Local anesthesia: types, methods, preparations. Anesthesia and Narcosis: How They Work and Should You Be Afraid of Them Types of Anesthesia by Method of Administration

long time people sought to alleviate suffering, conquer pain. For centuries, scientists have invented methods to eliminate unbearable discomfort during surgical operations. And only when anesthesia was invented, it became possible.

a brief description of

Anesthesia is a temporary loss of pain sensitivity. AT ancient time decoctions, infusions, ice, poppy seeds, alcohol, dope were used for pain relief. Everything was used that could dull the sensation of pain even a little.

The discovery of the anesthetic properties of cocaine laid the foundation for local anesthesia. However, the pronounced dependence and high toxicity were huge disadvantages of this method. Later, the drug "Novocain" appeared, which in 1905 was used for local anesthesia.

It is even difficult to imagine how many procedures were performed without the relief effect of an analgesic. Anesthesia is a unique opportunity:

• relieve the patient of discomfort and pain;
• create the necessary conditions for the operation by the surgeon.

Main types

Each method of anesthesia has its own mechanism of action on human body, complexity and methodology. Today, several types of it are known:

• local anesthesia;
• regional;
• conductive;
• general anesthesia.

The first three types of anesthesia is the interruption of the transmission of impulses from tactile, temperature, pain receptors through the nervous system. The depth, duration and area of ​​anesthesia depend on the drug, its volume and concentration, as well as the method and site of administration. For these anesthesia medicines are used:

• "Lidocaine".
• "Novocaine".
• "Markain".
• "Bupivacaine".
• "Naropin".

Local anesthesia

A fairly common type is a great chance to perform simple and small operations. It is widely demanded in dentistry, some surgical interventions. Local anesthesia is anesthesia that is produced in several ways. Let's consider them.

Injection anesthesia

This method is based on the introduction of an anesthetic in layers. Initially, the drug is injected intradermally with a thin needle. The so-called "lemon peel" is formed. Next, a longer needle is used, which infiltrates the necessary tissues in layers. Nerve endings are blocked in the area of ​​operation. For this procedure, solutions with a concentration of 0.125-0.5% are used.

The patient does not experience pain, but discomfort remains.

Anesthesia application

What is this anesthesia? This procedure involves the use of a gel, ointment, patch, emulsion for a small area of ​​skin or mucous. Such anesthesia has a short-term and superficial character. It is used for low-pain procedures on a small area of ​​the skin.

Possible complications with such anesthesia are allergic reactions.

Conduction anesthesia

This procedure is performed by a surgeon, most often an anesthesiologist. So - what is it? This is the name of the introduction into the region of conducting nerves or the nerve trunk at some distance from the operated area. This allows you to achieve a blockade of the conduction of impulses.

Such manipulation does not exclude the risk of damage to a nearby vessel with the formation of significant hematomas. Damage to both the nerves and the trunk is also possible. Unpleasant consequences can lead to a long-term violation of skin sensitivity, loss of functioning of muscle tissues. The patient will need a long recovery period.

Regional anesthesia

This anesthesia is performed by an experienced anesthesiologist. This is the most popular method. Regional anesthesia is used for painful, voluminous and traumatic operations. There are two types of influence.

spinal anesthesia

This procedure is also called subarachnoid or spinal. It involves the injection of a local anesthetic into the spinal canal. A thin special needle is used, which injects 1-3 ml of the drug into strictly defined places.

This is a 100% guarantee that the spinal cord will not be accidentally damaged. This "error" is completely eliminated, since the anesthetic is injected at special levels where the spinal cord is absent.

The analgesic effect is achieved after 1-3 minutes. At the same time, depending on the anesthetic, it lasts from 40 to 120 minutes.

Manipulation is painless. Provides excellent analgesic effect. Due to the blockade of impulses, complete relaxation of the muscles is achieved.

Epidural anesthesia

Such a manipulation in terms of efficiency and technique of execution is quite similar to the spinal one. However, epidural anesthesia has its own differences. This is, firstly, the larger diameter of the needle. Secondly, when administered, it is not brought to the spinal canal. Anesthetic in the required amount (usually 10 to 20 ml) is distributed over the meninges. It washes the motor and sensory nerve roots.

If we talk about the duration, then epidural anesthesia is pain relief for 40-120 minutes. Exactly the same as with the spinal technique. However, this method has a great advantage. Through the lumen of the needle, it is possible to pass a special catheter into the epidural space. This makes it possible to administer the anesthetic, if necessary, again. Thus, it is possible to prolong pain relief up to 7-8, and sometimes more hours.

The severity of this anesthesia depends on the administered drug, its concentration and dose. This technique of anesthesia is widely demanded in most surgical interventions. Epidural anesthesia is used during childbirth, caesarean section. It is indispensable in the treatment of various chronic pain syndromes.

Possible consequences

If we touch on complications, then it should be emphasized that they are extremely rare. Patients after regional anesthesia may experience:

1. Headache. Patients face it after a spinal technique.
2. Pain in the spine. Discomfort can be felt for a long time. This phenomenon is observed after the epidural method.
3. Pressure drop. There is an expansion of many small vessels. This causes a sharp redistribution of the blood flow to the periphery from the central channel.
4. Epidural hematoma after vascular plexus injury. It is typical for people with low hematoma that puts pressure on the spinal roots. The patient feels a violation of skin sensitivity in this area and pain.
5. Total spinal block. The most severe complication, which is practically not treatable and threatens the life of the patient. It is extremely rare. An accidental puncture of the dura mater can provoke such a pathology, in which an amount of anesthetic intended for epidural injection enters the spinal canal.

General anesthesia

With this procedure, the cerebral cortex and some subcortical structures are inhibited. With deep anesthesia, even the respiratory ones are affected and, however, pain impulses still enter the brain. At the same time, their perception, as well as the response, is suppressed.

The main types of general anesthesia are:

• intravenous;
• inhalation.

Conclusion

Despite the possible complications of each type of anesthesia, such effects are extremely rare. Positive results are achieved thanks to the capabilities and knowledge of the anesthesiologist. It is he who can foresee possible difficulties and complications in advance. Accordingly, the doctor will offer the best method of pain relief, as well as take all measures to prevent unpleasant consequences.

During the operation, constant hardware and laboratory monitoring is carried out. Pressure, heart function, blood oxygen saturation are automatically controlled. With long-term interventions, additional studies are carried out that control all the vital functions of the body.

What lies behind the mysterious words “anesthesia”, “narcosis”, general anesthesia” and what types of anesthesia are there during surgery? Anesthesia is a decrease in the sensitivity of a part or the whole body, as well as a complete cessation of the perception of information about one's own state. Types of anesthesia - methods of introducing anesthesia during operations. Any operation under anesthesia is a risk for the doctor and for the patient, so it is necessary to carefully approach the choice of anesthesia

What do you need to know for a patient undergoing surgery under anesthesia? Why is anesthesia required for the operation?

The tasks solved by the modern anesthesiology service can be described as follows:

Creation optimal conditions for the work of the surgeon during surgery, which, therefore, determines the level of quality of surgical treatment,

Providing safe, effective pain relief for patients during surgery,

Ensuring and maintaining the life of the patient before, during and after surgery,

Protecting the patient from aggressive environmental factors acting on his body (biological, infectious, physical, chemical, etc., including surgical aggression).

What is multicomponent anesthesia?

General anesthesia or anesthesia, or rather, multicomponent anesthesia, is a toxic, controlled, drug-induced coma. A condition characterized by a temporary shutdown of consciousness, pain sensitivity, reflexes and relaxation of skeletal muscles.

What are the types and methods of anesthesia?

Depending on the ways of introducing drugs into the body, there are:

• Local anesthesia and its varieties:

Terminal,

infiltration

Conductor

Plexus

epidural

spinal

Caudal

Intraosseous

Intravenous under a tourniquet.

Methods of conduction, plexus, epidural, spinal, caudal, intraosseous and intravenous tourniquet anesthesia are combined into a group of methods regional anesthesia.

Regional methods of anesthesia characterized by the achievement of the effect of anesthesia, switching off conduction in a particular nerve or plexus of nerves, while maintaining the consciousness and breathing of the patient. Which in some cases may be the only safe way to conduct surgery, from the standpoint of preserving the vital functions of the body in patients with severe concomitant somatic pathology, as well as in aged patients.

