It is difficult to imagine that some time ago the word operation was associated with the word death. In those days, people on the operating table died from painful shock or blood poisoning.
For a long time, humanity has been moving toward the discovery of the concept of anesthesia. Thanks to the development of chemistry, this became possible. Nowadays, surgical intervention is sometimes a necessary procedure for the patient to continue living a full life.
This is a chance for health that cannot be obtained using only medication.
Endotracheal anesthesia. A little history
An irreplaceable discovery that protects the human body from stress and allows not only the patient to comfortably undergo surgery, but also enables surgeons to do their job.
Anesthesia is the main element of any serious surgical intervention - lungs, nervous system, esophagus, heart. It is characterized by a complete loss of consciousness.
General endotracheal anesthesia is different in that it can be used for patients of any age. It consists of inserting a special thin tube into the trachea, connected to a device, through which narcotic substances are injected.
That's why it has this name: endo - inside and trachea. It is also called intubation or combined, because the drugs enter both the blood and the respiratory tract.
The world of medicine became acquainted with endotracheal anesthesia back in the 14th-15th centuries, thanks to the Swiss Paracelsus. It was this doctor who first used the method of inserting a tube into a person’s trachea, which saved him from death.
Andrei Vesalius continued his path, proving that this particular anesthesia should become the main anesthesia. When conducting experiments on animals, the indispensability of endotracheal anesthesia was undeniable.
In the 17th and 18th centuries, thousands of drowned people on the Thames were saved by the English doctor Cologne, thanks to a special tube inserted into the trachea.
Further more. A German doctor showed that if you use a tube with a cuff, you can prevent the most dangerous complication of that time - the presence of foreign substances in the respiratory canals during endotracheal anesthesia.
The next stage in the field of anesthesia was recorded in 1942, when the Canadian doctor Griffith and his partner Johnson used muscle relaxants. It was truly a breakthrough in medicine. Muscle relaxants relaxed the muscles and prevented the patient from moving. Moreover, they made it possible to control and manage anesthesia.
The 50s began with the rapid conquest of endotracheal anesthesia and its widespread use, with the enormous contribution of Soviet doctors - Vishnevsky, Kupriany and others.
Mode of application
Laryngeal mask
Sevoran is used for low-flow anesthesia. That is, it is carried out with a low flow rate of fresh gas, which ranges from half a liter to a liter per minute, which is several times less than with high-flow anesthesia, when using which the flow of fresh gas is six or more liters per minute. Low-flow anesthesia has a number of very significant advantages over high- and even medium-flow, but more on that later.
General anesthesia with Sevoran can be carried out in two ways of supplying a gas-steam mixture directly into the patient’s respiratory tract:
- through an endotracheal tube - a polymer tube inserted into the tracheal cavity ensures the patency of the trachea and ensures normal ventilation of the lungs;
- using a laryngeal mask, which is fixed in the pharynx.
Endotracheal tube
The use of a laryngeal mask is as atraumatic as possible and is ideal for use in children, since the endotracheal tube can injure the vocal cords and other soft tissues in the throat if inserted carelessly. And due to its location, the laryngeal mask eliminates trauma to the trachea and does not cause irritation to it.
Advice: laryngeal masks are most often used for general anesthesia (especially for children), but there may be cases when tracheal intubation is not necessary. In this case, it is worth remembering that this means that the doctor has concerns about the possibility of undesirable consequences in the form of deterioration of the airway when using general anesthesia. This issue should be further discussed with the doctor himself. But if there are no such concerns, then it is better to insist on a laryngeal mask.
Carrying out endotracheal anesthesia
Indications
Endotracheal anesthesia is sometimes called complex due to the use of several narcotic substances introduced gradually into the patient's body. This allows it to be used for long operations that require more than 30 minutes. The muscles are relaxed at this time, consciousness is turned off, which allows the surgeons to do their job.
Indications for the use of endotracheal anesthesia:
- the need to use muscle relaxants during surgery;
- fears of airway obstruction;
- unstable nervous system;
- "full stomach" syndrome;
- long and extensive dental interventions;
- long-term operation using microsurgical equipment;
- operations in the oral cavity, head, pharynx, inner ear;
- laparoscopy.
How is endotracheal anesthesia performed?
