In your mind, is anesthesia a matter of “just a shot and a nap”? As a common man’s simple view, this is easy to understand but inaccurate. In fact, anesthesia is much more than that. Behind the “sleeping” process is the high content of modern medical technology. On the operating table, the surgeon concentrates on the lesion to move the knife, the anesthesiologist must watch the six directions and listen to the eight directions. While regulating the depth of anesthesia to ensure that the patient is in a pain-free state and that the surgery goes smoothly, the surgeon must use advanced instruments to manage the patient’s vital signs, including respiration, heart rate, blood pressure, nervous system, liver and kidney function, to ensure the safety of anesthesia, and must also be ready to respond to any unexpected situation. It can be seen that good anesthesia can escort the smooth operation, and the anesthesiologist, on the other hand, is the protector of life under the shadowless lamp.
Ans: What is the place of anesthesia in medicine?
Surgical techniques were developed before anesthesia techniques. But can you imagine what methods people used to prevent patients from struggling with severe pain before anesthesia was officially invented? They either tied the patient to the operating table; or to the patient to drink alcohol intoxication (alcohol ethanol is also a kind of anesthetic); or simply take a stick directly to the patient’s head a stick knocked out, and then rush to take a quick surgery; or even the patient will be put into shock blood, and then the blood delivery back after the operation is done. When you think about it, we are so lucky to live in the era of anesthesia science and technology. The United States has ranked anesthesia technology as the fourth greatest invention that changed the course of human civilization in the 20th century, which is sufficient to illustrate the contribution of the invention and progress of anesthesia to the promotion of medical science and to human health. This year is the 170th anniversary of the birth of anesthesiology, and it is all the more important for us to raise the public’s understanding and attention to anesthesia.
Anesthesiology is a high-risk discipline among all medical disciplines, and because of its high risk, anesthesiologists are among the most comprehensive medical personnel in terms of skills, knowledge, experience, theory, and methods of resuscitation. As for the rescue of patients with acute and critical illnesses, the contribution of anesthesiologists is no less than that of emergency medicine doctors and ICU doctors. Nowadays, after the anesthesiology department has basically solved its own safety problems, it should take the initiative to take the responsibility of guaranteeing the medical safety of the whole hospital, and to be the last “gatekeeper” of the discipline.
When talking about the development of anesthesiology in China, Prof. Yu Buwei proudly said that in recent years, the exchange between Chinese anesthesiology and the international community has become more and more frequent, for example, in the recently concluded 15th Global Conference of the World Federation of Anesthesiologists’ Associations held in Argentina, six Chinese professors were included in various committees of the World Federation of Anesthesiologists’ Associations. From this perspective, anesthesia is probably at the forefront of all medical specialties in China. At the same time, the World Congress of Anesthesia has also set up a special session on China, focusing on the achievements of the Chinese anesthesia discipline in various aspects. All these reflect that after more than 60 years of struggle, the Chinese anesthesia community has begun to come to a position of being on par with the advanced countries in the world, which is a very gratifying and proud achievement.
Short answer question: How does anesthesia protect the patient for surgery?
Before a patient undergoes surgery, he or she usually only considers the level of the surgeon in charge and hardly thinks about the impact of anesthesia on the success of the surgery, believing that the job of an anesthesiologist is simple: to give the patient a shot before the surgery and let him or her sleep peacefully. But did you know that anesthesiologists, who seem to only work with patients before surgery, are actually busy throughout the entire surgery? They are responsible for regulating the depth of anesthesia for the patient, keeping the patient in a pain-free state, ensuring that the surgery goes smoothly, and ensuring the safety of the anesthesia. In case of emergency (intraoperative hemorrhage, etc.), they are even busier. Therefore, anesthesiologists are known as “the protector of life under the shadowless lamp”.
In this regard, Professor Yu Buwei further introduced to us that, for anesthesia itself, the first is to relieve the patient’s pain, so that the operation can be carried out smoothly; the second is to maintain the normal vital signs of the patient during the operation, which requires the anesthesiologist to have a keen observation and the ability to deal with unexpected situations; the third is to maintain the vital signs, but also to adjust the internal environment of the patient’s body, that is, the cell survival environment. The third is that on the basis of maintaining vital signs, the internal environment of the patient’s body, that is, the environment for cell survival, must be adjusted. Many patients have water-electrolyte disorders, blood volume deficiency, anemia, acidosis, etc. for various reasons before surgery, which requires anesthesiologists to actively treat the patients so that the patients’ vital indicators and cell survival environment are in a normal state, so as to create conditions for smooth recovery after surgery. Therefore, the process of anesthesia is not simply a process of ensuring smooth surgery, but can also be considered as a therapeutic process. It can be said that the broad theoretical knowledge of anesthesiologists is the foundation, and the cross-fertilization of the multidisciplinary contents of pathophysiology, pharmacology, internal medicine, surgery, gynecology and pediatrics, anesthesia, and other basic and clinical medicine, as well as the accumulation of years of training and clinical experience, can forge a qualified anesthesiologist. When escorting the lives of surgical patients, it is inevitable to encounter dark rocks and currents. Therefore, anesthesiologists must have the ability to handle unexpected situations and manage the vital signs of the patient, including respiration, heart rate, blood pressure, nervous system, liver and kidney function, etc. At the same time, they must also have meticulous observation skills and be thorough in all aspects. In short, they are a group of busy but orderly, steady and dedicated doctors whose duty is to ensure that the patient completes the surgery with the surgeon in a pain-free and safe manner.