• Inhalation anesthesia

General anesthesia, known to patients under the name "mask anesthesia", provided with the help of easily evaporating (volatile) liquids: inhalation anesthetics (halothane, methoxyflurane, pentran or gaseous narcotic substances - nitrous oxide, cyclopropane, etc.) entering the patient's body through the respiratory tract the patient is called "inhalation anesthesia". To date, this technique pure form most often used in pediatric practice. In adult patients, as a rule, only as part of a "combined anesthesia". It should be noted that today inhalation anesthetics are quite safe drugs for the body, as they are quickly excreted from the body when breathing through the lungs, and their residues are completely destroyed by liver cells. In addition, inhalation anesthesia is considered a well-managed type of anesthesia, which makes it the method of choice in patients with diseases of the respiratory and cardiovascular systems.

· Non-inhalation anesthesia

The type of general anesthesia achieved by modern non-inhalation anesthetics, that is, drugs that are administered intravenously - "total intravenous anesthesia", or in another way, for example, intramuscularly - "intramuscular anesthesia". The advantages of intravenous general anesthesia are the rapid introduction into anesthesia, the absence of arousal, and a pleasant falling asleep for the patient. However, narcotic drugs for intravenous administration create short-term anesthesia, which makes it impossible to use them in their pure form for long-term surgical interventions.

• Combined anesthesia

Anesthesia achieved by the simultaneous or sequential use of its different methods related to the same type of anesthesia (for example, inhalation and non-inhalation). Recently, the most widespread neuroleptanalgesia. With this method, nitrous oxide with oxygen, fentanyl, and droperidol are used for anesthesia. muscle relaxants. Introductory anesthesia intravenous. Anesthesia is maintained by inhalation of nitrous oxide with oxygen and fractional intravenous administration of fentanyl and droperidol. This type of anesthesia is safer for the patient.

• Combined anesthesia

At the same time, methods of different types of anesthesia (local and general) are used.

Today, the most commonly used methods in the practice of an anesthesiologist are methods of both combined and combined anesthesia. Since the rational combination of the positive qualities of modern drugs, and the exclusion of their side effects and complications, guarantee reliable, safe enough for the patient, pain relief.

At endotracheal method of anesthesia the narcotic substance enters the body from the anesthesia machine through a tube inserted into the trachea. The advantage of the method is that it provides free airway patency and can be used in operations on the neck, face, head, eliminates the possibility of aspiration of vomit, blood; reduces the amount of drug used; improves gas exchange.

What are the main steps in anesthesia?

Drugs cause characteristic changes in all organs and systems. During the period of saturation of the body with a narcotic drug, a certain regularity (staging) is noted in the change in consciousness, respiration, and blood circulation. In this regard, there are certain stages that characterize the depth of anesthesia.

There are 4 stages: I - analgesia, II - arousal, III - surgical stage, divided into 4 levels, and IV - awakening.

Are there complications with anesthesia?

Complications during anesthesia may be associated with the technique of anesthesia or the effect of anesthetics on vital organs.

One of the complications is vomiting. Against the background of vomiting, aspiration is dangerous - the entry of gastric contents into the trachea and bronchi, which may result in respiratory failure with subsequent hypoxia - this is the so-called Mendelssohn's syndrome.

Respiratory complications may be associated with impaired airway patency.

Complications of tracheal intubation can be grouped as follows:

1) damage to the teeth by the laryngoscope blade; 2) damage to the vocal cords; H) the introduction of an endotracheal tube into the esophagus; 4) introduction of an endotracheal tube into the right bronchus; 5) exit of the endotracheal tube from the trachea or its kink.

Complications from the circulatory organs: a) hypotension - decrease blood pressure both during the period of induction into anesthesia and during anesthesia, it can occur due to the effect of narcotic substances on the activity of the heart or on the vascular-motor center. b) Heart rhythm disturbances (ventricular tachycardia, extrasystole, ventricular fibrillation). c) Cardiac arrest is the most formidable complication during anesthesia.

Cerebral edema.

Peripheral nerve damage.

Treatment of complications is immediate cardiopulmonary resuscitation. The frequency of occurrence, severity of complications and their outcome, as a rule, depend on the quality of anesthesia care.

What is meant by the term "anesthetic care"?

Anesthetic care for patients includes:

Assessment of the condition of patients before surgery, determination of anesthetic and operational risk;

Determining the feasibility and conducting, if necessary, intensive therapy in order to prepare the patient for surgery;

Appointment of premedication (drug preparation for anesthesia);

The choice of the method of anesthesia and the necessary means;

Anesthesiological support for planned and emergency operations, dressings and complex diagnostic studies;

Monitoring the condition of patients during anesthesia and conducting corrective therapy in order to prevent and eliminate life-threatening functional and metabolic disorders;

Awakening of patients after general anesthesia, if there are no indications for prolonged maintenance of drug-induced sleep;

Elimination of pain syndrome due to various causes (including incurable diseases) using special methods.

Are there any restrictions for anesthesia?

It should be noted that today there are no restrictions for anesthesia by age, or by the patient's somatic pathology. And there are only indications or contraindications for carrying out this or that technique of anesthesia. The choice of anesthesia technique is the right of the anesthesiologist-resuscitator and is determined by the level of his professional training and personal competence.

How to prepare a patient for anesthesia?

• The anesthesiologist examines the patient before the operation, while not only paying attention to the underlying disease, for which the operation is to be performed, but also finds out in detail the presence of concomitant diseases.
• If the patient is operated on in a planned manner, then, if necessary, they treat concomitant diseases, sanitize the oral cavity.
• The doctor finds out the allergic history (whether all drugs and substances are tolerated by the patient).
• Clarifies whether the patient has undergone surgery and anesthesia in the past.
• Draws attention to the shape of the face, chest, the structure of the neck, the severity of subcutaneous fat.

All this is necessary to choose the right method of anesthesia and narcotic drug.

• An important rule in preparing the patient for anesthesia is the cleansing of the gastrointestinal tract (gastric lavage, cleansing enemas).
• Before the operation, the patient is given special medical preparation - premedication:

Sleeping pills are given at night, and tranquilizers (seduxen, relanium) are prescribed for patients with a labile nervous system a day before surgery.

40 minutes before the operation, narcotic analgesics and 0.5 ml of a 0.1% solution of atropine are administered intramuscularly.

Immediately before the operation, the oral cavity is examined, removable teeth and dentures are removed.

How can you control the depth and effectiveness of the course of anesthesia?

During general anesthesia, the main parameters of hemodynamics are constantly determined and evaluated. Blood pressure and pulse rate are measured every 10-15 minutes.

To determine the level of anesthesia, BIS monitors can be used, which determine the electroencephalographic depth of sleep and muscle relaxation in the patient. -

To control ventilation of the lungs and metabolic changes during anesthesia and surgery, a study of the acid-base state (P O2, P CO2, pH, BE) of the patient's blood is carried out.

How is the course of anesthesia legally formalized?

During anesthesia, an anesthetic card of the patient is kept, in which the main indicators of homeostasis are necessarily recorded: pulse rate, blood pressure, central venous pressure, respiratory rate, ventilation parameters. This card reflects all stages of anesthesia and surgery, indicates the doses of narcotic substances and muscle relaxants .All drugs used during anesthesia are noted, including transfusion media. The time of all stages of the operation and the administration of drugs is recorded. At the end of the operation, the total amount of all drugs used is determined, which is also noted in the anesthesia card. A record is made of all complications during anesthesia and surgery. The anesthesia card is embedded in the medical history.

Anesthesia (Greek ἀναισθησία - without feeling) - a decrease in the sensitivity of the body or part of it up to the complete cessation of perception of information about the environment and one's own state.

Why is anesthesia required for the operation?

The tasks solved by the modern anesthesiology service can be described as follows:

• creation of optimal conditions for the work of the surgeon during surgery, which, therefore, determines the level of quality of surgical treatment,
• providing safe, effective pain relief for patients during surgery,
• ensuring and maintaining the life of the patient before, during and after surgery,
• protection of the patient from aggressive environmental factors acting on his body (biological, infectious, physical, chemical, etc., including surgical aggression).