Before undergoing general anesthesia, the patient must undergo an examination. Next, preparation for surgical sleep or premedication begins. If the operation is planned, then in the evening the patient is relaxed and calmed with the help of barbiturates.
An antihistamine is also prescribed and tranquilizers are selected. On the operating table, the patient is given atropine before the operation to exclude a situation of cardiac arrest and analgesics.
Anesthesia is carried out in three stages
. The most important stage. Before inserting the tube into the patient's trachea, the patient is disconnected. Any anesthesia that puts a person into anesthetized sleep is used. This is what allows you to insert a special tube that artificially ventilates the lungs. If an error occurs at this stage, for example, the tube is inserted incorrectly, then complications will arise during the operation.
Introduction- Support . It is used in the first and second stages of anesthesia. Combination drugs are administered. To prevent surgical injuries, anesthetic agents are used. And to relax muscles - relaxants.
- Removal . Anesthesia is administered by gradually reducing the dose of narcotic drugs and relaxants. When the mark reaches 0, then consciousness wakes up, and tone and the ability to independently ventilate the lungs return to the muscles. Then extrusion occurs - removal of the tube from the trachea.
Administration of anesthesia
There are several ways:
- intravenously with a gradual infusion of anesthesia. A combination of analgesics and anesthetics, seasoned with oxygen and nitrogen, is used;
- using inhalation using oxygen, nitrogen, narcotic, analgesic and anesthetic drugs.
Before the operation, anesthesiologists must check the effect of narcotic substances on the human body and decide which drug to use during surgery.
Initial anesthesia is usually light. His goal is intubation. If this is an inhalation method, then a mixture of nitrogen and oxygen or the preparations “Etrana”, “Ftorotana”, “Forana” and similar anesthetics are often used. If administered intravenously, it will most likely be a barbiturate with droperidol or fentanyl.
The dose is selected individually, taking into account body weight and body characteristics. Droperidrol typically lasts about 5 hours. But the effect of fentanyl lasts only 20 minutes and requires repeated administration. Half an hour before the end of the operation, its supply stops.
In order to insert the tube, you will need to relax your neck muscles. Muscle relaxants should already act here. After intubation, the patient is connected to mechanical ventilation and the deep sleep stage begins.
Support
This is a period of active work for surgeons. Anesthesia is monitored every 15 minutes throughout the operation. Blood pressure and pulse are observed. If a patient has cardiovascular problems, cardiac activity must be monitored.
All parameters are indicated by the nurse in a special anesthesia record. It also prescribes all the actions of the doctors, indicating the time, the dose of administered narcotic substances, and relaxants used during the operation. These records are then pasted into the patient’s medical history.
Exit from deep sleep occurs with a gradual reduction in the dosage of administered drugs. To restore breathing, atropine and proserine are administered one after another.
Advantages
It is not for nothing that this anesthesia is the most popular; a number of reasons contribute to this:
- Patency of the respiratory canals, regardless of the patient’s position.
- Use of a small dose of narcotic drugs.
- Use of muscle relaxants.
- The possibility of surgical intervention on the heart, which was previously impossible.
- Less exposure to toxic drugs.
- Easy awakening after endotracheal anesthesia.
- Minimal effect on the kidneys and liver.
- No risk of breathing or cardiac complications.
Anesthesia in plastic surgery: educational program from Frau Klinik
Any, even the simplest, plastic surgery is a serious stress for the body. Therefore, together with the surgeon, another doctor always works in the operating room - an anesthesiologist , whose task is to create comfortable conditions not only for the patient, but also for the surgeon’s work. In addition, it is this specialist who is responsible for the safety of the patient during the operation and immediately after it, monitoring all the vital functions of the body. Frau Klinik anesthesiologist Olesya Dmitrievna Regotun tells more about the peculiarities of her profession and important nuances for future patients especially for TecRussia.ru:
– It is well known that the indications for surgery are determined by the surgeon, and the possibility or impossibility of anesthesia is determined by the anesthesiologist. That is why the management of our clinic carefully monitors the process of working with the patient at all stages of his care. Professor Sergei Nikolaevich Blokhin personally supervises the examination of each patient:
- Before a person goes for surgery, an anesthesiologist must talk with him;
- having assessed and weighed all the risks, he selects the necessary type of anesthesia - depending on what operation is planned, based on analyzes and functional studies of the body (ECG, X-ray), as well as on the basis of the therapist’s conclusion;
- Only after this we make a final decision on the possibility of performing one or another type of anesthesia and set the day of the operation.
