The anesthesia

Definition of anesthesia

Anesthesia is an artificially induced state of unconsciousness. The anesthesia is brought about by administering medication and is used for this therapeutic and or diagnostic Carry out measures without causing pain sensations.

Procedure for anesthesia

The process of anesthesia is divided into three stages:

1. Prepare the patient for anesthesia
2. Performing anesthesia
3. Wake up from anesthesia and follow up.

Preparing for anesthesia (so-called general anesthesia) also includes a discussion that the anesthetist conducts with the patient before the anesthesia. This is intended to reveal possible risks for the anesthesia. These can e.g. previous diseases of the heart or diseases of the lungs. Various blood values ​​such as The coagulation of the blood and the ability of the blood to transport oxygen (so-called hemoglobin level) are checked before anesthesia. It is important that the patient informs the anesthetist about existing allergies. The following are of particular importance: Allergic reactions to certain drugs (e.g. penicillin), allergies to soy products and allergies to patches. If the patient's stomach contents run back (so-called reflux), e.g. at night, he should mention that too.

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Before the operation

In order to ensure a relaxed and adequate sleep in the night before the operation / anesthesia, a sleeping pill can be prescribed. This is usually a benzodiazepine such as Tavor (Lorazepam). Another medication can be taken immediately (but at least half an hour) before the operation to calm down. This is also a benzodiazepine, usually Dormicum (Midazolam). Even if a strict ban on eating, drinking and smoking is to be observed before the operation, the tablets can be taken with a few sips of water.

If there is an excessive fear of the operation, homeopathic medicines can also be taken in advance, if necessary, in order to, among other things, relieve anxiety or positively influence the risk of thrombosis.

Read more on the topic: Tavor Expedit

Preparation for anesthesia

Anesthesia must be planned individually. For this purpose, a preliminary discussion with the anesthetist and the patient usually takes place the day before the operation. It will be clarified whether certain allergies or previous illnesses exist and the patient is informed about the risks. Then the actual planning of the operation begins.

The anesthetist decides on the medication and the ventilation system. Shortly before the anesthesia, a safety talk takes place, where important information is asked again and it is ensured that it is the right patient and the right operation.

Only after these discussions does the introduction begin. The preparations for the anesthesia are usually carried out by a nurse (often with specialist training in anesthesia and intensive care medicine). The main aim of preparation before anesthesia is to constantly monitor vital signs:
The EKG continuously derives the heart's actions, a blood pressure cuff on the upper arm measures the blood pressure, a clip on the finger provides continuous feedback on the oxygen content in the blood.
In order to be able to inject drugs and fluids directly into the bloodstream, a vein must first be punctured in order to create permanent venous access. This often happens on both forearms

Induction of anesthesia

Induction of anesthesia describes the preparation for anesthesia and the safeguarding of the respiratory and circulatory functions. During operations, this initiation takes place in the room in front of the operating room and is carried out by the anesthetist or anesthetist. In an emergency, however, this can also be done on the street by the rescue service, but this is associated with greater risks. First of all, the patient is given venous access so that medication can be administered and the monitoring monitors are connected.

The anesthetist gradually gives the anesthetic medication. The patient falls into a twilight state and falls asleep. As soon as your own breathing stops, the anesthetist takes over the ventilation and secures the airways with a ventilation tube in the windpipe. Ventilation can now be continued by the ventilator. When the preparation is complete, the patient is pushed into the operating room and further prepared for the operation.

Induction of anesthesia begins with the administration of pure oxygen, which the patient breathes in through a mask for a few minutes. Since the patient's lungs do not fill with oxygen for a short time after falling asleep due to the anesthetic, this administration of pure oxygen serves as a buffer.