Anesthesiological care in general includes a wide range of tasks:

• preliminary assessment of the patient's condition in order to identify anesthetic risk,
• if necessary, intensive care for the patient in order to prepare him for surgery,
• premedication or drug preparation for anesthesia,
• choice of anesthesia method and drugs,
• the use of anesthesia for emergency and planned surgical operations, dressings and diagnostic studies,
• monitoring the patient's condition during anesthesia, prescribing medication correction in order to prevent life-threatening metabolic and functional disorders,
• awakening the patient after general anesthesia,
• elimination of pain syndrome in certain diseases (oncology and other incurable diseases) and other conditions.

Kinds

• General anesthesia or general anesthesia

Local anesthesia and its varieties

Local anesthesia is a reduction or complete cessation of the sensitivity of a certain part of the body.

There are the following types of local anesthesia:

1. Application.
2. Infiltration.
3. Conductor.
4. Spinal.
5. Epidural.

Application (surface) anesthesia is performed by applying an anesthetic to the area of ​​the mucous membrane or skin.

In this case, the anesthetic penetrates into the deeper layers of the tissue, causing dysfunction of nerve receptors and loss of sensitivity.

Application anesthesia is used for painful procedures in dentistry, cosmetology, otorhinolaryngology, gynecology, urology, etc.

Drugs that are used for local anesthesia (lidocaine, tetracaine, camistad, inocaine, EMLA, proxymetacaine, xylocaine, etc.) can be in various forms: aerosols, ointments, gels, sprays, solutions.

A contraindication for the use of application anesthesia is an individual intolerance to any drug. A complication of surface anesthesia is an allergic reaction, most often redness, slight swelling.

With infiltration anesthesia the anesthetic is injected. At the injection site, there is a blockade of the conduction of nerve impulses.

Infiltration anesthesia technique:

1. First, the anesthetic is injected intradermally.
2. Each new portion of the drug is injected into the edge of the nodule, which was formed by the previous injection. This creates an infiltrate from the anesthetic drug over the area of ​​​​the future incision.
3. Then the subcutaneous tissue is infiltrated.
4. Only after that, an incision is made with a scalpel of the skin and subcutaneous tissue.
5. Then layer-by-layer infiltration of muscle tissue with an anesthetic is performed.

Drugs that are used for infiltration anesthesia: novocaine, lidocaine, ultracaine.

Contraindications and complications. A contraindication for this type of anesthesia is hypersensitivity to anesthetic drugs. Complications with infiltration anesthesia are rare, most often these are allergic reactions.

Conduction anesthesia

An anesthetic drug is injected into the paraneural space, which causes a blockade of impulse transmission along a large nerve trunk.

The method is used during operations on the upper and lower extremities, thyroid gland, genitals, and dental operations.

Complications of conduction anesthesia. The most severe complication is neuropathy, and allergic reactions may also occur.

Spinal anesthesia is used when performing operations on the lower extremities, in the lumbar spine, some operations on the genitals, etc.

For anesthesia, procaine, tetracaine is used. lidocaine, bupivacaine.

Complications of spinal anesthesia: transverse myelitis, meningitis, anterior horn syndrome, etc.

Epidural anesthesia

With this method of anesthesia, anesthetics are injected into the epidural space of the spine through a catheter, while blocking the transmission of impulses along the nerve endings of the spinal cord.

The method can be used as an addition to general anesthesia in some operations, during caesarean section, for postoperative pain relief, often used during childbirth, caesarean section.

The most commonly used epidural blockades are lidocaine, ropivacaine, and bupivacaine.

Complications: epidural hematoma, high blockade, spasms, paralysis.

Indications for local anesthesia

• Small abdominal operations, operations on soft tissues;
• severe comorbidity;
• refusal of the patient from general anesthesia;
• gerontological (age) group of patients.

Contraindications for the use of local anesthesia

• Refusal of the patient;
• allergy to anesthetics;
• mental illness;
• large volume of operation;
• cicatricial tissue changes in the area of ​​surgical intervention.

General anesthesia

General anesthesia or general anesthesia is a reversible depression of the central nervous system, accompanied by a loss of pain sensitivity, consciousness, memory, relaxation of skeletal muscles.

This state is achieved with the introduction of one or more anesthetic drugs, the dose of which is selected individually by the anesthesiologist, depending on the type and duration of the surgical intervention and the individual characteristics of the patient.

By the number of drugs used, there are:

1. Mononarcosis (one agent is administered for anesthesia).
2. Mixed anesthesia (two or more drugs are administered simultaneously).
3. Combined anesthesia (use of anesthetics with analgesics, muscle relaxants, gangioblockers, etc.).

Allocate inhalation and non-inhalation anesthesia.

With inhalation anesthesia, anesthetic drugs are administered through the respiratory tract.

Inhalation anesthesia happens (depending on the method of administration of anesthetics):

1. Mask.
2. Endotracheal
3. Endobronchial.

Non-inhalation anesthesia achieved by the introduction of anesthetics intravenously, intramuscularly, rectally, etc.

The following drugs are used for anesthesia: nitrous oxide, chloroform, halothane, xenon, ketamine, halothane, propofol and many others.

As a rule, intracavitary surgical interventions are performed using combined endotracheal anesthesia with mechanical ventilation.

Out-of-cavitary operations can be performed with the patient's spontaneous breathing using mononarcosis.

Complications of general anesthesia. Severe complications of anesthesia are now rarely recorded, these are inadequate recovery of spontaneous breathing, respiratory arrest, arrhythmia, bradycardia, convulsions, cardiac arrest.

Contraindications to anesthesia (general anesthesia)

Pediatric anesthesiologists believe that in order to reduce the risk of complications, it is necessary to postponeanesthesia in childrenunder the following conditions:

1. Acute respiratory diseases.
2. Acute infectious diseases.
3. Severe malnutrition.
4. Pyoderma (purulent rashes on the skin).
5. Pronounced rickets.
6. Condition after vaccination (less than 10-14 days).
7. Hyperthermia of unknown nature.

In adults, the following pathological conditions will be contraindications to anesthesia performed during elective operations.

Combined and combined anesthesia

Most of the currently used methods of combined and combined anesthesia.

Combined anesthesia- simultaneous or sequential use of different methods of the same type of anesthesia (for example, inhalation and non-inhalation).

The simultaneous use of local and general anesthesia during a surgical operation is called combined anesthesia.

Treatment of complications

In mild cases, it is recommended to inhale oxygen and relieve convulsions by administering barbiturates in narcotic doses; in case of severe complications, cardiac and vasoconstrictor agents should be administered, blood substitutes should be transfused, mechanical ventilation should be performed through a mask or endotracheal tube, heart massage and the whole complex of resuscitation measures.

As is known, the composition of the anesthetic solution often includes adrenaline, a vasoconstrictor that increases the duration of anesthesia and reduces the resorption of the anesthetic, and hence its toxicity. This kind of "chemical tourniquet" allows you to get a good analgesic effect at lower concentrations of local acesthetic. However, an overdose of adrenaline can cause intoxication in the form of anxiety, fear, tremor, cold skin, shortness of breath, headache; in severe cases, there are cardiac arrhythmias, ventricular fibrillation.

Possible complications such as allergic reactions due to individual hypersensitivity to a particular anesthetic, they manifest as urticarial rash, edema, bronchospasm and laryngospasm, in severe cases, anaphylactic shock is possible. In the treatment of anaphylactic reactions, corticosteroids, antihistamines are used, and for bronchial spasms, oxygen inhalations, broncho- and antispasmodics are used.

Prevention of possible complications of local anesthesia are: purposeful clarification of anamnestic data on increased individual sensitivity to the drug, a clinical examination to identify contraindications, careful adherence to dosages of anesthetics and anesthesia techniques that avoid intravasal injections of the solution.

Inadequate anesthesia, the so-called "hypoesthesia", should also be considered a complication of local anesthesia. It is possible with a protracted operation or neglect of certain methodological techniques. If additional injections of anesthetic solution do not provide adequate anesthesia, then diazepam or small doses of fentanyl should be administered. If these measures are ineffective, they switch to general anesthesia.

Types of anesthesia in dentistry

Anesthesia is divided into local and general (narcosis). It is also customary to distinguish between drug and non-drug pain relief.

There are several types of non-drug anesthesia :

• audioanalgesia;
• electroanalgesia;
• anesthesia through hypnotic effects;
• computer anesthesia.

Drug anesthesia involves the injection of an anesthetic that blocks the conduction of an impulse for the time necessary for medical intervention. After a certain period of time, the drug breaks down, and the sensitivity is fully restored. Modern painkillers allow you to completely avoid discomfort during treatment.

