08.12.2020
Your doctor says that it is useless to continue conservative treatment of the joint. You seem to trust him - after all, you tried to find a good specialist. And at the same time, at the mere thought of surgery, some kind of chaotic mess arises inside, and you are ready to take literally handfuls of pills, just to avoid “going under the knife.”
Sound familiar?
It remains to understand what to do about it.
Surgery with local anesthesia
A local anesthetic numbs the area of the body being operated on. The patient is conscious and can observe the progress of the procedure or not see what is happening from behind a screen by agreement with the surgeon.
Often, such operations are performed quickly without serious tissue damage and do not pose a threat to the patient’s life. But if you still can’t calm down, then try the following:
- Discuss the progress of the operation with your doctor. Ask to talk about the risks, the time of the procedure, what the doctor will do and how dangerous it is for you. Ask about how other patients experience surgery, how long it takes them to recover, and what concerns they usually have.
Many patients are anxious primarily because of fear of the unknown, and everything incomprehensible seems dangerous to the brain, so awareness can play a key role in calming the patient.
- Ask your doctor if you can take any sedatives before the procedure and ask for a prescription if possible.
- Rest the day before the procedure. Take a walk in the fresh air, get some sleep, chat with your loved ones. Eliminate emotional stress and stress.
- Share your concerns with a loved one and enlist their support. Have them escort you to the clinic and pick you up after surgery to give you peace of mind.
- Think about how the procedure will benefit you. Focus on the result, not the process of the operation itself.
WHY PEOPLE AFRAID OF GENERAL ANESTHESIA
The modern history of plastic surgery begins at the end of the 19th century, when new surgical instruments were developed, antiseptics appeared, and anesthesia began to be actively used. Agree, it’s somehow strange to go through pain and suffering to improve your appearance, in fact, to improve your quality of life. It was only when anesthesiology reached its peak that women went in droves for rejuvenation.
The first plastic surgeries were performed under local anesthesia, and their radicality was minimal and their effectiveness was moderate. For example, anti-aging facial plastic surgery consisted of excision of a small strip of skin in front and behind the ear and suturing the wound: no detachment, no SMAS lifting, just skin. This rejuvenation could be performed annually.
As the operation became more complex, so did the anesthesia. Today we have the opportunity to safely carry out serious complex operations aimed at correcting all parts of the face. The duration of anesthesia can be from one to eight hours. All types of pain relief can be divided into local, regional and general.
The diagnosis has been made, what to do next?
Next, everyone needs to calm down and sort out the life of the patient’s family “on the shelves.” Everything has already happened - the tumor has grown, there is no point in analyzing the reasons for its occurrence. Causes of cancer - past, present - long and difficult treatment. Not abstract therapy, but a specific operation and hospitalization date for the surgical stage, or multi-week chemotherapy and radiation treatment.
It is necessary to discuss with a relative with cancer who will help with getting a bulky bag to the emergency department on the day of hospitalization, who will visit and on what days. Who will help me go to chemotherapy several times a week or attend radiation sessions every day? Finally, how will the family function during this period, who will take responsibility for the children or elderly parents left at home, who will take care of the dacha, who will walk the dog.
Everything is very specific and with a detailed discussion of practical issues, because each time it becomes more difficult for working relatives to ask their superiors to accompany their loved one to a medical institution. It is likely that assistance will have to be distributed to all family members.
It seems that the first days after receiving the diagnosis are not the best time to discuss family life. But it only seems, firstly, that this forced distraction from painful thoughts will eliminate the “funeral” mood. Secondly, the cancer patient sees how important his opinion is to the family; one cannot “go limp” if many problems cannot be resolved without it. Thirdly, it is by their desire to help that loved ones demonstrate their love. For the patient and his family, discussing plans for the near future is an important job that eliminates unnecessary thoughts.
FEAR ONE: “I’M AFRAID OF NOT WAKING UP AFTER GENERAL ANESTHESIA”
This is why some patients ask to have the operation performed under local anesthesia or a “lighter” intravenous anesthesia.
Let it be known to you that endotracheal anesthesia, when the machine breathes for the patient, is the most controlled, manageable and safe. Thanks to the endotracheal tube, the patient's tongue never sinks - which is precisely what intravenous anesthesia is dangerous for.
There was a sad situation in my life when my friend died after a gynecological operation due to retraction of the root of the tongue. They didn’t keep track of the position of the lower jaw, and oxygen stopped flowing into the respiratory tract.
It is to control the state of breathing even during intravenous anesthesia, for example during minor operations lasting up to two hours, that our anesthesiologists always use air ducts or laryngeal masks, which help control the position of the lower jaw and the root of the tongue.
Modern anesthesia machines are sensitive to the slightest change in pulse, pressure and oxygen level in the patient’s blood. In case of danger, they sound such a siren that it is simply impossible to miss this state. In addition, almost all drugs used by anesthesiologists for anesthesia have antidotes: substances that neutralize them. So, I hope I managed to dispel this fear.
Risks
In general, general anesthesia is safe. Even very sick patients can be safely anesthetized. The surgical procedure itself involves much greater risk.
Modern general anesthesia is an incredibly safe procedure.
However, older adults and those undergoing lengthy procedures are most at risk for complications . These findings may include postoperative confusion , heart attack, pneumonia, and stroke.