One speaks of preoxygenation. First, a strong pain reliever is injected through the intravenous cannula during anesthesia. This is an opioid, often fentanyl or sufentanyl. The effect is initially expressed by a certain drowsiness and sleepiness, which is generally perceived as pleasant. The anesthetist then injects the actual anesthetic (so-called Hypnotic) - the most common anesthetic is propofol. Sleep then occurs in less than a minute. Breathing is now taken over by the anesthetist or the nurse:

For this purpose, air is pumped into the lungs by means of a pressure bag through a mouth and nose mask. If there are no difficulties with this form of ventilation, a so-called muscle relaxant is injected. On the one hand, this facilitates the intubation that follows and, in many cases, also makes the operation easier, as the muscles are less tense. In order to be able to guarantee mechanical ventilation during anesthesia for the duration of the operation, there are generally two ways of pumping air into the lungs.
On the one hand, a so-called laryngeal mask, which closes off the entrance to the windpipe with an inflatable rubber ring.
On the other hand, a plastic tube (so-called. Tube), which is introduced into the trachea by intubation. While the laryngeal mask is gentler on the oropharynx, ventilation via a tube offers better protection against stomach contents overflowing into the lungs.

Read more on the subject at: Types of anesthesia - which are there? and intubation anesthesia

During anesthesia

After successful placement of the laryngeal mask or intubation, it is important to maintain sleep (anesthesia) during the operation. For this purpose, anesthetic is either continuously applied via the intravenous cannula (also mostly Propofol) or continuously given into the lungs via the breath. In the first case one speaks of TIVA (total intravenous anesthesia), in the second case of inhalation anesthesia. Commonly used inhalation anesthetics are Desflurane, Sevoflurane and Isoflurane. The freedom from pain is guaranteed by repeated or continuous administration of the opioid via the intravenous cannula.
During the entire period of anesthesia, the anesthetist monitors the patient's vital functions:

• breathing
• Blood pressure and
• Cardiac function.

How deep the anesthesia is can be determined by controlling the brain waves. Here, electrodes on the forehead and temple are used to derive the brain waves and thus the depth of sleep (so-called BIS monitoring).
During the diversion of the anesthesia, the patient begins to breathe independently again. At this moment the tube or the laryngeal mask is pulled out.
In the hours after the anesthesia or surgery, blood pressure, blood oxygen levels and heart activity are monitored. In the hospital, this happens in the so-called recovery room.

Anesthesia diversion

The anesthetic diversion is also the beginning of the waking up phase.For most medications, it is enough to wait and stop further supply to reverse the effect. The anesthetist usually plans this while he is observing the operation, so that the recovery only takes a short time.

Some drugs can also be turned off by an antidote. This works with opioids and certain muscle relaxants.

When the anesthetic wears off, the body gradually begins to control its own functions and its own breathing begins. The anesthetist observes this and speaks to the patient. As soon as one's own breathing is sufficient, the ventilation hose is pulled out, which often happens in the operating room. In rare cases, if breathing is insufficient, a new ventilation hose must be placed.

The patient is then taken to the recovery room, where a further check of the body functions is carried out. The anesthesiologist accompanies the removal of the anesthesia throughout, so that intervention is possible in the event of complications. In some patients, the elimination takes significantly longer, as the breakdown of the drugs does not work equally quickly for everyone.

Read everything about the topic here: Anesthesia diversion - procedure, duration and risks

Wake up time

The time to wake up begins when the anesthesia is drained and the drug concentration in the blood drops. Independent breathing sets in and your eyes can be opened upon request. As soon as the ventilation tube is removed, the patient is brought to the recovery room and continues to be closely monitored. B.

The consciousness is awakened a little already in the operating room, but it takes a few hours to wake up. After-effects such as nausea and vomiting can be reacted to directly in the recovery room, and more serious complications can also be easily identified.

After general anesthesia, confusion often occurs, which is also used to define the time to wake up. This ends when the person concerned is fully oriented. This means that the person concerned must know their own name, be able to estimate the date and know where they are. Only when the person concerned can safely answer these questions will they be transferred to the normal ward.

Major operations with subsequent artificial coma are an exception. These patients are often transferred directly to the intensive care unit and only taken out of anesthesia after their health has stabilized.

Aftermath of anesthesia

General anesthesia always puts a lot of strain on the body and has some after-effects. The anesthetic drugs act centrally and thus on the brain. A common consequence of anesthesia is slight confusion after waking up. In most cases this will decrease after a few hours.

In some people affected, especially the elderly, however, long-term delirium can develop, which in extreme cases can lead to permanent need for care.

