Step into the mysterious world of anesthesia

Text/Lai Yuehui

The birth of anesthesia is a milestone in the development of surgery, which has gone through 170 years of development path, from the beginning of simple clinical anesthesia, developed into a clinical discipline integrating clinical anesthesia, pain diagnosis and treatment, critical illness monitoring and treatment, and emergency resuscitation. How are people paralyzed? What are the types of anesthesia? Does general anesthesia have an effect on intelligence?

On July 18th, Duan Yi, attending physician of the Department of Anesthesiology of Beijing Tsinghua Changgeng Hospital affiliated to Tsinghua University, was invited to share the knowledge related to anesthesia.

The "Face to Face with Famous Doctors" column was launched by China Business Daily. Through the alliance of famous doctors and media authorities, we will work together to build a content ecology, bring the public health education from chronic disease management, first aid knowledge, prevention and treatment of serious diseases to daily life, and help build a healthy China.

How are people paralyzed? How long does it take to wake up after surgery?

When doing anesthesia surgery, patients usually care about two questions: First, can the anesthesiologist numb himself? The second is the duration of the anesthesia, can you wake up just after the operation?

Regarding the above two questions, Duan Yi explained that the current anesthesia is the continuous use of short-acting drugs, which has been anesthesia all the time, and when the operation is done, the anesthesia is stopped. In the case of general anesthesia, the patient will wake up within half an hour after the operation, so there is no need to worry that the doctor will perform the operation without the anesthesia working, nor do you have to worry about the anesthesia time being too long.

As long as the patient is in surgery, the anesthesia will not stop early. At the end of the operation, the doctor stops the administration, and most patients with general anesthesia will wake up within half an hour, and the lumbar-hard combination anesthesia or anesthetic is a nerve block drug, which may take a little longer to recover, and the longest will not exceed a day.

In addition, referring to the role of anesthesiologists in surgery, Duan Yi said that before surgery, anesthesiologists need to prepare for surgery: prepare anesthesia needles, anesthesia machines, as well as cardiac, electrical, blood pressure, brain oxygen monitoring, and even ultrasound equipment should be prepared, but also prepare corresponding drugs.

Duan Yi listed specific cases here, such as painless gastroscopy generally uses generally intubulated general anesthesia, but for anesthesiologists, in addition to preparing 2 to 5 anesthetics for patients, they must also prepare 2 to 3 kinds of rescue drugs. In cholecystectomy or appendectomy, the use of intubation general anesthesia is the need for anesthesiologist to establish an artificial airway in the process of general anesthesia, more than 6 kinds of drugs will be used, the patient may only remember the first injection, and the next few injections will not be remembered. In general, there is basically no numb patient, but according to the patient's body type, living habits, eating habits, etc., the dose of anesthesiologists to choose anesthetics will vary.

Commonly used methods of anesthesia

Duan Yi introduced that there are many ways of anesthesia, and the most commonly used are the following types:

Painless gastrointestinal endoscopy uses general anesthesia without intubation, which is a type of general anesthesia. Usually the anesthesiologist will explain to the patient that with a little anesthetic, the patient only needs to sleep, but in fact, after the patient falls asleep, the doctor will do a lot of work, at this time the patient is unconscious and will not remember.

Appendix surgery requires an artificial airway, which is intubated general anesthesia. The same as the painless gastrointestinal endoscopy mentioned above is general anesthesia.

For caesarean section or painless delivery, women need to be anesthetic on the waist, which belongs to lumbar anesthesia or epidural anesthesia, and may also use lumbar-hard combined anesthesia, which is anesthesia of the lower body, to the abdomen.

The anesthetic used for wrist fractures is brachial plexus block, and the doctor only needs to anesthetize the corresponding arm, similar to the bone nerve, which is only anesthesia and needs to be operated on in the area range.

The mole removal uses local anesthesia, such as if the patient wants to cut a mole, the doctor applies local anesthetics under the skin around the mole.

In addition, with the concept of comfort medicine to improve, in addition to general anesthesia, other anesthesia methods patients are conscious, conscious will be nervous and afraid, then the doctor will use some sedative drugs for patients, this is called compound sedation, also known as procedural sedation, the most commonly used anesthesia method is the above several.

Does general anesthesia have an effect on intelligence?

When patients choose anesthesia, they usually take into account the impact of anesthesia on the body, and there is no shortage of related discussions on the Internet, and there is more discussion about whether general anesthesia will have an impact on intelligence. In this regard, Duan Yi said that in addition to intravenous anesthesia, there is also a type of inhalation anesthetic, which is inhaled through a mask, and the anesthetic will eventually be discharged. The anesthetics that doctors use now are short-acting and can be metabolized, so there is no need to worry about the effects of anesthesia on intelligence.

Duan Yi further explained that when the patient finishes the operation and stops taking the drug, the anesthetic in the body will gradually metabolize and will not have any effect on the nervous system. At present, the anesthetics used in hospitals for most people, from discontinuation to complete metabolism, the speed of fast needs 10 to 20 minutes of metabolism, and the slow speed will be metabolized after 24 hours of stopping the drug. In addition to the dose of anesthetic drugs, the age of the patient is also a consideration for the speed of metabolism.

Is postoperative analgesia necessary?

Duan Yi suggested that postoperative analgesia requires patients to follow the advice of an anesthesiologist. Generally, before the operation, the doctor will familiarize himself with the patient's medical history, conduct a pre-anesthesia visit to the patient, and during the visit, the doctor will discuss with the patient whether to do postoperative analgesia.

First of all, postoperative analgesia is a self-funded item, so the patient needs to consider whether he is willing to bear this part of the cost. Before the operation, the anesthesiologist will clearly inform the patient how high the probability of postoperative pain or even severe pain is, how large the surgical wound will be, and give medical advice, whether to use postoperative analgesia will comply with the patient's wishes. Duan Yi stressed that in the case of economic conditions permitting, patients can choose postoperative analgesia, because postoperative analgesia is conducive to postoperative recovery, usually patients will not sleep well, eat well, and reduce the amount of activity in the case of very painful wounds, which is not conducive to wound recovery.

Most importantly, postoperative analgesia will also reduce some complications, such as abdominal surgery to use postoperative analgesia, patients can get out of bed as soon as possible without pain, the benefits of this have two points: First, can promote the recovery of intestinal peristalsis, early exhaustion. Second, for high-risk groups, it can prevent the formation of venous thrombosis in the lower limbs, which can easily cause serious complications such as myocardial infarction, cerebral infarction, and pulmonary embolism.

The so-called high-risk groups are obese patients, the elderly, and pregnant women. Especially for pregnant women, it is very easy for women to form blood clots after giving birth, so after a cesarean section in the hospital, or having a child, doctors will urge women to get out of bed early, because if they do not walk, blood will accumulate in the veins of the lower limbs, and blood clots will form. Blood clots grow in blood vessels, will follow the blood circulation to other organs, if it reaches the coronary artery of the heart will cause myocardial infarction, if it reaches the pulmonary artery, it will cause pulmonary embolism, reaching the cerebral blood vessel will cause cerebral infarction.

Finally, Duan Yi said that as long as conditions permit, patients are best to get out of bed as soon as possible after surgery, and pain is the culprit that restricts patients' activities. Therefore, postoperative analgesia is very necessary.

(Proofreader: Yan Jingning)