↑ What types of anesthesia are there?
The following types of anesthesia are used for surgical operations:
- General anesthesia , which is performed with the installation of a laryngeal mask or with tracheal intubation and mechanical ventilation (artificial ventilation)
The main difference between general anesthesia and other options is that the patient’s consciousness is completely turned off, sensitivity is lost and all reflex reactions of the body, including breathing, are suppressed. Depending on the degree of breathing impairment, the anesthesiologist decides on the method of ensuring airway patency: an endotracheal tube or a laryngeal mask. The endotracheal tube is installed directly in the larynx. Its main task is to separate breathing to prevent the risk of gastric contents entering the lungs. The mask is made of thin soft latex, is located on the pharynx and does not penetrate the larynx, which eliminates irritation of the patient's respiratory tract. Many patients are wary of general anesthesia, but in practice it is considered one of the most effective and safe methods of pain relief.
- Intravenous anesthesia with spontaneous breathing
In this case, the patient is also unconscious, but breathes naturally. This type of anesthesia is justified during long-term operations, as it makes it possible to dose anesthetic drugs into the blood at a certain speed throughout the entire surgical procedure.
- Regional anesthesia (spinal and epidural)
The analgesic effect is achieved by turning off conduction in a specific nerve or plexus of nerves. The person is conscious and breathing naturally. The main nuance when using this type of anesthesia is that the patient may experience strong emotional experiences: he seems to “participate” in the process of his operation, observes the work of the surgeon, which often causes psychological discomfort. Therefore, in some cases, the patient is additionally (if desired) given a sleeping pill, which allows him to sleep peacefully in the operating room and not experience stress from what is happening.
- Local anesthesia with anesthesiological support
Each of us has probably encountered this type of pain relief: tooth extraction, medical procedures at the gynecologist, swallowing a probe for diseases of the gastrointestinal tract, etc. Widely used for minimal surgical interventions, for example, when opening boils.
Most plastic surgeries are performed under general anesthesia, which is usually called anesthesia. But the final choice of the type of anesthesia always remains with the anesthesiologist, who is guided not only by the patient’s health indicators, but also by the type of operation. For example, blepharoplasty (eyelid surgery) is most often performed under general anesthesia with the installation of a laryngeal mask; for other facial operations, general anesthesia with tracheal intubation is used, but when performing intimate plastic surgery, preference is given to regional anesthesia with intravenous sedation.
↑ Anesthetic drugs
There are several types of “professional” painkillers:
- drugs for intravenous administration, which may have a hypnotic effect, an analgesic effect, or a combination of both,
- inhaled gases, which also combine hypnotic and analgesic effects,
- drugs that relax muscles.
Throughout the operation, sleeping pills and painkillers are supplied to the patient’s body at a certain rate through intravenous and inhalation access. In this way, their concentration in the blood is maintained at a certain level, providing the patient with sleep and pain relief. After the operation is completed, the anesthesiologist stops administering the drugs, their concentration decreases, and the person comes to his senses (usually this happens quite quickly, within 10 minutes).
“It is important to note that until the person falls asleep and is anesthetized, the operation does not begin,” explains Olesya Regotun. “When the surgeon’s work is completed, the anesthesiologist prepares the patient for awakening, ensuring that he feels comfortable when he “emerges” from anesthesia, as well as during the immediate future.” postoperative period, and accompanies him to the ward.”
↑ The main risks associated with anesthesia
“Any planned operation, especially of an aesthetic nature, is always carried out against the background of the most favorable physical (somatic) and psychological state of the patient,” emphasizes Dr. Regotun. – During a mandatory consultation with an anesthesiologist, the risks associated with the patient’s health condition are determined, my job is to reduce them to a minimum. Therefore, unfortunately, it also happens that the desired operation is impossible or is postponed: for example, when additional examinations or even treatment are needed, which will reduce the likelihood of various kinds of complications. After all, aesthetic surgery is not performed for medical reasons, so it is especially important here that the risks of anesthesia do not exceed the risks of the operation itself.”