In children, confusion often manifests itself in screaming and raving, since they cannot assess the situation. Furthermore, people often complain of nausea and vomiting after anesthesia, as the body tries to get rid of the medication and toxins normally enter the body via the gastrointestinal tract.
Here you can find out more about: General anesthesia for children

Headaches are also a relatively common aftereffect of anesthesia. In addition, ventilation can lead to a sore throat and hoarseness, as the ventilation tube irritates the mucous membrane and the vocal cords. Some sufferers also complain of hair loss and sleep disorders, which can also be attributed to the strong medication. Most of the aftermath will quickly resolve without further intervention.

Read more about the following here: After-effects of general anesthesia

Risks and complications of anesthesia

A lot has happened in modern medicine since the first operations under anesthesia began. However, new methods do not change anything about the fact that anesthesia is in principle not harmless. Because despite all the precautionary measures and developments of the last decades, anesthesia remains a high-risk medical intervention, in which risks and complications cannot be completely ruled out. Worldwide, within the member states of the World Health Organization, around 230 million operations are performed annually using general anesthesia, and the number is rising. With the amount of operations involved, complications are inevitable.

Complications that can be related to the anesthesia have been investigated in studies. A European study found 0.69 per 100,000 deaths specifically related to anesthesiological measures. Anesthesia is one of these measures.

Read more on the topic: Fear of anesthesia / general anesthesia

Effects

Overall, the mortality rate, i.e. the proportion of people who die because of anesthesia, is relatively low. The proportion of people who die from complications during the operation that do not fall within the anesthesiological field is much higher.
A study from the United States reveals the percentage distribution of reasons for death in patients. According to this study, 46.6% of the main reason to die from anesthesia is an overdose of the anesthetic. Just behind, 42.5% of deaths are due to side effects of the anesthetic. Only 3.6% of deaths are pregnancy-related, according to the study. When interpreting these numbers, it should be borne in mind that they indicate the anesthesiological measures as the reason for the patient's death. Even in elderly patients or people with relevant comorbidities in poor condition, the deaths are in the low range (27 / 100,000 - 55 / 100,000).

Aside from the rare deaths, there are other complications that can occur with general anesthesia.

Rare complications of anesthesia are bruises or heavy bleeding, which can result from injecting anesthetics and require medical treatment. Infections caused by an existing catheter and which can be responsible for the occurrence of sepsis, for example, are extremely rare. The same applies to nerve damage, which can become noticeable after the operation in the form of numbness, pain and inability to move.

A more common complication is damage that can be caused by positioning during the operation. These complications usually manifest themselves in the form of temporary paralysis and slight skin damage, which in most cases regress after a few days. As with most drugs, allergic reactions sometimes occur with the anesthetics. Usually, however, only slight allergic reactions occur, in rare cases an allergic shock, which requires intensive medical treatment.

Hoarseness, difficulty swallowing and awareness

A common complication after the operation is hoarseness and difficulty swallowing, which are caused by intubation and which in most cases resolve on their own. Intubation can also damage teeth and even result in tooth loss.

One complication, which is a major concern of many people who are about to undergo anesthesia, is that they might notice the operation despite anesthesia (medical: awareness). Since such an experience can have severe psychological consequences in 10% -30% of cases, the worries are not unfounded. However, the frequency with which this phenomenon occurs is around 0.1% to 0.15%, which is very low.

Overall, life-threatening complications that can be associated with the anesthesia are gratifyingly rare. However, even with the most modern anesthesiological procedures, complications cannot be prevented and in some cases even lead to the death of the patient. This is due, among other things, to the fact that nowadays operations are performed on patients whose general condition can be classified as poor due to severe concomitant diseases. If you have concerns about the need for general anesthesia before an operation, this should be mentioned at the anesthesia consultation before the operation.

Read more about the topics: Anesthetic side effects and anesthetic complications

Side effects of anesthesia

The side effects of anesthesia can manifest themselves in very different ways and depend on many other factors. If complications occur during or after an operation, this is not necessarily due to the anesthesia. The risk of complications during anesthesia is based, among other things, on due to the patient's previous illnesses and increases with age. Damage after the procedure or mortality caused by the anesthesia itself are put at a very low percentage.