Judgment question: Is local anesthesia necessarily safer than general anesthesia?
For a long time, the people have been torn between the choice of general anesthesia or local anesthesia. Many patients will also communicate in private, why suffer from the same disease, do the same surgery, you can use local anesthesia, and I have to use general anesthesia. In this regard, Professor Yu Buwei said, the choice of anesthesia, mainly from several aspects to be considered.
First is the site of surgery, for example, heart surgery, it is unlikely to use local anesthesia, this is because the risk of such surgery is very high, and involves the human body is very important vital organs, so usually choose general anesthesia. Because the patient is under general anesthesia, the doctor can establish an artificial airway through the endotracheal tube, and the patient’s breathing is controlled by the ventilator of the anesthesia machine. Then, in case of circulatory accidents, the doctor can avoid delaying the resuscitation time by not having to do endotracheal intubation in a frenzied manner. The surgery of the extremities is often more local and nerve block anesthesia, that is, local anesthetic is injected into the peripheral nerve trunk near the nerve, by blocking the conduction of nerve impulses, so that the area innervated by the nerve is anesthetized.
The second depends on the patient’s preoperative physiological status. For example, if two patients have appendicitis, one is a 30-year-old adult and the other is a centenarian, their surgical procedures are exactly the same, but the risks are completely different. 30-year-old adults are fit and healthy, and a sudden appendicitis can be done with local anesthesia; however, for a centenarian, it is necessary to consider whether to use semi-anesthesia, local anesthesia, or general anesthesia. But for a centenarian, it is necessary to consider whether to use semi-anesthesia, local anesthesia or general anesthesia. In such cases, we need to take into account the history of cerebral infarction, coronary heart disease, pulmonary insufficiency and liver impairment, because the organs of the elderly have gradually degenerated, so we need to choose an anesthesia method that is safest for the patient through a comprehensive judgment.
So anesthesia is a problem that requires comprehensive consideration, not a seemingly very simple problem. Even for the same surgery, the most suitable anesthesia method is selected based on the patient’s functional status, the type of surgery, the surgeon’s proficiency, and the anesthesiologist’s own proficiency and mastery of the best anesthesia technique, in order to achieve the most ideal anesthesia effect. Currently, most anesthetic drugs are used without significant accumulation in the body, and a high quality postoperative recovery can be obtained, such as propofol. Therefore, patients do not have to reject general anesthesia, but should listen to their doctors and choose the most reasonable anesthesia plan according to the specific situation of their individual surgery.
Knowledge link: how much do you know about anesthesia methods
1.Surface anesthesia: the method of anesthesia drug spraying or dressing is commonly used, mainly for mucosal surface anesthesia, such as maxillary sinus puncture and other minor surgeries.
2.Local anesthesia: also known as local infiltration anesthesia or block anesthesia, the anesthetic is injected into the surgical site or around the nerve trunk to achieve the purpose of local anesthesia, suitable for small and medium-sized surgery.
3.Lumbar anesthesia: anesthetic drug is injected into the spinal cavity to anesthetize the spinal nerve for the purpose of lower body anesthesia. This kind of anesthesia is suitable for lower abdominal surgery, lower limb and perineal surgery of shorter duration.
4.Epidural anesthesia: it is similar to the site and method of lumbar anesthesia, but using intubation, continuous drug administration, time is not limited, applicable to large, medium and small operations in various parts of the chest, abdomen and lower limbs.
5, general anesthesia: one is inhalation anesthesia, the anesthetic is inhaled through the respiratory tract, inhibiting the central nervous system, consciousness and pain sensation temporarily disappear; the other is intravenous anesthesia, the anesthetic is dripped into the vein to produce the effect of general anesthesia. Nowadays, most hospitals use intravenous inhalation compound anesthesia, which is effective and has small side effects after the patient wakes up.
6, needle analgesic anesthesia: referred to as needle anesthesia. Needle anesthesia is one of the valuable heritage of traditional medicine in China, including auricular needle anesthesia and body needle anesthesia. In general, the effect of acupuncture anesthesia is worse than drug anesthesia, rely on it alone to complete the surgery and some difficulties. However, it is simple, economical, safe and also has a certain effect of promoting recovery after surgery, so it is a better anesthetic aid.