significant difficulties. Moving a patient to a ward in conditions of respiratory and circulatory disorders can lead to serious consequences.
Before delivering the operated patient to the ward, he should be examined. If the patient is wet from sweat or dirty during surgery, it is necessary to thoroughly dry him, change his underwear and carefully transfer him to a gurney.
Transferring the patient from the operating table should be done by skilled orderlies under the guidance of a nurse or doctor. Two or (when shifting very heavy, overweight patients) three persons are involved in shifting the patient: one of them covers the shoulder girdle, the second puts both hands under the pelvis, and the third under the straightened knee joints. It is important to instruct inexperienced attendants that when transferring, they should all stand on one side of the patient.
When transporting from the operating room to the ward, it is necessary to cover the patient so that cooling does not occur (this is especially true for elderly people). When transferring the patient to a gurney or stretcher, and then to a bed, the patient's position changes. Therefore, you need to be very careful that the upper part of the body, and especially the head, is not raised too much, since low blood pressure can cause anemia of the brain and respiratory distress.
The nurse anesthetist and the doctor who observed the patient during the operation and pain relief should follow the patient into the room, observe how he is transferred from the gurney to the bed, and help position him correctly. The ward nurse must know about the nature of the surgical intervention and must also monitor the correct and comfortable position of the patient. After general anesthesia, the patient is laid completely flat on his back, without a pillow, and sometimes with his head down to prevent vomit from flowing into the respiratory tract.
If it is cold in the ward, then you need to cover the patient with heating pads and cover him warmly. At the same time, overheating should not be allowed, since increased sweating results in dehydration of the body.
The nurse should ensure that the patient, covered with heating pads, does not develop a burn. She checks the temperature of the heating pad by touch, avoiding applying it directly to the body.
In the patient's room, a constant supply of humidified oxygen is installed. Oxygen-filled pillows should always be available to the nurse. Some surgical departments and clinics have special oxygen wards into which patients are placed after thoracic surgery. The oxygen cylinder is located in the ward or on the lower floor, where there is a control panel, from there oxygen is sent through pipes into the wards and supplied to each bed. Through a thin rubber tube inserted into the nasal passages, the patient receives a metered amount of oxygen. To humidify, oxygen is passed through the liquid.
Oxygen after surgery is necessary due to the fact that when a patient switches from breathing a mixture of drugs with oxygen to breathing with ambient air, acute oxygen starvation may develop with the phenomenon of cyanosis and increased heart rate. Inhaling oxygen by the patient significantly improves gas exchange and prevents the occurrence of hypoxia.
Most patients are transferred to the recovery room with a drip of fluid or blood. When transferring the patient from the table to the gurney, it is necessary to lower the stand on which the vessels with infused blood or solutions were located as much as possible, so that the rubber tube is stretched as little as possible, otherwise, with a careless movement, the needle may be pulled out of the vein and you will have to perform venipuncture or venesection again on the other limb . An intravenous drip is often left until the morning next day. It is needed to administer the necessary medications, as well as to infuse a 5% glucose solution or saline solution. It is necessary to strictly take into account the amount of fluid administered, which should not exceed 1.5-2 liters per day.
If anesthesia was carried out using the intubation method and the patient did not recover from the state of anesthesia for various reasons, in these cases the tube is left in the trachea until the patient fully awakens. The patient is transferred from the operating room to the room with the endotracheal tube not removed. Immediately after he is delivered to the ward, a thin tube from the oxygen system is connected to the tube. It is necessary that in no case does it cover the entire lumen of the endotracheal tube. The patient should be monitored very carefully during this period, since serious complications are possible due to biting the tube, pulling it out with an inflated cuff or a tamponed oral cavity.
For those patients who need to continue oxygen supply after surgery, it is recommended to replace the oral tube with a tube inserted through the nose. The presence of a tube allows you to remove phlegm that accumulates in the trachea by suctioning it through a thin tube. If you do not monitor the accumulation of sputum and do not take measures to remove it, then the presence of a tube can only harm the patient, since it deprives him of the ability to get rid of sputum by coughing.
The nurse anesthetist involved in the anesthesia should remain at the patient's bedside until the patient is fully awake and the danger associated with the use of anesthesia has passed. Then she leaves the patient with the ward nurse and gives her the necessary information and instructions.
It is always necessary to create favorable conditions for a postoperative patient. It is known that when a nurse is in the ward, the very fact that she is nearby brings relief to the patient. The nurse constantly monitors the state of breathing, blood pressure, pulse and, in case of changes, immediately informs the anesthesiologist and surgeon. During this period, the patient should not be left unattended for a single minute due to the fact that unpleasant complications may arise associated with both the operation itself and the administration of anesthesia.