Lungs and airways

Possible problems that may arise include breathing. Initially, the insertion of the hollow probe (Tube) into the windpipe as difficult if swelling or bleeding obstruct the view of the structures. Furthermore, so-called aspiration can occur, i.e. the penetration of foreign bodies such as choked up or vomited food particles into the airways. In that case, these can be relocated, which means an acute risk of suffocation for the patient, or subsequently cause pneumonia. However, aspiration is rarely fatal, as swallowed foreign bodies are removed endoscopically and subsequent inflammation can be prevented with antibiotic therapy.

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If the anesthesia is not deep enough or if the airways are irritated by the intubation too much, a so-called bronchospasm can occur. The smooth muscles in the walls of the windpipe and bronchi instinctively cramp up, which narrows the airways. Patients with known lung diseases (e.g. Asthma, COPD) represent a particularly frequently affected group. Muscle-relaxing or bronchodilating drugs and increased ventilation pressures provide relief.
To one Laryngospasm it is when the muscles of the larynx cramp and the glottis is closed. Breathing is no longer possible and the consequences of a lack of oxygen are threatening. This complication is more likely to occur during anesthesia diversion, i.e. when the tube is removed from the windpipe. Using mask ventilation, oxygen can be administered, obstructing secretions must be removed and, in an emergency, a muscle relaxant is used, which relaxes the muscles of the larynx.

Cardiovascular system

Other possible complications involve the cardiovascular system. The effect of the anesthetic causes, among other things, the blood vessels widen, which can cause blood pressure to drop, and the heart beats less. While this fact doesn't matter much to a healthy patient, a weakened patient with a pre-existing cardiovascular system can react very strongly to it. A rapid drop in blood pressure is treated with fluids to increase blood volume and drugs that narrow blood vessels. Any cardiac arrhythmias that occur are treated with appropriate substances (Antiarrhythmics) fixed again. Individual extrasystoles, i.e. additional heartbeats in a normal rhythm, are occasionally recorded, but are not cause for concern. Heart attacks during the procedure are more likely to occur in patients with heart disease. In the worst case, the consequence of surgical stress, lack of blood and insufficient supply of the heart muscles can lead to cardiac arrest, which requires immediate resuscitation measures. To keep the risk of this as low as possible, previous drug treatment of previously injured patients and regular blood pressure monitoring are recommended.

mental problems

The condition feared by some people during an operation is the "intraoperative wakefulness“ (Awareness), in which the patient then has memories of words or sentences or sensations such as pain, panic or fear. The frequency is estimated at 0.1-0.2% and in most cases existing memories are not perceived as stressful. Serious mental disorders as a result of this experience only occasionally occur. The risk of such a state of wakefulness is increased with lower doses of anesthetics with regard to any previous illnesses, extended airway protection, the administration of muscle relaxants, a technical defect in the equipment responsible, but also on the patient side the previous abuse of alcohol, drugs or sleeping pills. In order to exclude possible wakefulness monitoring systems are already used, which register electrical brain activity and perceptual ability of the hearing.

Allergic reaction

Allergic reactions are also considered a possible complication, but they rarely play a role. Muscle relaxants are the most common cause, but anesthetics, antibiotics or latex gloves can also trigger an allergic reaction. This can manifest itself as simple reddening of the skin, constricted bronchi and anaphylactic shock with a collapse of the circulatory system as a result. The rest of the procedure is limited to removing the triggering allergen and administering fluids and medication to stabilize the patient.

Nausea and vomiting

A dreaded complication of anesthesia is nausea and vomiting after anesthesia, as there is a risk of aspiration (inhalation) of vomit. If saliva or vomit is inhaled, respiratory infections can easily develop and patients should be monitored and treated. Incidents have decreased in recent years thanks to new medical techniques and procedures, but they can still occur today. The incidence rates in recent years have been around one case of aspiration in 2000-3000 operations, with the number in pregnant women at 1/1000 being slightly higher.

