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Anaesthetics and Resuscitation

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Anaesthetics and Resuscitation

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Introduction: anaesthetics and the anaesthetist

Anaesthetics is the medical speciality that studies the way to reduce or stop pain and consciousness so that the human body can undergo a surgical intervention or other invasive medical procedure (endoscopies, radiological procedures, etc.) with minimal alteration of its normal functions.

The anaesthetist has always been known as the doctor who "puts patients to sleep" before they undergo an operation, but the practice of this speciality includes other areas, and not just the operating theatre. Nowadays, an anaesthetist is a specialist in "perioperative" medicine. During the stage before the operation (preoperative), the anaesthetist must examine and prepare the patient who is to undergo the intervention. During surgery (intraoperative), he/she is responsible for suppressing pain and maintaining the patient's vital signs. This care continues after the operation has finished, until the patient is in a suitable condition to return to the ward.

Pain control after surgery (postoperative) is of vital importance for the patient's well-being to ensure that the surgery is successful and to avoid complications. The anaesthetist has an in-depth knowledge of the medications and techniques that best suit each patient and each type of intervention to ensure a comfortable postoperative period.
 

Everything you need to know about anaesthetics and did not dare ask

Are there different types of anaesthesia?

The body can be desensitised to surgical pain in various different ways. They can be grouped into three categories:

►General anaesthesia. The patient remains unconscious and does not feel anything. This is actually a controlled and reversible "intoxication" using a variable number of drugs, sometimes more than a dozen. Some of these are injected intravenously or intramuscularly and others are inhaled as gases. The anaesthetist constantly calculates the doses to adjust the level of anaesthesia to the needs of the intervention and each patient's characteristics. A number of techniques are also used to maintain the patient's breathing and circulation within normal limits, assisted by a variety of sophisticated electronic systems. Once the operation is over, the anaesthetist restores consciousness and controls the vital signs, which takes a varying length of time according to the patient and the intervention.

►Sedation. The patient remains conscious and calm due to the sedative effects of the medication. There is generally a variable degree of drowsiness. Sedation is often used for endoscopies and alongside a regional anaesthetic.

►Regional anaesthesia. A large area of the body is numbed (e.g. the arm) so that it can be operated on. To do this, the anaesthetist injects a certain amount of anaesthetic drugs close to the nerves that are sensitive in that area. The patient remains awake or half asleep (sedated), but does not feel any pain. There are numerous regional anaesthetic techniques, depending on the area that is to be operated on. The most commonly used techniques are epidural and spinal, where the anaesthetic is injected into the spinal canal by means of a puncture in the lower back, stopping all sensitivity in the lower half of the body.

►Local anaesthesia. The anaesthetic is applied directly to the area that is to be operated on. It is used for minor interventions on very limited areas.

When and how will I wake up?

The time it takes to regain consciousness after the anaesthetic depends mainly on its duration and on the type of anaesthetic medication that has been used, and both of these factors, in turn, vary according to the operation that has been performed. If we add to this the fact that there are numerous differences between people in terms of their sensitivity to the anaesthetic medication, it is easy to understand that the time it takes for you to come round may vary from a few minutes to several hours.
Due to the wide range of circumstances that can occur, you must ask you anaesthetist about your particular case.
You are normally brought round in the operating theatre itself and then you will be taken to the recovery unit or room, where you will be cared for by a team of specialised nurses under the anaesthetist's supervision. This surveillance will be kept up until you have recovered enough to be taken back to your room.

Why am I asked about my medical history?

As the anaesthetic and the surgery may alter the body's normal functions to a varying degree, your anaesthetist must know as accurately as possible what your state of health is. You will therefore be asked about diseases that you have suffered from, medication that you take regularly, possible allergies, smoking habits, consumption of alcohol and other drugs, etc.
It is very important that you follow the anaesthetist's recommendations for your pre-surgery preparation, as he/she will be responsible for your medical control during the operation.

Why is it important not to eat or drink before being anaesthetised?

Anaesthesia alters one's normal reflexes, so some of the body's defence mechanisms will stop working. It is therefore necessary for you to have an empty stomach to prevent food from being regurgitated and passing into the respiratory tract. The anaesthetist will tell you how long you must refrain from eating and what you can take, e.g. medication with a sip of water.
For your own safety, it is important that you follow these instructions carefully, otherwise it may be necessary to postpone the intervention.