General anesthesia in dental treatment is used relatively rarely and in the presence of special indications. Most often it is used in maxillofacial surgery.

Local anesthesia in dentistry

Most procedures are preceded by local anesthesia. For the body, it is much safer than anesthesia. Until recently, the most common anesthetics were Novocaine and Lidocaine, but more effective drugs are now being used.

There are several types of local anesthesia:

• application;
• infiltration;
• conductive;
• intraligamentary;
• intraosseous;
• stem.

1. Application anesthesia. It is an anesthesia that provides superficial anesthesia. It is carried out by spraying or applying the drug in the form of an ointment to the mucous membrane of the oral cavity. The most commonly used is 10% Lidocaine in aerosol cans. Application anesthesia is indicated to reduce the sensitivity of soft tissues at the site where the injection will be made, as well as in the treatment of the mucous membrane (for stomatitis and gingivitis) and the opening of small suppurations. In therapeutic practice, it can be used before removing mineralized deposits in the cervical region, and in orthopedic practice, when preparing a tooth for prosthetics (turning).
2. infiltration anesthesia. Infiltration anesthesia allows you to anesthetize one tooth or a small area of ​​the mucosa. It is practiced in the removal of the neurovascular bundle, as well as in the treatment of deep caries. The injection is usually carried out in the projection of the root apex. In this case, the anesthetic drug blocks the conduction of the pain impulse at the level of the nerve branch. Most often, the upper teeth are anesthetized in this way, since the relatively small thickness of the bone of the upper jaw allows the anesthetic to penetrate relatively easily to the nerve endings.
3. Conduction anesthesia. It is needed when infiltration does not give the desired effect, or it is required to anesthetize several adjacent teeth. It is also used for extirpation of teeth, opening of abscesses in periostitis and exacerbation of chronic periodontitis, as well as for draining a purulent focus. An anesthetic injection will allow you to temporarily “turn off” the entire nerve branch. Most often, tuberal and palatal conduction anesthesia is performed before interventions on the upper jaw (if necessary, they are supplemented with incisive anesthesia), and for anesthesia mandible- torusal or mandibular.
4. Intraligamentary (intraligamentous) local anesthesia. Often practiced in pediatric dentistry in the treatment of deep caries and its complications, as well as in cases where the tooth is to be removed. Injection of the drug is carried out in the periodontal ligament, which is located between the wall of the alveoli and the root of the tooth. At the same time, the mucous membranes do not lose their sensitivity, which excludes the child from accidentally biting the cheek, tongue or lip.
5. Intraosseous anesthesia. It is indicated during the operation for the extirpation of the tooth. First, an anesthetic is injected into the gums, and after the onset of local numbness, into the spongy layer of the jawbone in the interdental space. In this case, only the sensitivity of a certain tooth and a small area of ​​\u200b\u200bthe gum disappears. The effect develops almost instantly, but lasts a relatively short time.
6. Stem anesthesia. Carrying out stem anesthesia in dentistry is possible only in a hospital setting. Indications for its implementation can be pain of a high degree of intensity, neuralgia (in particular, of the facial nerve), as well as serious injuries of the jaws and zygomatic bone. This type of anesthesia is also practiced before the start of surgical interventions. An anesthetic injection is carried out in the region of the base of the skull, which allows you to immediately turn off the maxillary and mandibular nerves. The effect of stem anesthesia is characterized by power and long duration.

Contraindications

Before performing anesthesia, the dentist must definitely find out if the patient has serious somatic diseases or allergies to medications.

Contraindications to the use of painkillers can be :

• allergic reactions after the administration of anesthetics;
• acute cardiovascular diseases in history (heart attacks or strokes less than six months ago);
• diabetes;
• some other hormonal disorders against the background of pathologies of the endocrine system (thyrotoxicosis, etc.).

Important: In decompensated forms of endocrine diseases, the patient should be treated exclusively in a hospital. Particular care must be taken when conducting anesthesia for children and pregnant women.

Latest Research

Anesthesia doesn't work the way it was thought for decades, scientists have found. The results of the study were published in the journal PLOS Computational Biology.

Previously it was assumed that anesthesia blocks consciousness, disrupting the transfer of information between different parts of the brain. A decrease in the amount of information transmitted between brain regions has been experimentally confirmed. But scientists were haunted by the question: what if not the amount of information decreased due to a violation of connections, but vice versa? They conducted an experiment with ferrets, making them unconscious with the help of isoflurane, an anesthetic drug, and monitoring the changes in the brain. It turned out that the reduction in the amount of information occurs in the original area, the prefrontal cortex, and not on the way to other zones. It turned out that it was not that the information could not be transmitted, but that there was simply nothing to transmit.

However, the authors of the work are careful with the conclusions and emphasize that other studies are needed to unambiguously confirm this hypothesis. They also hope that further work in this area will answer one of the most important questions in neuroscience - where consciousness comes from.

Anesthesia is one of the miracles of medicine, with the help of which the doctor has the opportunity to provide the patient with the most effective type of medical care - surgical. The main types of anesthesia and anesthesia used by modern anesthesiologists are described in this article.

General and local are not types of anesthesia

I have already written about this many times in other articles, but I think it’s worth repeating, because. I often see this error on the Internet and in the media.

Anesthesia is always general, it means turning off consciousness. The so-called "local anesthesia", as the people often call it, is anesthesia in which a person is conscious, and anesthesia occurs on a limited part of the surface of the face / body. With these terms sorted out, let's move on.

So, according to the method of administering drugs to a patient, anesthesia can be: inhalation (mask), intravenous and endotracheal.

By the number of drugs used, there is mononarcosis (1 drug is used) and multicomponent anesthesia.

Inhalation anesthesia

The first type of general anesthesia was inhalation of ether vapors. The principle of narcotic effects on the body is built on the ability of lung tissue to actively absorb and release gases. By inhaling drugs that have the ability to change from a liquid to a gaseous state or vapour, high concentrations in the blood can be achieved. Passing through the vessels of the brain, there is a direct effect on neurons with immersion in a state of deep narcotic sleep.

The main preparations for inhalation are as follows:

• (today almost never used).

All of them have different physicochemical and pharmacodynamic properties. Combines their method of introduction into the body and the need to form a gas mixture with oxygen in certain proportions using respiratory equipment.

For reference: the area of ​​​​the lungs in an adult is up to 100 m2

Advantages in ease of implementation, relatively easy handling, short duration of action, which is extremely important for performing minor surgical interventions.

Achieving a great depth of such anesthesia is associated with the risk of severe respiratory disorders. This limits its use in surgery. Therefore, inhalation anesthesia is used mainly in various areas of pediatric surgery.

Intravenous anesthesia

The introduction of narcotic drugs intravenously carried out non-inhalation types of anesthesia during surgery. They are characterized by a relatively long duration of action and greater depth compared to inhaled agents. Depending on the drugs used, there are:

• Classical intravenous anesthesia, recofol;
• – administration of fentanyl with droperidol. It can be carried out both on spontaneous breathing, and combined with artificial ventilation of the lungs;
• Ataralgesia - combined administration of sibazon with. This combination of substances causes a superficial, sparing anesthesia and can be combined with other types of anesthesia.

Multicomponent endotracheal anesthesia

With long, voluminous operations, the advantage is given to multicomponent. His distinctive features are:

• Intravenous administration of narcotic drugs (thiopental, fentanyl, sibazon);
• The introduction of muscle relaxants (ditilin, arduan);
• Tracheal intubation with controlled breathing using a ventilator.

This combination allows you to reduce the dose of narcotic drugs, achieve excellent pain relief and muscle relaxation, and ensure adequate oxygenation of the body.

In some cases, if there is no need for general anesthesia, use:

• local anesthesia;
• Conduction anesthesia;
• Epidural or spinal anesthesia.

These methods of pain relief are based on local injections into tissues or structures of the peripheral nervous system. At the same time, against the background of preserved consciousness, pain sensitivity of a certain anatomical region is completely lost. Combined anesthesia is a combination of regional anesthesia with neuroleptanalgesia or ataralgesia.

For more information about the types of anesthesia, anesthesia, see this video:

The general name of the methods of anesthesia.