Malignant hyperthermia

A very rare complication is the so-called malignant hyperthermia. This is an inherited disease that appears for the first time when anesthetic is administered and is considered life-threatening. There is an over-activation of the muscle fibers, which consume energy in an uncontrolled manner, which inevitably leads to an increase in carbon dioxide, a rise in temperature and acidification in the body. Corresponding symptoms are stiff muscles, palpitations, and metabolic and organ failure, which ultimately leads to death. If such a predisposition is suspected, tests can be carried out beforehand or the triggering substances can be dispensed with. In an emergency, "Dantrolene“Used, which has lowered mortality very drastically in recent years.

This acutely life-threatening condition can only be remedied by immediately discontinuing the anesthesia or by replacing the causative medication. Other measures include cooling and close intensive care monitoring.

Read more about the topics: Side effects of anesthesia and after-effects of general anesthesia

Types of anesthesia

General anesthesia can be achieved in different ways. The various types of anesthesia usually differ in terms of the various drugs used. Not every drug is suitable for every patient and every procedure. The duration and type of the procedure are decisive, as there are short-acting and long-acting drugs.

Possible intolerances and allergies of the patient must also be taken into account. When it comes to drugs, for example, a distinction is made between gas anesthesia and total intravenous anesthesia. The former cannot be used with a certain genetic change, as this can lead to malignant hyperthermia. Another distinction is the type of ventilation. For short procedures, ventilation with a mask is sometimes sufficient, while for long procedures, a ventilation tube is necessary. General anesthesia can therefore be varied with many levers and must be planned individually, which makes an exact classification into types almost impossible. This makes emergency anesthesia so dangerous because planning cannot take place.

Anesthetics

An anesthetic consists of three different types of medication, as three major body functions have to be controlled. These functions are consciousness, pain perception and muscle function.

The first group of drugs are sleeping pills or sedatives, which turn off consciousness. These include, for example, propofol, thiopental and etomidate.

The second group are the opioids, which switch off the sensation of pain. These include fentanyl or ketamine, which have a much stronger effect than morphine.

The last group of drugs are the muscle relaxants.These are supposed to switch off your own use of the muscles so that ventilation and movement of the muscles from the outside work better. Examples of muscle relaxants are succinylcholine or rocuronium.

Most anesthetic drugs are given directly through the blood, but anesthetic gases can also be used. The best-known anesthetic gases are sevoflurane or isoflurane.

During the anesthesia, the anesthetist can also control the circulatory functions with medication. Not every anesthetic drug is suitable for every patient and every procedure, so the anesthetist has to plan an anesthetic individually. Emergency anesthesia therefore have significantly greater risks than planned interventions.

Anesthesia with propofol

Propofol is one of the strong sleeping pills and sedatives and can therefore be used to switch off consciousness. Propofol is exclusively hypnotic and has no effect on the sensation of pain.

The effect occurs very quickly and the half-life in the blood is short, which means that an anesthetic is possible to the minute. Serious side effects are rare. Pregnancy or a soy allergy are reasons for exclusion from using propofol. Particular care must be taken with children.

Read more about the topic: Short anesthesia with propofol

CO2 anesthesia

CO2 anesthesia does not normally mean anesthesia in the classic sense, which is initiated by an anesthetist, but deep unconsciousness due to too much CO2 in the blood. This can come from the body's own processes as well as from external influences.

CO2 anesthesia using the body's own CO2 can result from poisoning with medication or drugs, but also from a chest injury or being extremely overweight. What these three causes have in common is decreased breathing and thus an accumulation of CO2 in the blood. Another cause is poorly controlled artificial ventilation. This can be caused by various regulatory mechanisms in the body, which have an undesirable effect on ventilation.

The high percentage of oxygen in particular can influence the body's CO2 emissions via different systems. External CO2 poisoning can occur through accidents. Examples of this are the accumulation of CO2 in fermentation cellars or silos. A targeted CO2 anesthesia is not used in medicine and is only known from animal slaughter.

Anesthetic gas

Anesthetic gases, also known medically as inhalation anesthetics, are used to induce and maintain general anesthesia. The aim of these drugs is to switch off consciousness, pain perception, reflex mechanisms and muscle relaxation. Another effect of the anesthetic gases is a deliberately created memory gap about everything that happens during the administration of the gases (amnesia).