In the post-anesthesia period, patients in a state of post-anesthesia sleep in a supine position may have a recessed tongue. Proper retention of the jaw in this case is one of the responsible tasks of the nurse anesthetist. To prevent the tongue from retracting, and at the same time difficulty breathing, the middle fingers of both hands are placed behind the corner of the lower jaw and, with light pressure, push it forward and upward. If before this the patient’s breathing was wheezing, now it immediately becomes smooth and deep, cyanosis disappears.
Another danger that the nurse should be aware of is vomiting. The greatest danger for the patient is the entry of vomit into the respiratory tract. After a long operation and anesthesia, the patient must be under continuous supervision of medical personnel. At the time of vomiting, it is necessary to support the patient’s head, turn it to one side, promptly place a barrel-shaped basin or a prepared towel, and then put the patient in order. The sister should have tongs with gauze balls for wiping the mouth, or if there is none, then in case of vomiting, you need to put the end of a towel on your index finger and wipe the cheek space with it, freeing it from mucus. In case of nausea and vomiting, the patient should be warned to refrain from drinking for some time.
It should be remembered that everything medications preventing vomiting after anesthesia is ineffective, so the most reliable helpers in this are peace, clean air and abstinence from drinking.
One of the frequent companions of the early postoperative period is pain. The pain expected in connection with the operation, especially in combination with the emotion of fear, was left behind. It would seem that the patient’s nervous system should be in a state of complete rest after the operation is completed. However, this condition does not always occur in the postoperative period, and here the pain factor associated with the operation begins to act with particular force.
Painful irritations, coming primarily from the surgical wound, especially bother patients in the first days after surgery. Pain has an adverse effect on all physiological functions of the body. To combat local pain, the operated patient strives to maintain a motionless position, which causes him painful tension. During operations on the chest and upper abdominal organs, pain limits the movement of muscles involved in the breathing process. In addition, pain prevents the restoration of the cough reflex and expectoration of sputum, sometimes for many hours and days. This leads to the accumulation of mucus, clogging the small bronchi, resulting in the creation of conditions for the development of pneumonia in the postoperative period, and in the immediate hours after anesthesia and surgery, acute respiratory failure of varying degrees may occur. If the pain lasts for a long time, then painful stimuli exhaust the patient, disrupt sleep and the activity of various organs. Therefore, the elimination of pain in the early postoperative period is the most important therapeutic factor.
To eliminate local pain in connection with the operation, there are many different techniques and means. In order to reduce pain syndrome in the immediate hours after surgery, before closing the chest, a paravertebral blockade is performed from the parietal pleura of 2-3 intercostal nerves above and below the surgical wound. This blockade is carried out with a 1% solution of novocaine. To prevent pain in the area of surgical incisions in the chest and abdominal walls, an intercostal blockade of nerve conductors with a 0.5-1% novocaine solution is performed on the operating table.
In the first days after the operation, those undergoing surgery, mainly due to pain in the wound, and partly due to uncertainty about the strength of the sutures or any other complications, are very careful, fearful and do not dare to change the position given to them.
From the very first day after surgery, patients should actively breathe and cough up sputum in order to prevent pulmonary complications. Coughing helps to straighten the lungs and prepares patients for physical activity.
To eliminate postoperative pain, various narcotic and sedatives are widely used - morphine, promedol, scopolomine mixtures, and, more recently, neuroplegics. After low-traumatic surgical interventions, pain is significantly reduced from the use of these substances. However, in most cases (especially after very traumatic operations), the effect of drugs is ineffective, and their frequent use and overdose lead to respiratory depression and blood circulation. Long-term use of morphine leads to addiction, drug addiction.
An effective method of combating postoperative pain was the use of therapeutic anesthesia, proposed by professors B.V. Petrovsky and S.N. Efuni. Therapeutic anesthesia or self-anesthesia according to the method of these authors is carried out in the postoperative period with nitrous oxide and oxygen in such ratios that are almost completely harmless. This mixture, even at a very high concentration of nitrous oxide (80%), is completely non-toxic. The method is based on the following principles:
- the use of a drug that does not have a depressing effect on the patient’s vital functions;
- ensuring sufficient pain relief in the postoperative period;
- normalization of respiratory function and hemodynamic parameters;
- the use of nitrous oxide with oxygen, which does not excite the vomiting and cough centers, does not irritate the mucous membranes of the respiratory tract and does not increase mucus secretion.
The self-anesthesia technique is briefly summarized as follows. After nitrous oxide and oxygen are established on the dosimeters in a ratio of 3:1 or 2:1, the patient is asked to pick up the mask from the anesthesia machine and inhale the gas mixture. After 3-4 minutes, pain sensitivity disappears (while maintaining tactile sensitivity), consciousness becomes clouded, and the mask falls out of your hands. With the return of consciousness, if pain arises again, the patient himself reaches for the mask.