It is impossible to imagine the existence of modern medicine without the use of anesthesia, which is carried out in almost all invasive diagnostic and therapeutic procedures. As you know, pain is one of the essential signs of tissue damage or inflammation, which most often requires immediate assistance. However, pain sensations are an obstacle to its full-fledged provision, not only because they bring significant discomfort, but also often lead to such a life-threatening condition as pain shock. The fight against pain began long before the discovery of modern painkillers. So, if you believe the manuscripts, then back in 1500 BC. in Egypt, the use of drugs based on opium was put into practice, and in the 2nd century BC. It is described that hemp powder was used in China to eliminate pain. Oddly enough, almost two millennia passed before the successful public use of anesthesia, which allowed major operations, until September 30, 1846, William Morton performed a painless operation using medical ether. Since then, the effectiveness of anesthesia has increased significantly, which is associated with the discovery of new drugs and their competent use.

Anesthesia is called a decrease in sensitivity throughout the body or in certain areas of it. To fully understand the mechanism of its occurrence, one should recall the mechanism for obtaining, conducting and analyzing information about the environment. So, the composition of all sense organs includes the following departments:

• peripheral (consists of receptors or organs that perceive certain signals from environment);
• conductive (consists of nerve pathways that conduct an electrical impulse to the central analyzer);
• central (includes the cerebral cortex, which is responsible for the conscious processing of information, and subcortical formations, the purpose of which is the automatic reaction of the body to external influences);

If at least one of the links in this chain, which are responsible for interacting with the outside world, fails, there is a complete or partial loss of sensitivity. According to the factors of its occurrence, medical anesthesia should be distinguished, which is carried out in order to prevent pain at the time of medical or surgical intervention, and pathological, resulting from a disease or injury.

In the United States of America alone, more than 40 million surgeries per year are performed that require anesthesia. In addition, many invasive procedures performed outside the operating room require good anesthesia. At the same time, the use of anesthesia leads to death in about 1 case per 20,000 healthy patients. Although, according to statistics, worldwide, perioperative mortality attributable to anesthesia has decreased by more than 90% over the past few decades. At the same time, the overall postoperative mortality remains about 4%.

The development of perioperative complications is determined by many factors and can occur both as a result of anesthesia or the immediate consequences of surgical intervention, and be associated with the characteristics of the patient himself.

The introduction of anesthesia into practice was initially recognized as a dangerous undertaking, which is associated both with the individual characteristics of the patient and with the experience of doctors.

From a public health perspective, understanding the nature and extent of complications associated with the use of anesthesia is important and falls into several levels. So, in a narrow sense, for individual patients, obtaining accurate information about the likelihood of specific postoperative complications is a necessary condition for informed decision-making related to anesthesia and surgery. A broader view of the risk of complications in the use of anesthesia involves the analysis of different patients, doctors or hospitals, which provides an excellent opportunity to assess and improve the quality of care.

Patient observation periods:

• intraoperative;
• the first 48 hours after the operation;
• the entire period of hospitalization or the first 30 days or longer after surgery (during this period, the accuracy of observations is significantly reduced);

Modern medicine is closely related to analgesic measures, the use of which not only reduces the patient's discomfort, but also greatly facilitates the procedures due to the patient's lack of response to pain irritation.

Anesthesia in sick children is highly dependent on the age and maturity of the child, as well as the experience of the anesthesiologist. Most methods of anesthesia combine the use of general anesthesia for the surgical procedure itself with regional anesthesia for postoperative pain control. This is due to the complexity of interaction with a small child. In addition, in very young children, the myelination process is not yet complete, which is manifested by a more pronounced response to external influences due to the immaturity of the pyramidal tracts (which have a controlling downward influence from the cerebral cortex). Therefore, anesthesia in children is of great importance.

In anesthesia, one should take into account such features of children as a lower binding capacity of blood plasma proteins (relative to adults), a relatively low amount of adipose tissue and muscles, as this affects the pharmacodynamics and pharmacokinetics of the drugs used. Because of this, the calculation of doses of drugs and the intervals between their repeated injections during anesthesia in a child does not coincide with similar measures in adults.

The use of inhalants during general anesthesia in children is much more common than among adults. However, one should take into account such anatomical features of children as the narrowness of the airways, their high vulnerability, the high likelihood of mucosal edema and increased salivation. These factors, individually or in combination, can cause respiratory failure. In addition, children younger age have a smaller chest volume due to the low mobility of the diaphragm, ribs and sternum, while air resistance in the airways is increased. These features determine the use of endotracheal anesthesia.

When carrying out manipulations, the anesthesiologist should be more careful, due to the more pronounced tissue vulnerability in children compared to adults.

We should not forget about the importance of the psychological preparation of the child, especially at the age of over three years, which consists in conducting a conversation with the conviction of children that the procedure is painless.

Anesthesia should begin with premedication (promedol and atropine). Promedol in children under 6 months of age should be used with caution, as it can affect the functioning of the respiratory center and cause respiratory arrest.

Introduction to anesthesia of children under 5-6 years of age is carried out with the help of inhalation of drugs through a mask. With good determinability of veins in children older than this age, the introduction into anesthesia is carried out by intravenous administration of drugs.

Anesthesia is maintained using a mask (older children with short operations) or endotracheally (in very young children or in large, heavy operations).

After surgery, the most effective method of postoperative pain relief is epidural anesthesia, which is indicated for volumetric interventions on the organs of the abdominal cavity, pelvis, and chest.

Throughout the operation, the anesthetist must monitor the heart rate, body temperature and muscle tone. In addition, the use of oxygen in excess can lead to the destruction of the surfactant.

Anesthesia requires special care in the presence of concomitant acute infectious diseases, respiratory diseases, severe rickets, pustular skin lesions, within 6 months after vaccination.

Anesthesia is determined by the degree of need for the effect of anesthesia. So, in some cases, it is possible to use local anesthesia for small, superficial interventions. However, despite the local effect, anesthetics can lead to adverse effects on the heart and brain, manifested by arrhythmia, convulsions, loss of consciousness and allergic reactions. However, local anesthesia is considered the safest method of pain relief.

Sometimes, to reduce anxiety and increase the effectiveness of local anesthesia, local anesthesia is combined with sedation.

In contrast to children, the use of intravenous anesthesia has become most widespread in adults and adolescents. With this method of general anesthesia, an intravenous catheter is inserted through which anesthetics and other drugs are needed to achieve the desired effect. In some cases, combined use of intravenous and inhalation anesthesia is possible.

To achieve pain relief in a certain area, it is possible to use regional anesthesia, which allows you to keep the patient conscious. However, its effect is to some extent determined by the individual anatomical features of the body, and therefore it is not always one hundred percent effective. In cases where the required pain relief is not achieved, general anesthesia is performed.

Anesthesia in the elderly has its own characteristics due to age-related changes in metabolism. In practice, in most cases, the real (passport) age differs from the biological one, which is associated with climatic, economic, social and other conditions that cause premature aging of the body. A feature of the elderly is a decrease in the body's compensatory capabilities while maintaining the normal functioning of organs and systems under normal conditions. In addition, when providing anesthesia, one should take into account the frequent spread of diseases such as atherosclerosis, cardiosclerosis, changes in the respiratory system (by restrictive, obstructive or emphysematous types), renal disorders and decreased liver function due to a decrease in blood flow in it.

The physiological differences between the elderly and adults include low sensitivity to catecholamines, more rigid chest(leads to more significant energy consumption during breathing), changes in the gastric mucosa with a high incidence of ulcers.

Patients taking antiplatelet agents and anticoagulants should be switched to low molecular weight heparins 5 days before surgery. Antihypertensive therapy in the elderly is stopped 6 hours before surgery and resumed after it.

The optimal choice for anesthesia in the elderly is multimodal anesthesia using regional anesthesia. The introduction of drugs is carried out slowly, with the control of all vital signs. To prevent the development of atelectasis, a "recruitment" is carried out every 2 hours (inspiratory pressure increases for 30 seconds).

Pathological anesthesia is caused by the action of exogenous or endogenous factors and is caused by a violation of the perception, conduction and processing of information from the external environment. Unlike medical anesthesia, which results from the action of drugs on certain receptors in the sensory chain, pathological anesthesia develops as a result of a disease, injury, or functional impairment that disrupts normal perceptual processes.