There are a few different substances that are used as anesthetic gas in Germany. A distinction can be made between two groups of substances, which differ in their physical state at room temperature. Xenon and nitrous oxide are gaseous at room temperature, whereas the so-called volatile anesthetics are in liquid form and have to be administered via a vaporizer. The usual agents in this group of substances are isoflurane, sevoflurane and desflurane.

The effect of anesthetic gas can be based on a high level of binding to fatty substances (Lipophilicity). In this way, the gases can easily pass into the blood after inhalation and their concentration can be controlled in a controlled manner. The gases accumulate mainly in fatty tissues such as the brain. This is an advantage because the conscious mechanisms to be controlled are controlled from there and the anesthetic gas takes effect quickly. The exact mechanism of action of anesthetic gas is not fully understood. However, reactions on the cell walls and on ion channels are discussed and suspected.

In modern anesthesia, various anesthetics are usually used in order to minimize the side effects of one substance from another drug.

The side effects of anesthetic gas cannot be generalized, as these differ from active substance to active substance. However, all substances have in common that they can cause a life-threatening metabolic derangement with an accompanying rise in body temperature (malignant hyperthermia) as a side effect. Despite the rarity of this side effect, it is a very feared complication of any anesthetic under inhalation anesthetics. Other side effects are the dose-dependent damage to the heart muscle, blood vessels and the airways. Liver damage can also be caused by elimination in the liver.

The anesthetic gas is removed from the body by exhaling the gas once the operation has ended and the patient is to be awakened again.

Anesthesia at the dentist

Anesthesia and anesthesia also play an important role in dentistry. In the case of larger interventions, which may also go beyond individual dental treatments, appropriate procedures must be used to ensure freedom from pain. The need for anesthesia can also be given by very anxious patients who do not want to undergo a dental examination or minor treatments while fully conscious. There are different types of dental anesthesia. Which of these is used is decided by the upcoming procedure and, if possible, the patient's request. A broad distinction is made between local anesthesia, surface anesthesia, sedation and general anesthesia.

Local anesthesia

The most common application at the dentist is local anesthesia. This is a local anesthetic that takes place in the area of ​​nerve endings and does not affect consciousness. The anesthetic is injected into the desired location using a syringe. Within local anesthesia, a distinction is made between infiltration anesthesia and conduction anesthesia. Intraligamentary and intraosseous anesthesia are subordinate.
In infiltration anesthesia, the solution is injected near the root of the tooth or under the mucous membrane. In this way, individual teeth, the surrounding bone and the overlying skin, e.g. The lining of the mouth or the skin of the face. This variant is particularly used in the upper jaw.

Conduction anesthesia

Circuit anesthesia is a popular choice in the lower jaw area. The local anesthetic is placed close to the nerve trunk in order to make the entire supply area of ​​this nerve insensitive to pain. In the lower jaw this usually affects the "Inferior alveolar nerver “, loosely translated as the nerve of the lower jaw teeth. Analogously to this, the so-called maxillary nerve (Maxillary nerve) affected.
If only a single tooth is to be anesthetized, this can be done with the above intraligamentary method. In this case, the drug is inserted directly into the tooth's holding apparatus at the root and, so to speak, finds its way through the bone to the tip of the root. The surrounding tissue is spared.
Intra-osseous, i.e. In the bones between two tooth roots, a local anesthetic is rarely administered nowadays, as the increased risk of infection and the availability of better alternatives speak against it.

Surface anesthesia

Surface anesthesia is less invasive. In the form of rinsing solutions, ointments or sprays, only the superficial oral mucosa is numbed. This method can be useful to reduce the puncture pain of a possible subsequent injection, which is particularly indicated in children, or for minor treatments on the gums.

Sedation

Another alternative is sedation. The patient is treated with calming substances (sedative) mostly in combination with painkillers (Analgesic sedation) is put into a twilight sleep in which he feels neither fear nor pain. The administration (application) takes place through veins into the bloodstream (intravenous). However, sedatives have a habitual effect and a potential for dependency in the long run. In addition, incapacity to drive is to be expected after sedation. In contrast, general anesthesia is much more complex and carries greater risks. The patient must be artificially ventilated and constantly monitored during the procedure. The recovery phase after general anesthesia is longer and side effects such as nausea and vomiting are not uncommon. The time after the treatment, in which you have to avoid eating and drinking, ultimately depends on the procedure itself and the form of anesthesia chosen. This precautionary measure is intended to protect the oral cavity from injury and to prevent the ingestion of food particles or liquids.