What happens during anaesthesia and after I lose consciousness?

Once you are unconscious, the anaesthetist begins the most delicate part of his/her work, which consists of controlling your vital signs and treating any alteration in your physical state that occurs during the operation. Taking his/her own knowledge and experience as a basis, he/she will also use sophisticated electronic monitoring systems and will administer a number of medications to you. Some are needed to maintain your state of unconsciousness while surgery is performed, whereas others will regulate the functioning of your vital organs, particularly heart rate, blood pressure, breathing, and kidney and brain function. The anaesthetist can therefore treat any medical problem that occurs during the operation. As you are coming round, the necessary medical treatment will be started to reduce any postoperative pain and discomfort.

Can I choose the type of anaesthetic?

Yes, within certain limits. There are interventions that can be performed under different types of anaesthetic, but for others it is not possible to choose. After studying your individual case, your options and the pros and cons of each of them will be explained to you and you will be advised as to which of the techniques is most suitable in your case.

What are the risks of anaesthetics?

All surgical interventions and all anaesthetics involve some degree of risk, which varies greatly according to the type of intervention, in particular, and the patient's previous physical condition. Fortunately, serious accidents associated with anaesthetics are exceptional, although when they do occur they have a great social impact.
Complications related specifically to anaesthesia have decreased considerably over the last 30 years due to the development of more potent, safer medications and sophisticated control and monitoring systems.
The number of deaths attributed to anaesthetics has also dropped significantly. It is currently calculated that the risk of death caused directly by an anaesthetic is one case in every 200,000, which is considerably lower than the risk of suffering a serious traffic accident.
In any case, each patient and each intervention involves a specific risk. Ask your anaesthetist about the particular complications that can be associated with your intervention.

Portfolio of services

  • PRE-ANAESTHETIC CONSULTATION: For patients who are due to undergo an operation. It serves to establish preliminary contact between the patient and the anaesthetist, to assess any possible risks and, as far as possible, to reduce them before the intervention.
  • REGIONAL ANAESTHESIA: Epidural, spinal, brachial plexus blocks (axillary, interscalene and others), femoral nerve blocks, sciatic nerve blocks, foot block. Intravenous regional anaesthesia.
  • GENERAL ANAESTHESIA, with or without endotracheal intubation.
  • EPIDURAL ANALGESIA FOR LABOUR PAINS, which provides great relief for the future mother 
  • POST-ANAESTHESIA RECOVERY UNIT, a special room for the care and observation of patients during the immediate postoperative period.
  • SEDATION IN ENDOSCOPIES: this makes it possible to perform gastroscopies and colonoscopies with exceptional comfort for the patient.
  • SEDATION IN RADIOLOGICAL PROCEDURES: some of these procedures can be painful and cause the patient a lot of discomfort, so it is necessary to offer some kind of anaesthesia despite the fact that they are not strictly speaking surgical interventions.
  • TREATMENT OF ACUTE POSTOPERATIVE PAIN, using specific postoperative analgesia protocols for each type of surgery. In certain cases epidural analgesia is used for several days.

Special techniques

►COMBINED ANAESTHETIC TECHNIQUES involve the combination of two types of anaesthesia, to reduce pain and ensure excellent postoperative comfort. Some examples of techniques that are widely used at Clínica Vistahermosa are:

  • Epidural+general anaesthesia: in complex abdominal surgery (e.g. colon, stomach, etc.)
  • Brachial plexus+general anaesthesia: in shoulder surgery.
  • Spinal and epidural anaesthesia for controlling postoperative pain in knee and hip replacement surgery.

►ANAESTHETIC MANAGEMENT OF PATIENTS WITH INTUBATION DIFFICULTIES using different procedures, including fibrescope-guided intubation in patients with anatomical pharyngolaryngeal or craniofacial alterations.

Medical staff

  • Dr. Javier Moro (Coordinador del Servicio)
  • Dr. Orlando Tovar
  • Dr. Jesús Cano
  • Dr. Enrique Cárdenas
  • Dr. José Valdivia
  • Dr. José Amorós
  • Dr. Miguel Angel Alvarez
  • Dr. Jorge Burruezo
  • Dra. Miloslava Baskova
NURSES
  • Montserrat Rodenas
  • Marta García
  • María García
  • Pilar Arnés
  • Iris Campos
  • Patricia Baldó
  • Maica Cano

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