- Read more about this: Risks associated with anesthesia during plastic surgery - review by TecRussia.ru and comments by anesthesiologist Natalya Akhtyamova
Unfortunately, many plastic surgeons neglect medical standards and operate independently, without the participation of an anesthesiologist. The danger is that the patient’s body may begin to respond to surgical trauma, such as decreased blood pressure, fainting, which can become a serious threat to health and even lead to death. Therefore, when choosing a clinic, due attention should be paid not only to the operating surgeon, but also to the team of anesthesiologists who, in case of unforeseen circumstances, can save your life.
| You can get detailed information and also sign up for a consultation: • by phone, • or on the website of the clinic of plastic surgery and cosmetology “Frau Klinik” • Clinic address: Moscow, st. Gilyarovskogo, 55, metro station "Prospekt Mira" |
Complications after endotracheal anesthesia
We have already mentioned that if the tube is inserted incorrectly, complications arise. They can appear during or after surgery.
Often, in the presence of cardiovascular diseases, improper use of drugs is accompanied by loss of large amounts of blood and tracheal intubation.
After the operation, troubles may occur in the form of the following complications:
muscle pain;- sore throat after using the tube;
- cough after endotracheal anesthesia;
- lung infection;
- allergic reactions;
- nausea;
- loss of consciousness;
- disorders in the nervous system;
- brain damage;
- laryngospasm;
- itching;
- shiver;
- injuries to teeth, tongue, throat.
Usually these manifestations disappear within 2 days. There is no need to blame the doctor for all complications; the individual characteristics of the patient’s body and his susceptibility to medications play a big role here.
Due to the large number of complications when using the tube, the laryngeal mask appeared in 1981. It is not inserted into the trachea, but is located at the entrance to the larynx. Thanks to the cuff on the mask, a tight seal is created. This is a completely safe invention that eliminates the occurrence of laryngospasm after surgery.
But, despite such advantages, the use of a mask is not always successful and appropriate, not to mention the high cost. It happens that due to a leak in the mask between the larynx and esophagus, asphyxia occurs. And besides, it cannot be used in emergency cases due to the problem of a “full stomach”.
How is anesthesia administered?
There are several types of painkillers, differing in the form of the condition, purpose and mode of action:
- solutions for intravenous administration that have a hypnotic or analgesic effect (or both);
- gases for inhalation, also combining two effects;
- drugs for muscle relaxation.
The Osnova plastic surgery clinic uses a modern approach to anesthesiology, in particular multicomponent. This means that during the operation, not one, but several types of drugs are used at once, each of which is responsible for a separate function. Some provide pain relief, others have a hypnotic effect, and others promote muscle relaxation.
During work we use inhalation anesthesia. The drugs enter the patient's body through a laryngeal mask connected to a ventilator or an endotracheal tube. The operation does not begin until the patient falls asleep. Throughout the entire intervention, the anesthesiologist monitors the condition of the patient’s body using a large number of sensors connected to the patient. The optimal concentration of drugs is maintained throughout the operation. After finishing the work, the surgeon gives the command to the anesthesiologist to stop the anesthesia. From this moment, the concentration of drugs begins to slowly decrease, and a short time after the operation, the patient wakes up and is sent to the intensive care ward under the supervision of medical workers.
Within 20 minutes after the end of the manipulations, the patient will be fully conscious and clear-minded, will be able to talk with his loved ones and will feel great. Our anesthesiologists are highly qualified specialists who ensure complete safety and comfort for our patients.
Endotracheal anesthesia - contraindications
Endotracheal anesthesia cannot be used for everyone. There are serious contraindications that cannot be ignored:
Infectious diseases.- Problems with the endocrine glands.
- Kidney and liver diseases.
- Diseases of the lungs and bronchi.
- Respiratory diseases.
- Severe endocrine diseases.
- Unusual structure of the pharynx.
If there are contraindications, another method of anesthesia will be considered. An examination must be carried out; perhaps you do not yet suspect any diseases.
Anesthesia is contraindicated for acute manifestations of these diseases. The anesthesiologist should learn about them before surgery during a consultation.
Otherwise, it is better to refuse surgery and insist on fulfilling the preoperative requirements. It is also important that the anesthesiologist warns the patient about the type of anesthesia that will be used.