Read more on the topic: Local anesthesia in dentistry

Wisdom teeth

General anesthesia is not absolutely necessary when removing the wisdom teeth. The desire for general anesthesia is usually caused by fear, but every general anesthetic offers great risks that are disproportionate.

In addition to the normal risks, the risk of rebleeding increases because, unlike local anesthesia, no vasoconstricting medication can be used. One advantage of anesthesia is the ability to remove all four teeth in one operation. The final decision on the type of anesthesia must be made jointly by the anesthetist and the patient.

You can find out more about the topic here:

• Pull wisdom tooth under general anesthesia
• Anesthesia at the dentist

Anesthesia in children

In Germany, children up to the age of 14 may only be anesthetized with the consent of their parents. Between the ages of 14 and 18, children can independently decide whether or not to have an anesthetic, provided the attending physician has no doubts about the child's maturity. Since children cannot be seen as “small adults” from a medical point of view, there are a number of special features to consider when using anesthesia. In addition, a distinction is made between three subgroups: premature babies, newborns and infants as well as toddlers, school children and adolescents. The anesthetist must adapt his instruments and the dose of narcotics to the physical characteristics. For example, smaller lungs and narrow airways, lower cardiac output and a longer retention period for medication in the body due to lower liver and kidney functions. In the case of babies in particular, warming pads and blankets or heat lamps are also used, as these cool down quite quickly at room temperature.

Read more on the topic: Anesthesia in children

preparation

Children should also fast before anesthesia, i.e. the last food intake must not be less than 6 hours ago, the last fluid intake not less than 2 hours ago. Infants can be breastfed up to 4 hours beforehand. In the event that the sobriety is not given, there is the "rapid sequence induction"(RSI). The processes of intravenous anesthesia induction are modified with the aim of a faster process in order to keep the risk of suffocating on the stomach contents as low as possible. If necessary leftovers can be removed through a gastric tube. In children, in addition to the previous oxygen administration (Pre-oxygenation) mild ventilation between muscle relaxation using so-called relaxants and the subsequent insertion of the ventilation tube (Intubation) is recommended as children become oxygen deficient earlier than adults.

Induction of anesthesia

Inhalation induction is a popular form for young children. The child breathes the anesthetic (e.g. Sevoflurane) through a mask, falls asleep and only then can an indwelling venous cannula be inserted painlessly. This method becomes risky if complications arise during the sleep phase and there is still no venous access through which drugs can be administered quickly. Alternatively, intravenous induction (e.g. with Propofol), which is recommended for children from 7 years of age or with a weight of 25 kg. By numbing the puncture site beforehand (Lidocaine / plaster containing prilocaine or ointment) the insertion of the cannula should go smoothly. Rectal induction can be used for very small and extraordinarily anxious children. The drug (methohexital) is inserted into the child's rectum. As soon as the child has reached sleep, the anesthesia can be continued in other ways. There is also the option of nasal or intramuscular induction. In the case of nasal anesthesia induction, the drug is introduced through the nose by syringes or nebulizers, which promises a quick and reliable effect. In the other case, the active ingredient is injected directly into a muscle. Nowadays this method is rather an exception and is mainly used in emergency medicine.

If the anesthesia has been successfully initiated, a muscle relaxant is injected analogous to adult patients, which relaxes the muscles and prevents the triggering of protective reflexes such as coughing, choking and vomiting while the airway is secured (Intubation).

Anesthesia during a gastroscopy

General anesthesia is also not absolutely necessary for a gastroscopy. Alternatively, the person can be given a strong sedative and the throat is numbed with a spray. For people who are very anxious or who cannot work properly, such as children, general anesthesia can be useful or even necessary. Here, too, the risks of general anesthesia must be weighed up against the benefits.