If the operation was performed under endotracheal anesthesia, then slight pain is often felt when swallowing and talking. This is explained by the presence of infiltration of the mucous membrane of the larynx (from the endotracheal tube), pharynx (from the tampon). In the presence of such phenomena, the patient’s speech should be limited, various inhalations and gargling with an antiseptic solution should be used.
Patient care in the postoperative period is exclusively important It’s not for nothing that there is an expression “the sick person was taken out.” The nurse is directly involved in the organization of care and its practical implementation. At the same time, accurate, timely and high-quality implementation of all doctor’s prescriptions is very important.
The stay of patients in the recovery room in the first days requires especially careful monitoring by doctors. IN last years Along with the surgeon, the anesthesiologist is directly involved in the management of the immediate postoperative period, because in some cases it is much easier for him than for the surgeon to find out the causes of certain complications, and starting from the preoperative period, he carefully monitors the dynamics of the patient’s functional state. Along with this, the anesthesiologist is well acquainted with measures for the prevention and treatment of the most common respiratory and cardiovascular disorders in patients.
Taking into account the possibility of acute respiratory failure, the anesthesiologist in the first postoperative hours must have at the patient’s bedside everything necessary for tracheal intubation and artificial ventilation.
If respiratory failure becomes prolonged, the patient cannot cough up sputum well - a tracheotomy becomes necessary. This small operation usually greatly improves gas exchange conditions. It not only allows you to reduce the harmful space of the respiratory tract, but also creates conditions for the suction of mucus from the bronchi. Controlled or assisted breathing can be performed at any time through the tracheotomy cannula.
Blockage of the tracheotomy tube with secretions occurs when the patient has copious amounts of sputum. Given that after a tracheotomy the patient cannot effectively cough up sputum, it must be very carefully aspirated periodically.
The history of the use of anesthesia during operations goes back more than 160 years. Every year, hundreds of thousands of surgical interventions are performed around the world, during which patients are injected with substances that put them to sleep and relieve pain. There are still many myths and misconceptions associated with the use of anesthesia. Let's comment on the most popular of them.
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Anesthesia has many complications
At the first stages of the development of anesthesiology side effects during the use of general anesthesia occurred in 70% of cases. Today, complications of this kind are observed in 1-2% of patients undergoing surgery using anesthesia. As a rule, these are allergic reactions to injected substances. If the operation is performed with the participation of an experienced anesthesiologist-resuscitator, serious consequences can usually be avoided. The most serious complication of anesthesia is anaphylactic shock, but it occurs in only one patient out of ten thousand.
After anesthesia, some patients experience discomfort, which includes vomiting, nausea, dizziness, pain when swallowing, temporary memory loss, or confusion. All these symptoms disappear within a few hours of waking up.
Contrary to popular belief, general anesthesia does not negative impact for mental activity.
The use of anesthesia is not always justified
In domestic medicine, the situation is rather the opposite. Until now, many medical procedures in our country are carried out without pain relief, which is extremely difficult for patients and extremely inconvenient for doctors. This state of affairs is especially typical for dentistry: for many decades, almost all types of dental treatment (including very painful ones) were carried out “on the spot”. Today, Russian doctors are trying to use more gentle techniques. Changes are happening in better side, but still quite slow.
You may not wake up after anesthesia
The vast majority of patient deaths during operations are in no way related to the effects of medications used for anesthesia. Most often, the causes of death are an unforeseen situation that arises during the intervention process and the notorious human factor. During the operation, the patient’s life in the full sense of the word is in the hands of the anesthesiologist-resuscitator. Unfortunately, the shortage of such specialists in domestic hospitals is about 50%. Until this problem is resolved, there remains a risk that an overworked anesthesiologist will distract himself from the next patient at the wrong time or make some mistake.
Before the invention of anesthesia, patients rarely survived during and after operations
To a large extent this is true. In an era when surgical interventions were performed without pain relief, no more than 30% of patients survived operations. The likelihood that the patient would not survive the painful shock was very high, and the chances of survival directly depended on the qualifications and speed of the doctor’s work.
Under anesthesia, a person experiences erotic visions
A side effect of this kind does sometimes occur when sombrevin is used for anesthesia, a drug that until recently was used during short-term surgical interventions. Sombrevin is now prohibited due to the high risk of allergic reactions and a large number of contraindications.
The effect of anesthesia may be interrupted during surgery
An experienced anesthesiologist selects the drugs necessary for anesthesia in advance and calculates their dosage based on the patient’s weight and the characteristics of his condition. During the operation, medications are supplied to the patient’s bloodstream using automatic dispensers, and equipment that monitors vital parameters controls the amount of incoming solutions and corrects the process in case of any deviation from the norm. Therefore, the statement that you can wake up before the end of the operation due to “lack of anesthesia” is not true.
