In abdominal operations a variety of techniques of anesthesia can be applied. Generally they are divided into those in which the patient is sleeping - general anesthesia and those in which the patient does not sleep - local anesthesia.
In general anesthesia various medications are used which interfere with the contraction of the muscles / muscle relaxants / causing sleep and lack of memory and drugs for anesthesia.
Muscle relaxants are necessary to create favorable conditions for the surgeon during the operation. They relax all the voluntary muscles in the body, including the respiratory muscles. With relaxed respiratory muscles, a person is unable to breathe on his own. Therefore, during the operation air is fed through the apparatus for artificial respiration. This device delivers the necessary gases through a tube inserted into the throat. This should not scare you - the manipulation is done only after falling asleep and is not felt. At the end of the operation when the muscles recover their activity, the patient begins to breathe on his own and artificial respiration is terminated.
Each anesthesia begins with medications causing lack of memory and sleep. The goal is really to provide comfort and lack of unpleasant memories from the introduction of anesthesia, the whole operation and decommissioning of anesthesia. For better assessment of the need for such drugs we are using a special technique, showing the depth of sleep.
There are many methods for anesthesia during surgery and they are applied and combined depending on many factors. The goal is that the patient really feels no pain, and the modern pharmacy offers many and various means.
Another method of anesthesia possible only under certain abdominal surgery is local anesthesia. With this type of anesthesia are achieved favorable conditions for operation only in a specific area of the body. The patient remains fully conscious and keeps his own breathing. This type of anesthesia is performed most often by injection into the spine at the waist. It is the better choice whenever possible due to the fact that the patient obtains less medication than in general anesthesia. This is important when the patient has other illness / for eg. high blood pressure / or is taking other medicines.
As with any medical intervention, anesthesia also carries some risks which are different from those of the operation and with which you need to be familiar.
In general anesthesia, for example, placing of the tube for artificial respiration can injure teeth or throat. After such a trauma patient feels pain and this can cause changes in the voice. In rare cases may occur infections of the throat or lungs, especially if there was a sore throat.
In most medical interventions, including anesthesia, there might be adverse reactions to medications used. Thanks to modern technology and organization of work, they are now reduced to a minimum. Be sure to tell your anesthesiologist about any hypersensitivity / allergy / to food, medicines and other substances that have occurred in the past!
In local anesthesia are possible headache, nausea, and pruritus within the first 24 hours, especially in younger patients. Spinal cord injuries are excluded, as in the area of prick there isn’t spinal cord - there are only nerve trunks arranged in a bundle like horse tail. Damage to the nerve trunks is theoretically possible, but practically does not happen. They swim in the cerebrospinal fluid and flee from the needle tip.
Modern medicaments and equipment allow the combination of various methods and techniques of anesthesia. For example it is possible to combine a local anesthesia with general anesthesia. Thus achieving a peaceful postoperative period, during which the pain is absent. The elimination of operational and post-operative pain is fully within the power of modern medicine.
Each type of anesthesia has its advantages and disadvantages that you should be informed in advance by your anesthetist. Generally, they are the following:
In general anesthesia
- It takes the mind of the patient and reduces operational stress
- It allows adequate muscle relaxation for a long period of time
- Allows full control of breathing and circulation
- Application in allergic patients without risk to their lives
- It is applied without rotating the patient in different positions
- It is applied quickly and is reversible
- It requires more care, complexity and is more expensive
- It requires a certain degree of preoperative patient preparation
- It can cause physiological fluctuations, which require urgent active intervention
- It is associated with less serious but more common complications such as nausea, vomiting, sore throat, headache, tremors or slow return to normal functioning of the brain
- It is related to the possibility of the development of malignant hyperthermia - a rare inherited muscular condition in which upon exposure to certain anesthetics / but not all / may lead to severe and potentially lethal temperature increase
In local anesthesia
- The patient is fully conscious
- The patient breathes alone
- It is much more difficult for the patient to breathe in stomach contents in vomiting
- Requires much less care after surgery and fully recovery much more quickly and easily
- Postoperatively patient is much better anesthetized.
- The stress of surgery is much smaller
- Discharge of patients with small and medium sized operations can be possible very soon / same day /
- Much cheaper than general anesthesia
- The patient may be afraid and wants to be asleep
- Requires significantly more skill and experience by the anesthesiologist
- Some of the blocks require almost 30 minutes to reach their full effectiveness and are more time-consuming
- Sometimes it may not be fully effective and to require additional medicines to achieve complete control of pain
- Upon intravenous administration of the anesthetic there can be a higher toxicity to the affected tissues
- More often, there may be nausea and vomiting for a longer period after surgery
- In some operations simply we can not apply local anesthetic
I hope that now it is clear, from what has been said here, that the anesthesia is the art of objective possibilities and subjective judgments and desires. All they have to be discussed with the anesthesiologist before surgery and to find the right path, satisfying patient and the anesthesiologist and the surgeon. So, do not be afraid to ask. Only when you are well informed about the forthcoming anesthesia, its possibilities, pros and cons, you will sign the document, called "Informed consent for anesthesia" with a calm hand. And the confidence and the calm are very important to the success of the operation.