Examples of diseases leading to the development of anesthesia:

• in the peripheral section (long-term, chronic intoxication leading to damage to nerve endings, for example, diabetes mellitus, alcoholism);
• in the conduction department (injuries, tumors, other pathological processes that cause interruption of the conduction of a nerve impulse along afferent pathways to the central analyzer, for example, traumatic injury to the spinal cord);
• in the area of ​​the central analyzer (local destructive and degenerative processes, for example, a hemorrhagic stroke in the occipital lobe can lead to serious visual impairment).

Depending on the prevalence, there are full and partial anesthesia.

Full anesthesia

Complete anesthesia can be induced both purposefully and develop as a result of pathological processes. With this type of anesthesia, there is a complete loss of sensitivity and impaired consciousness, which is most typical for all types of coma (primary cerebral, endocrine, toxic, hypoxic, thermal). The main point of application for the development of complete anesthesia is the brain structures responsible for maintaining consciousness and active interaction with the environment.

Partial anesthesia

Partial anesthesia is the blocking of individual feelings, while almost always consciousness is preserved. As a rule, the causes that cause partial anesthesia are great amount and they appear with the defeat of any of the departments of the analyzer.

Types of partial anesthesia:

• there are no pain sensations;
• temperature perception is completely absent;
• no tactile sensitivity;
• there is no information about the position of the body;
• taste sensations are absent;
• smell is absent.

The problems of the absence of sensitive sensations are dealt with by specialized specialists whose area of ​​interest affects the affected sensory organs.

Types of anesthesia in medicine

The use of different types of anesthesia is most often combined. So, for the induction of anesthesia, inhalation anesthesia can be used, and to maintain the resulting state, intravenous anesthesia, and vice versa. In case of superficial surgical intervention that does not require unconsciousness (abscess, furuncle, fracture of the humerus), anesthesia is performed by a specialist trained to perform the desired type of anesthesia (chopping the desired area with local anesthesia or performing case blockades).

Conducting general anesthesia is aimed at the absolute elimination of pain arising from external influences for greater safety of surgical intervention. It is important to note that general anesthesia affects the level of consciousness.

To obtain high-quality general anesthesia, preparation is required some time before the operation. Premedication is needed to reduce the stress caused by waiting for the operation, reduce general excitability, increase the pain threshold, and reduce the activity of the exocrine glands.

General anesthesia combines such qualities as adequacy and component.

The adequacy of anesthesia is determined by the degree of its compliance with the volume and severity of the surgical intervention, as well as age, concomitant lesions, initial condition and individual characteristics of the body.

Component is provided:

• depression of mental processes (manifested by anesthesia or severe sedation);
• blocking pain;
• the development of hyporeflexia as a result of exposure to the nervous system;
• muscle relaxation.

Previously, only one drug was mainly used to obtain the desired state, however, due to the toxic effect and the high frequency of side effects due to high concentrations, the administration of several drugs has become widespread. This also allowed to reduce the load on the liver (responsible for destruction) and kidneys (responsible for excretion). Adequacy and multicomponent nature are ensured by the use of modern drugs, the interaction of which causes anesthesia - hypnotics, analgesics, muscle relaxants.

Anesthesia drugs are administered in three ways:

• inhalation;
• intravenous;
• combined.

To ensure the safety of general anesthesia, it is necessary to assess the condition of the respiratory tract, since this type of anesthesia may cause respiratory depression. Aspiration may also occur - the reflux of food in the stomach into the bronchial tree, followed by the development of bronchitis and pneumonia. If indicated, an endotracheal tube or laryngeal mask is used.

The installation of the endotracheal tube is performed using a laryngoscope and is accompanied by painful sensations, so it should be carried out after the introduction into anesthesia.

The laryngeal mask consists of a soft material and is not inserted as far as the laryngeal tube.

The choice of tactics of conducting

When the operation has a short duration and there are no respiratory disorders, anesthesia is mainly used:

• intravenous;
• mask.

For a long operation with impaired regularity of respiratory movements and a high risk of aspiration, anesthesia is used:

• intubation;
• endotracheal.

Extensive abdominal operations should be accompanied by artificial ventilation of the lungs.

Stages of general anesthesia

• introduction;
• maintenance;
• recovery from anesthesia with recovery of consciousness.

During general anesthesia, the body goes through certain stages:

Stage I is characterized by an increase in pain threshold with unchanged consciousness.

II stage:

• Strong excitation when using only ethyl ether;
• Temporary increase in respiratory rate and heart rate;
• A state of euphoria with dilated pupils (when taking barbiturates).

In stage III, the 1st, 2nd and 3rd levels can be distinguished.

• 1st - light general anesthesia (the patient is immersed in sleep, pupillary constriction is observed, corneal and other reflexes are preserved). At this stage, it is possible to perform short-term low-traumatic operations;
• 2nd - optimal general anesthesia (narrowing of the pupils, absence of corneal and other reflexes). After the introduction of drugs that cause muscle relaxation, large intracavitary operations can be performed.
• the 3rd is characterized by toxic effects (all vital functions are inhibited, the pupils are dilated) and, as a rule, should be avoided;

In stage IV, the patient comes out of anesthesia.

Regional anesthesia has a number of advantages over general and local anesthesia, which is associated with less use of opioids, less frequent occurrence of postoperative pain requiring the administration of opioids in large doses, as well as a reduction in the duration of hospitalization and a rapid improvement in well-being after surgical treatment.

The essence of anesthesia with this type of pain relief is that the conduction of pain impulses from peripheral receptors to the brain is blocked.

Types of anesthesia by duration of exposure:

• single injection (the duration of anesthesia is determined by the rate of destruction of the anesthetic);
• prolonged administration (duration depends on the regularity of administration of the drug);

Indications for regional anesthesia:

• anesthesia during surgery;
• pain relief after surgery;
• chronic neuropathic pain, as well as pain arising in connection with malignant tumors;
• preventive analgesia during arthroplasty and amputation in some cases reduces the incidence of phantom pain;

Contraindications for regional anesthesia:

• the patient's uncertainty about the effectiveness of anesthesia;
• incompetence of the anesthesiologist;
• high risk of complications;
• the desire of the patient not to be conscious during the provision of medical care.

Changes in physiological processes in the body during regional anesthesia:

• decrease in stress hormones;
• reduced protein catabolism and less impaired glucose metabolism;
• electrolyte balance in most cases remains at the preoperative level;
• stress-induced fibrinolysis disturbances are less pronounced, which reduces the incidence of thrombosis and pulmonary embolism.

However, regional anesthesia has its advantages and disadvantages, so the type of anesthesia is determined by the anesthesiologist depending on the specific clinical case. It has also been proven that, other things being equal, 30-day mortality after anesthesia has no difference between general and regional.

Types of regional anesthesia:

• epidural anesthesia;
• conduction anesthesia;
• spinal anesthesia.

Epidural anesthesia

Epidural anesthesia is one of the types of regional anesthesia, in which the introduction of drugs is carried out directly into the space formed between the periosteum of the vertebrae and the dura mater of the spinal cord. The development of anesthesia is due to the blocking of pain impulses in the synapses of the spinal cord.

The achievement of the desired effect can be assessed by the development of analgesia. When evaluating the effectiveness of the anesthesia performed, sensitive (needle prick), motor (Bromage scale) and sympathetic (hand temperature) blockades are considered separately.

The possibility of using epidural anesthesia depends on the area that needs to be anesthetized (for example, the head tissue cannot be anesthetized due to the fact that it is innervated by cranial nerves).

At the same time, pain relief with epidural anesthesia of the chest, abdomen, groin and legs makes sense.

Indications for epidural anesthesia:

• conducting childbirth without surgical intervention;
• C-section;
• together with general anesthesia, to reduce the dose of opioids;
• anesthesia after surgery lasting several days, with precise control of the amount of administered drugs;
• sometimes anesthetics and steroids are administered for back pain.

The drug during epidural anesthesia is distributed in two directions:

• to the spinal nodes;
• into the subarachnoid space.

The severity of the effect is determined not only by the volume, but also by the degree of dilution of the drug. A large amount of diluted anesthetic causes a block of sensitivity at a high level with a less pronounced block of motor functions. With small amounts of concentrated preparations, the block is determined at a low level. Also, weakly concentrated anesthetic solutions practically do not affect motor functions.

The low effectiveness of epidural anesthesia may be due to:

• mosaic (asymmetric) anesthesia, which occurs when the needle is deflected and the anesthetic enters the area of ​​the dura mater, which leads to uneven distribution of the drug;
• a weak dose of anesthetic and an early start of the operation, before the onset of the effect of analgesia;
• the adequacy of the blockade of the sacral segments;
• discrepancy between the height of the introduction of anesthetics and the volume of the operation.