Some specific conditions increase the risk for a patient undergoing general anesthesia, for example:
- obstructive sleep apnea, a condition in which people stop breathing while sleeping
- seizures
- existing heart, kidney or lung disease
- high blood pressure
- alcoholism
- smoking
- previous negative reactions to anesthesia
- medications that may increase bleeding - aspirin, warfarin , for example
- drug allergy
- diabetes
- obesity or overweight
Anesthesia: features and nuances
General anesthesia allows the surgeon to perform his work efficiently, and the patient not to experience pain, fear and discomfort.
General anesthesia is characterized by:
- complete loss of consciousness when the patient is put into medicated sleep
- lack of response to surgery and external stimuli
- loss of sensation
- muscle relaxation
These states are achieved through the introduction of anesthetic substances into the body. The choice of specific medications for medicated sleep is the task of the anesthesiologist.
Preparation for anesthesia includes the following steps:
- tests (general and clinical blood tests, urine tests)
- undergoing examinations by specialized doctors (therapist, cardiologist, dentist, gynecologist, etc.)
- undergoing diagnostics of organs and systems (cardiogram, ultrasound of the heart, etc.)
- history taking
- identifying allergic reactions to medications
A few days before the proposed operation, the anesthesiologist studies the research results, talks with the patient, and then selects the type of anesthetic drug and dosage.
Story
General anesthetics have been widely used in surgery since 1842, when Crawford Long prescribed diethyl ether to a patient and performed the first painless operation.
On October 16, 1846, American dentist and surgeon Thomas Morton first administered ether anesthesia to a patient to remove a submandibular tumor.
In Russia, the first operation under anesthesia was performed on February 7, 1847 by Pirogov’s friend at the professorial institute, Fyodor Inozemtsev.
Pirogov himself performed the operation using anesthesia a week later. Over the course of a year, 690 operations were performed under anesthesia in 13 cities of Russia, 300 of which were performed by Pirogov!
Soon he took part in military operations in the Caucasus. Here, for the first time in the history of medicine, he began to operate on the wounded with ether anesthesia. In total, the great surgeon performed about 10,000 operations under ether anesthesia.
How to help a patient accept changes in appearance?
Active treatment does not make anyone look better, surgery and chemotherapy deplete one’s strength, facial features become sharper, the skin becomes pale, and some medications cause hair loss. It is very difficult for women to endure these changes. You can reassure the patient that “I always like you,” but the woman will not be reassured by an untruthful stock phrase.
Changes in appearance are upsetting and frightening. One can hope that after completion of therapy everything will improve - this indeed is the case. Or you can, as in the “Fashionable Sentence,” change here and now: buy new clothes, put on makeup, cover up your hair loss with a bright scarf or hat. It is ideal to visit a stylist, it immediately changes your mood and increases your self-esteem.
Rule one. You shouldn't endure pain just to avoid anesthesia.
Almost any manipulation associated with causing severe pain is more harmful to the body than anesthesia. Therefore, in the civilized world they adhere to this point of view: where it is possible to relieve a patient of pain, this is certainly done. Modern medicine has very wide possibilities for this.
In addition, anesthesia with the use of artificial respiration devices significantly expands the capabilities of surgeons and allows them to provide assistance to those patients who cannot be helped with other types of surgical intervention. Of course, all contraindications of the patient, his age, and body capabilities are taken into account.
Side effects
Nausea is a common side effect of general anesthesia.
There are a number of potential side effects of anesthesia.
Some people may experience none, others several. None of the side effects are particularly long-lasting and usually occur immediately after anesthesia.
Side effects of general anesthesia include:
- temporary confusion and memory loss, although this is more common in older people
- dizziness
- difficulty urinating
- bruising or soreness from the IV
- nausea and vomiting
- trembling and chills
- sore throat due to breathing tube
Stages
The Gödel classification, developed by Arthur Ernest Gödel in 1937, describes four stages of anesthesia. Modern anesthetics and updated methods of drug have improved the speed of onset of anesthesia , overall safety and recovery, but the four stages remain essentially the same:
General anesthesia is similar to a comatose state and different from sleep.
Stage 1 or induction . This phase occurs between the administration of the drug and loss of consciousness. The patient moves from analgesia without amnesia to analgesia with amnesia.
Stage 2, or arousal stage . The period after loss of consciousness, characterized by agitated and delirious activity. Breathing and heart rate become erratic, and nausea, dilated pupils, and holding your breath may occur.
Due to irregular breathing and the risk of vomiting, there is a danger of suffocation. Modern fast-acting drugs are aimed at limiting the time spent on the 2nd stage of anesthesia.
Stage 3 or surgical anesthesia : muscles relax, vomiting stops, breathing is suppressed. Eye movements slow and then stop. The patient is ready for surgery
Stage 4, or overdose : if too much anesthetic has been administered, then depression of the brain stem occurs . This leads to respiratory and cardiovascular collapse.
The anesthesiologist's priority is to get the patient to stage 3 anesthesia as quickly as possible and keep him there throughout the operation.
Preoperative assessment
Before undergoing general anesthesia, patients should undergo a preoperative assessment to determine the most appropriate medications, their amount and combination.
Some of the factors that should be examined in the preoperative assessment include:
- body mass index (BMI)
- disease history
- age
- medications taken
- time before anesthesia
- alcohol or drug use
- use of pharmaceuticals
- examination of the oral cavity, teeth and respiratory tract
- cervical spine mobility study
It is important that you answer these questions accurately. For example, if a history of alcohol or drug use is not mentioned, insufficient anesthesia may be given, which could lead to dangerously high blood pressure or unintentional intraoperative awakening.
