Fear of pain is one of the most ancient and frightening. Pain can deprive consciousness, reason and lead to death from pain shock. The question of anesthesia before mankind arose at the very moment when various manipulations with the body, skin, and organs began to be carried out. And if many years ago anesthesia was "yard" (distracted, allowed to scream, given a lethal dose of alcohol), then in our time medicine has stepped forward so much that there are a great many methods of anesthesia and with each new discovery it is easier to endure a new method of anesthesia, and side effects he has less and less effects.
Types of anesthesia
For a better understanding, consider the basic methods of anesthesia.
1) Local anesthesia.
From the name it is clear that the zone of its action is determined locally. The person remains conscious, and there are few side effects and undesirable consequences of this type of anesthesia. Most commonly used:
- Superficial (application) - used in medicine (dentistry, otorhinolaryngology, cosmetology, gynecology) when you need to anesthetizesmall area of skin. The sensitivity of the site is lost, the patient feels numbness. The anesthetic may be in the form of a gel, aerosol, spray, or solution.
- Infiltration - the introduction of a drug that blocks nerve impulses is performed subcutaneously, by injection.
- Conductor - the drug is injected into the paraneural space, which causes a blockade of impulses along a large nerve trunk. This is a more serious type of local anesthesia, it is used in operations on the limbs, thyroid gland, and so on.
- Spinal - the introduction of anesthetic occurs in the cerebrospinal fluid using a thin needle. The sensitivity of the lower segment of the abdomen and limbs is lost. Used during operations in the lumbar spine, legs, etc.
- Epidural is an anesthesia widely used in childbirth and caesarean section. The difference from spinal - the introduction occurs with the help of a catheter into the epidural space, and the blocking of impulses does not occur at the level of the roots of the spinal nerves, but the nerve endings of the spinal cord are completely blocked.
2) General anesthesia.
During general anesthesia, the work of the central nervous system is completely inhibited, the person is unconscious, the skeletal muscles are relaxed, there is no pain sensitivity. General anesthesia requires careful selection of drugs by an anesthetist, recovery after it is more difficult, often a ventilator is required to restore breathing aftergeneral anesthesia. Types of General Anesthesia:
- inhalation - anesthetics are administered through the respiratory tract, mask, endotracheal, endobronchial devices are used;
- non-inhalation - administration occurs intravenously, intramuscularly (depending on the number of drugs administered and their combinations - mononarcosis, mixed anesthesia, combined anesthesia).
For patient safety and global pain relief, a combination of inhaled and non-inhaled pain relief is sometimes used.
Let's take a closer look at one of the most common types of non-inhalation anesthesia - total intravenous anesthesia, what it is, how it is performed, etc.
An alternative to inhalation anesthesia
abbreviated TBVA is a type of general anesthesia used for operations that do not require muscle relaxation. A feature of this method is the combination of several drugs in smaller doses than if each of them were needed separately. Thus, the negative side effects on the body from each drug are reduced. Anesthetics in TVVA are supplemented with tranquilizers, antipsychotics, hypnotics, analgesics, as a result, the combination of several drugs enhances the effect of anesthesia.
Why TVBA?
It is necessary to focus on total intravenous anesthesia, because it is in Russia that the inhalation type of anesthesia cannot yet become widespread. The reason is the lack of modernanesthetics and low-flow anesthetics. Intravenous administration of anesthetic drugs helps facilitate recovery from anesthesia, adjust the dosage.
Method benefits
- To carry out such anesthesia is technically simple.
- Reliability, intravenous anesthetic can be administered in fractional doses.
- The introduction to the state of sleep occurs quickly, almost instantly.
- Physiological sleep.
- Due to the joint action with tranquilizers, the patient does not have an excitation phase (no fears and anxiety).
- Individual approach to each patient - it is possible to calculate the effective chemical structure of the anesthetic in each individual case.
Books about TVVA
Smith's book "Total Intravenous Anesthesia" is a good quality desktop guide for anesthesiologists. Before the appearance of the Russian-language edition, there were no such books in Russian medicine.
In his book, Smith, in collaboration with White, de alt with the following topics in detail and competently:
- total intravenous anesthesia - concept, technique, its scientific basis;
- history of the origin of intravenous anesthesia;
- TVBA methods;
- pharmaceutical analysis of drugs used in this type of anesthesia;
- advantages and disadvantages of TVBA;
- conduction and influence of TVVA for certain groups of patients;
- monitoring the action of anesthetics during anesthesia;
- what is the futureawaiting intravenous anesthesia.
Preparing for TVBA
Total intravenous anesthesia is one of the simplest types of anesthesia, and the preparation for it is also quite primitive. An anesthesiologist examination, bowel movement (or enema) is required. It is better not to eat before anesthesia (or the day before) so that a gag reflex does not occur. If required, medical preparation is carried out, the patient is given or administered drugs that stabilize the psycho-emotional state.
Selection of an anesthetic agent, auxiliary drugs and their dosages are selected personally and individually by an anesthesiologist. The calculation is always carried out for each specific case.
Technique
There are two main types of drugs used in total intravenous anesthesia: hypnotic and analgesic, so there are several infusion strategies. For most operations, the technique is as follows: the rate of hypnotic infusion does not change throughout the operation, and the analgesic is changed depending on the intensity of the surgical intervention (the patient's reaction is also taken into account). It happens that they act and vice versa: the rate of infusion of the analgesic is maintained at a constant level, the introduction of the hypnotic is changed.
The first method has an advantage in the form of a quick awakening of the patient at the end of the operation. Therefore, this technique is used more often, but the pharmacokinetics of drugs should be taken into account and proceed from the characteristics of the operation and the condition.patient.
Precautions
No matter how simple the use of intravenous anesthesia may seem, it is necessary to treat the choice of an anesthesiologist, the selection of drugs as carefully as possible. Unfortunately, things are not always easy. Qualification of the staff, constant monitoring of the patient after the end of the operation, correctly calculated dosages, control of homeostasis systems will help to get out of anesthesia easily and without negative consequences and memories.