The essence of conduction anesthesia is the effect of an anesthetic agent in the epineural or endoneural space of the node, nerve or plexus, followed by the development of a reversible blockade of the transmission of the nerve impulse.

For the first time, conduction anesthesia was used in 1884 by the surgeon William Halsted to block the brachial plexus, pudendal and tibial nerves. In the future, the development of new drugs has significantly increased the effectiveness of this method of anesthesia.

Conduction anesthesia has found application in traumatology, dentistry and therapy in patients with prolonged, chronic pain.

In addition to the anesthetic, adrenaline can be administered (causes vasoconstriction at the injection site, which slows down the absorption of the anesthetic and increases the duration of the effect), steroid drugs (have anti-inflammatory properties) or opioids (potentiate the analgesic effect).

Possible adverse effects of conduction anesthesia:

• vascular damage;
• Pneumothorax;
• Damage to the nerve plexuses;
• Damage to the thoracic lymphatic duct
• The development of an infectious process at the injection site of the anesthetic;
• The toxic effect of the drug;
• Allergic reaction for an anesthetic.

spinal anesthesia

The essence of spinal anesthesia is the introduction of an anesthetic during a lumbar puncture into the subarachnoid space, resulting in a block in the transmission of impulses at the level of the roots of the spinal cord.

Unlike epidural anesthesia, in spinal anesthesia, in addition to analgesia, there is also muscle relaxation and loss of other types of sensitivity.

Spinal anesthesia has a number of advantages, such as fewer severe systemic complications and the absence of nausea and vomiting. In addition, the patient is conscious and can communicate with the doctor.

There are only two positions for spinal anesthesia - lying on your side or sitting. In addition, it is important to note that fewer drugs are administered with this type of anesthesia, in contrast to epidural anesthesia.

Complications of spinal anesthesia include post-puncture headache, which occurs in 3% of cases.

Contraindications for spinal anesthesia

Absolute:

• The unwillingness of the patient;
• Insufficient technical equipment of the operating room;
• Violations of the blood coagulation system;
• Taking indirect anticoagulants or low molecular weight heparins 12 hours before anesthesia;
• Inflammatory skin diseases at the injection site of the anesthetic;
• Increased cranial pressure;
• Depletion of compensatory reserves of the cardiovascular system;

Relative:

• Increased emotional excitability of the patient;
• Mental and neurological diseases;
• Heart disease with decreased cardiac output;
• Inability to adequately assess the duration and volume of surgery;
• History of syncope, AV block.

The essence of local anesthesia is the direct blocking of peripheral receptors responsible for the perception and transformation of signals from the environment. Usually this type of anesthesia is used for small, superficial operations. After the introduction of the anesthetic, a feeling of fullness develops, which disappears after a few seconds, being replaced after a few minutes by the complete absence of pain in the injection area. In some cases, it is possible to preserve the sensation of some manipulations in the area of ​​local anesthesia, but pain is not noted.

Absorbed, anesthetics can cause arrhythmias, seizures, syncope,. Despite this, this type of anesthesia is recognized as the safest, although not the most effective.

Local anesthesia is divided into infiltration and contact.

Infiltration anesthesia;

Infiltration anesthesia is one of the most common methods of pain relief, which is primarily due to the simplicity of its implementation and the good severity of the effect.

Infiltration anesthesia is divided into:

• direct (pain relief at the injection site);
• indirect (pain relief develops as a result of the spread of the drug into the surrounding tissues);

Infiltration anesthesia has found application in dentistry, surgery and diagnostic interventions. The use of this type of anesthesia is excluded only in the case of purulent diseases (due to violation of the rules of asepsis) and oncology (violation of the principle of ablastics, that is, prevention of the spread of tumor cells as a result of their destruction).

In surgery, the anesthetic is injected intradermally until a "lemon peel" is formed, after which the zone of interest to the doctor is chipped with a deeper injection of drugs. Pain relief occurs 10-15 minutes after the administration of the anesthetic.

The method of infiltration anesthesia according to Vishnevsky (creeping infiltrate method) deserves special attention. To some extent, this method includes elements of conduction anesthesia, since the action of the injected anesthetic is directed to the nerves involved in the conduction of nerve impulses. Also, this method of anesthesia can be called a case blockade, since the essence of anesthesia is the introduction of an anesthetic into the fascial infiltrate until a tight infiltrate is formed. This type of anesthesia greatly facilitates the surgical intervention, since the fasciae are peeled off from the muscles and neurovascular bundles, which facilitates their isolation and revision.

The case blockade method is widely used in the treatment of such acute conditions as acute renal failure as a result of burn disease.

Contact anesthesia

Contact anesthesia refers to local anesthesia and is caused by direct surface interaction of the anesthetic with the skin or mucous membranes.

This type of anesthesia is widely used in ophthalmology and is caused by instillation of an anesthetic. Contact anesthesia is also used when performing diagnostic measures on the respiratory tract (bronchography, bronchoscopy) and is achieved by irrigating the mucous membranes with an anesthetic solution. The effect is achieved in 2 - 3 minutes and lasts up to half an hour.

An important feature of these anesthetics is their high toxicity, which is why their use should be limited to small doses.

The use of anesthesia in medicine

Anesthesia plays a huge role in medicine, providing not only less stress for the patient, but also higher comfort for the operating specialist if it is carried out correctly.

At the present stage of development of medicine, anesthesia in dentistry has great opportunities. First of all, this is due to the modernization of outdated equipment, the use of less traumatic methods of treatment. In addition, modern drugs with high efficiency and low severity of side effects are becoming widespread.

The method of anesthesia in dentistry is chosen by the dentist and depends on the planned intervention:

Anesthesia in dentistry uses the following types:

1. Contact anesthesia (lidocaine is used).

Indications for contact anesthesia in dentistry:

• removal of deposits on the teeth;
• removal of a tooth with high mobility;
• preparation for another type of anesthesia.

2. Infiltration anesthesia (is the most used method and is sometimes called "freezing"). The drug is injected under the mucosa, periosteum or into the bone itself. It happens direct and indirect.

Indications for infiltration anesthesia in dentistry:

• manipulations on the teeth and their canals;
• treatment of pulpitis;

3. Conduction anesthesia (anesthetic is delivered to the exit site of the trigeminal nerve and its branches with the subsequent development of anesthesia).

• interventions on molars;
• activities affecting the gums;
• massive interventions.

4. Stem anesthesia (anesthetic is injected at the base of the skull, which leads to blockade of the V cranial nerve).

Indications for conduction anesthesia in dentistry:

• extensive operations;
• unbearable pain;
• consequences of injury.

5. General anesthesia (fear, mental and neurological disorders).

In most cases, the anesthetic is administered together with a vasoconstrictor, which increases the duration of the effect and slows down its absorption. In addition, in some situations, allergies to certain anesthetics may occur, which leads to the development of severe allergic reactions.

Anesthesia of the tooth during medical procedures

Anesthesia of the tooth can be either temporary, resulting from the use of drugs to prevent or eliminate pain, or permanent, resulting from the removal of the pulp as a result of its inflammatory changes.

Performing high-quality anesthesia of the teeth in dentistry is of great importance, as it forms not only physical comfort, but also psychological, which reduces the fear of painful, unpleasant interventions in the oral cavity and reduces the number of advanced cases of the disease.

Anesthesia of the teeth located on the upper jaw has a number of differences from the anesthesia of the teeth of the lower jaw. Since the bones of the upper jaw are more porous, the spread of the anesthetic is faster and more efficient. At the same time, the less porous structure of the lower jaw, a large number of muscular and ligamentous elements leads to the fact that a separate anesthesia of the tooth is impossible. Therefore, the introduction of an anesthetic is carried out in the area of ​​​​the exit of the nerve trunks, which leads not only to anesthesia of the tooth, but also to the cheeks, lips and tongue.

Dental treatment without anesthesia

Treatment of teeth without anesthesia depends on the severity of their damage. So, with superficial caries, it can be treated without anesthesia, while with a more widespread and deep process, treatment without anesthesia is gradually becoming a thing of the past, since the use of anesthetics increases the comfort of medical procedures. Although when filling canals after removal of the pulp, anesthesia is not recommended, which allows the doctor to suspect the introduction of a gutta-percha pin at the root apex.