Anesthesia and pill

Basically, there are no dangers from the pill with general anesthesia, but many drugs have an influence on the effectiveness of the pill. Since many different drugs are used in general anesthesia, this question cannot be answered in a general way.

As safe contraception may not be guaranteed, additional contraceptive measures should be used in the first few weeks after anesthesia. In order to clarify the individual case, the attending physician should be contacted.

Anesthesia despite a cold

A mild cold is usually not an obstacle to general anesthesia, but the anesthetist must decide on a case-by-case basis. In the event of a cough, it must be clarified whether ventilation can be ensured during anesthesia. It must be weighed whether the increased risk with ventilation is more serious than postponing the operation.

A slight increase in body temperature does not automatically represent an obstacle, but the cause of the increase in temperature must be looked for. Here, too, it must be weighed whether the body can withstand the additional stress of general anesthesia and whether it makes sense to postpone the operation.

If you have a fever, you should only perform operations that cannot be postponed, as the body is already under great stress. In the case of a cold, the question of whether it is necessary to postpone it is therefore always an individual decision.

Find out more about the topic: Anesthesia despite a cold

pregnancy

During pregnancy, anesthesia should only be used for absolutely necessary and irreversible Interventions come into question. The responsible anesthetist must be informed about a possible or existing pregnancy as part of each anesthetic procedure and fully explain the risks and possible complications to the patient. A basic distinction is made between the need for anesthesia gynecological interventions, such as in the Obstetrics, or for non-gynecological operations due to previous illnesses. Except for the first 2-3 weeks of pregnancy (SSW) the use of anesthetics is particularly critical for the child up to the 16th week of pregnancy.

There are some physical changes that need to be considered in the anesthetic procedure in a pregnant patient. For example, a pregnant woman applies never as sober, which is why ventilation is only provided via an intubation tube and not via a Ventilation mask can be done to prevent the ingestion of vomit (aspiration) to prevent. In addition, it should be noted that anesthetic drugs start to work earlier and decrease in their effect more quickly when the anesthesia is drained. Safeguarding the airway can be more difficult because the mucous membranes in pregnant women are better supplied with blood and minor injuries cause heavier bleeding. A adequate oxygen supply is also indispensable for mother and child, whereby an oversupply can also be harmful, as the oxygen delivery to the child is impaired.

In addition, the Coagulability of the blood increased what the risk for thrombosis or Embolisms elevated. The child is also exposed to narcotics in the womb, as these are through the placenta and the umbilical cord enter the fetus's bloodstream.Like general anesthesia, the risks for complications during pregnancy are Miscarriages or premature births slightly increased while a PDA (Epidural anesthesia), which is often used for painless delivery and is usually well tolerated. Complications that can occur during an epidural include more suddenly Drop in blood pressure, fever or a headache in the days thereafter by irritation of the meninges in the spinal canal. The drop in blood pressure can be counteracted by infusions, which increase the blood volume in the circulation. On vasoconstricting substances (Vasopressors) should be avoided, as these reduce the blood flow to the uterus and can thus harm the child.

Anesthesia for intestinal play

A colonoscopy (Colonoscopy) is mostly used in specialized medical practices (Gastroenterologist) or on an outpatient basis in the hospital. During the examination, a movable endoscope is inserted into the anus and from there pushed along the intestine to the transition into the small intestine.

This procedure is generally associated with little pain, but advancing the instrument is often found uncomfortable. Therefore, if desired, the patient may be given a sedative (e.g. Midazolam) often given in combination with a pain reliever such as tramadol via an injection. This combination is known as analgesic sedation. This manifests itself as a kind of twilight sleep, during which, among other things, In contrast to anesthesia, no external ventilation is necessary. So-called short anesthesia with propofol are now also used.

The examination is generally considered to be safe and harmless. It is worth mentioning, however, that the choice of sedation or anesthesia before a colonoscopy significantly increases the risk of complications, despite careful monitoring of so-called vital parameters (e.g. Pulse, oxygen saturation, blood pressure) by the medical staff. If the drug used is poorly tolerated, this usually has an impact on the cardiovascular system and the lungs. The decision to use anesthesia during the colonoscopy should therefore not be made lightly and can still be made during the examination.

Read more on the topic: Anesthesia for a colonoscopy