Anesthesia in the treatment of injuries depends on the degree of damage and subsequent therapeutic measures. Anesthesia is a necessary component of pathogenetic treatment, as it reduces the level of stress and prevents the development of pain shock.

The type of anesthesia also depends on the stage of transportation of the victim. It is known that traumatic shock is one of the most common causes of prehospital mortality.

At the prehospital stage, the following types of anesthesia are available to the paramedic:

• effective transport immobilization (reduces the mobility of damaged tissues);
• injection of opioids or painkillers of non-narcotic origin;
• inhalation of oxygen and nitrous oxide;
• novocaine blockade.

In a specialized medical institution, active infusion therapy is carried out in combination with combined anesthesia (as a rule, a combination of general and regional types of anesthesia).

Infiltration anesthesia is also recommended in the treatment of the consequences of a crash syndrome and burn disease, which includes a perirenal blockade. The mechanism of its action is to act on the nerve plexuses located along the renal pedicle and the abdominal part of the aorta.

Anesthesia during surgery

Anesthesia in the treatment of surgical pathology depends on the duration and volume of the planned intervention. So, when opening a superficially located abscess, local anesthesia may be sufficient, while with the development of peritonitis, serious preoperative preparation is necessary with a complex anesthesia.

As a rule, conducting anesthesia during treatment in a hospital with the required equipment and drugs does not cause difficulties for experienced professionals.

If there is a need for surgical intervention during pregnancy, local or regional methods of anesthesia are used to minimize the impact on the physiological processes of the mother's body, as well as reduce the possible pharmacological effects on the developing fetus. Ideally, surgical procedures should be delayed until the second trimester to minimize fetal exposure to teratogens in critical period organogenesis (from 15 to 56 days), as well as limit the risk of preterm birth (typical of the third trimester).

Before surgery, it is recommended to measure the fetal heart rate using Doppler ultrasound before, during and after surgery. The patient must consent to an emergency caesarean section and staff must be prepared for fetal distress.

Pregnant women are at increased risk of aspiration and are more likely to have upper airway edema, which may increase the risk of failed intubation.

The safety of anesthesia as a whole is aimed at preventing a teratogenic effect, eliminating fetal asphyxia and preterm birth. While research examining teratogenicity is unethical, it is generally accepted that local anesthetics, volatiles, inducers, muscle relaxants, and opioids are not teratogenic when used at clinical concentrations. The use of nitrous oxide is still best avoided given its effect on DNA synthesis and its teratogenic effects in animals.

The essence of anesthesia during natural childbirth

The pains that occur during childbirth are divided into visceral (the result of stretching of the cervix and uterine contractions, is dull, indefinite) and somatic (as a result of tissue tension and are acute, periodic).

The essence of anesthesia during natural childbirth is to reduce the pain that occurs during the passage of the birth canal by the fetus and the preservation of the natural biomechanism of childbirth, which is impossible in the absence of consciousness in the woman giving birth.

Anesthesia for caesarean section

Anesthesia for caesarean section can be epidural, spinal and general. The doctor chooses the type of anesthesia after assessing the pregnant woman and the fetus. In the absence of contraindications, it is possible to perform anesthesia chosen by the patient.

Epidural anesthesia for caesarean section, in the case of an already installed epidural catheter and indications for delivery, can be performed with the introduction of an additional dose of anesthetic through the catheter. With the appearance of a characteristic feeling of numbness in the abdomen, surgical intervention is allowed.

The advantage of epidural anesthesia for caesarean section can be attributed to a lower concentration of anesthetics in the systemic circulation of the maternal body, which significantly reduces the severity of the effect of these drugs in an already born child.

General anesthesia for childbirth

General anesthesia for cesarean section is used when it is impossible or unwilling to perform epidural anesthesia during childbirth. With general anesthesia, a rapid loss of consciousness occurs. It is indicated in emergency situations when immediate delivery is necessary. In such cases, it is relatively safe for the child.

Conducting general anesthesia is dangerous due to the high risk of throwing gastric contents into the respiratory tract. Because of this, the anesthesiologist carries out a set of measures aimed at protecting against this phenomenon. Before the operation, hydrochloric acid in the stomach is neutralized, and when anesthesia is performed, a tube with an inflatable cuff is inserted into the trachea.

It is important to note that it is forbidden to eat any food after the onset of labor.

Epidural anesthesia for childbirth

Epidural anesthesia during childbirth is becoming more widespread due to its advantages over other methods of pain relief. With this type of anesthesia, consciousness remains unchanged. The moment of its application depends on the specific clinical case.

Epidural anesthesia during childbirth is performed in the lumbar region. The patient sits or lies on his side. The puncture site is located below the end of the spinal cord.

Algorithm for epidural anesthesia during childbirth:

• local anesthesia of the injection site;
• insertion of a special needle into the epidural space;
• holding a soft conductor (catheter) along the needle;
• removal of the needle and fixation of the catheter.

The effect of anesthesia develops slowly, is felt 10-20 minutes after the administration of the drug and is maintained until the end of labor. The time of anesthesia is extended by the introduction of additional doses through the established catheter.

During this type of anesthesia, a feeling of pressure during contractions may persist.

Epidural anesthesia during childbirth sometimes leads to weakening of contractions. In most pregnant women, during this type of anesthesia, relaxation is observed, combined with an increase in the tone of the uterus.

Epidural anesthesia during childbirth allows you to accumulate strength and, thus, increase the efficiency of the further course of the birth process.

Complications after epidural anesthesia

Even careful and competent management of anesthesia can be accompanied by side effects. So, after epidural anesthesia, low blood pressure is most often detected and, although in rare cases such dangerous complications as a hyperergic reaction to local anesthetics, apnea, and neurological disorders can develop. A drop in blood pressure after epidural anesthesia can be prevented by fluid therapy. All patients are advised to remain in bed for the duration of anesthesia.

After epidural anesthesia, the development of headache is observed in 0.7-1.4%. As a rule, its occurrence can be prevented by observing a certain position during anesthesia. Recommendations for getting rid of headaches include bed rest, fluid intake and pain medications.

Often accompanied by chills. It develops as a normal reaction of the body, as well as a condition that frolics after epidural anesthesia. Warming can be used to combat pain-induced chills.

In rare cases, during anesthesia, there may be a decrease in breathing due to weakening of the respiratory muscles. In such situations, inhalation of oxygen will be effective.

During pregnancy, the veins of the epidural space expand, and therefore the risk of introducing the drug into the systemic circulation increases. Therefore, before the introduction of a full dose of the drug, the doctor injects a small part of it and waits for the appearance of systemic effects, in the absence of which he introduces the rest of the anesthetic.

System effects include

• dizziness;
• metallic taste;
• heartbeat.

In some cases, there may be insufficient pain relief after epidural anesthesia. The anesthesiologist then applies a series of actions, such as changing the position of the patient's body or manipulating the catheter. Repeated anesthesia is rarely required.

During anesthesia, which accompanies all diagnostic or surgical intervention, the doctor is next to the patient and monitors the state of the respiratory, cardiovascular and nervous systems. Therefore, the optimal duration of anesthesia is determined by the duration of the intervention.

After surgical interventions, it is possible to use prolonged epidural anesthesia, which significantly reduces discomfort from constant, aching pain in the surgical area.

Carrying out medical procedures without anesthesia

Currently, they are moving away from performing medical procedures without anesthesia, although there are situations when the introduction of painkillers significantly changes the picture of the disease and can lead to an incorrect diagnosis.

In addition, treatment without anesthesia for diseases that have a long course and are accompanied by constant, aching pain not only reduces the quality of life, but also causes a decrease in immunity, which is caused by chronic stress.

Consequences of anesthesia

As with any external intervention in the body, the consequences of anesthesia can be unpleasant, and even life-threatening.

The most common adverse effects of anesthesia include:

• feeling of nausea;
• Chills;
• Pain in the head;
• syncope;
• Various degrees of clouding of consciousness.

Less common effects of anesthesia:

• The development of pneumonia;
• Injuries of the oral cavity;
• Awakening during general anesthesia before the end of surgery.

Rare adverse effects of anesthesia:

• Injury to the nerves when performing regional anesthesia;
• Anaphylactic shock;
• Eye injury during general anesthesia;
• Fatal outcome.