Every patient is unique. There are so many misconceptions about Anaesthesia, as described earlier. Do not get an opinion about your surgery from non-medical people based on their past experiences.
By Kshalini Nonis
Anaesthesia or the loss of sensation during tests and surgical operations prevents pain and discomfort and enables a wide range of medical procedures to be carried out. It can be described as the use of medicines to prevent pain during surgery and other procedures. We had a chat with Dr Heshan Amarathunge, Former MO Anaesthesia, Pottuvil Hospital and District General Hospital, Hambantota, regarding the facts on Anaesthesia.
Q: Can you describe the different types of Anaesthesia?
General anaesthesia: completely puts you to sleep.
Regional anaesthesia uses injectable medicine at the nerve level to block pain in a bigger part of your body, like your arms and legs.
Local anaesthesia: uses injectable medicines or local anaesthetic gel to make a smaller part of your body pain-free.
Monitored anaesthesia care: when the patient is under sedation and analgesics (painkillers) but not completely under sleep
Q: What are some of the complications associated with the above mentioned types of Anaesthesia ?
Complications during surgeries
Complications associated with the respiratory system – Aspiration of gastric (stomach) fluid into lungs
Low Oxygen levels in blood (Hypoxia)
Very high levels of carbon-dioxide in blood
Complications associated with cardiac system
High or low blood pressure
Low blood sugar levels
Heart attacks(MI) or irregular heart rhythm (Arrhythmias)
Other
Local soft tissue injuries and other Anaesthesia drug related side effects
Q: What are some of the myths and their explanations associated with Anaesthesia?
Myth - Spinal Anaesthesia causes lifelong back aches. There can be temporary pain at the injection site for a few hours, but almost no long-term pain.
Myth - Spinal Anaesthesia can damage your spinal cord. The spinal cord ends at the L1-L2 vertebral level in adults, and Anaesthesia is given below the L3 vertebral level.
Myth- Spinal Anaesthesia will completely make you touch/sensation free. It will make the relevant part pain-free, but you will still feel the touch.
Myth- Anaesthesia effects are permanent. All the effects are reversible.
Myth - You will reveal all your life secrets during general Anaesthesia. During Anaesthesia, you will be completely asleep and unable to talk due to total muscle paralysis.
Q: Can you tell us about anesthesia for different groups of people such as children and pregnant mothers?
Children are not small-scale adults when it comes to Anaesthesia. They have low oxygen stores, are more prone to hypoglycemia (low sugar levels in the blood), and are more prone to excessive heat loss. Their airways are small and need a specially trained Anaesthetist to manage them. This category is further divided into neonates (less than 28 days of age), infants (up to 12 months), and children (1–14 years). Each category needs different medications and techniques. Children are difficult to manage because they are uncooperative and have a different physiology than adults. Special Anaesthetic are used for children.
Obstetric Anaesthesia is also challenging, as both the mother and the foetus need care. A pregnant mother is different from a female adult as she has many physiological changes in her body due to progesterone, and it takes a few days to become normal after delivery. It’s best to avoid any surgeries during the first trimester (1 st 3 months of pregnancy), while the second trimester remains the safest (4-6 months). The drugs that we use during the surgery can affect both the mother and the foetus. Also, close foetal monitoring is needed during surgery. During pregnancy, Spinal Anaesthesia is usually preferred over General Anaesthesia.
Q: What are other risk groups when it comes to Anesthesia and what are the reasons for this?
Elderly population ( over 65 years.) Due to ageing, most of the organ systems are not performing their normal functions.
Obesity – It is difficult to find veins to give IV drugs. It is difficult to determine the exact body weight to give an exact drug dose. It lso increases the risk of breathing problems.
Drug addicts- (cannabis, heroin, etc) – These illicit drugs will change how your heart and lungs work and will interfere with the Anaesthesia. Also, they will need a different level of Anaesthesia during surgery.
In addition, patients with heart diseases, lung problems, endocrine/hormonal disorders, and liver diseases are at high risk.
Q: Can you tell us about Anesthesia at different stages in the operating process such as
a) Assessing before surgery
A pre-op assessment is done by an Anaesthesia doctor prior to the surgery. The doctor will examine the patient and do some relevant blood tests. If needed, some patients may undergo a few other tests, like ECGs and X-rays. Depending on the clinical findings and the test results, the doctor will assess the risks and benefits of the surgery for the patient. If the patient is not fit for the surgery, the surgery will be postponed until the issues are sorted out.
b) Getting ready
for surgery
If you are fit for surgery, you will need to give your written consent for the surgery. You can always discuss your doubts before the surgery. Patients are advised not to take solid food within 6 hours prior to the surgery.
c) During surgery
In General Anaesthesia, you will be put to sleep, and a tube will be inserted to your trachea (wind pipe). This tube will be connected to a machine, and the machine will control your breathing. Gas will be administered through this tube to maintain your sleep.
Spinal Anaesthesia: a drug will be injected into the Subarachnoid space.
d) Post- operative care
Once the surgery is done, you will wake up from General Anaesthesia. Then you will be transferred to the recovery area to stabilise before being transferred to the ward.
You will be ideally kept in the hospital for at least 24 hours after the surgery. Any surgery done with local Anaesthesia can be discharged on the same day.
Q: What is the procedure to be followed if there are any complications or emergencies during surgery?
Different complications are encountered during surgery. An Anaesthetist will be available near the patient throughout the surgery, and he or she will manage the complications. If the patient is not stable enough to go ahead with the surgery, it will be stopped, and once he has recovered he will be and later sent to the ICU.
Q: Are there any side- effects of Anaesthesia and if so what are they?
Anaesthesia drugs will have some effect on your heart rate and blood pressure and will be used cautiously. In addition, general side effects like nausea, headaches, dizziness, urine retention, etc. can occur.
Q: Anything else you would like to add on Anaesthesia?
Every patient is unique. There are so many misconceptions about Anaesthesia, as described earlier. Do not get an opinion about your surgery from non-medical people based on their past experiences. Any surgery has some risks, and all the doubts that you have can be discussed with the surgeon or the Anaesthetist. Nowadays, there are many advanced drugs and equipment, and most surgeries have a higher success rate than in the past.
The most important point is to always share your medical illnesses and any drugs (including illicit drugs) with the medical team to avoid unnecessary complications during the surgery, as we maintain confidentiality.
Q: Can you give us a checklist?
Anaesthesia has three types: general, regional, and local. Risk groups like pregnant mothers, children, etc. need special care during surgery. The mode of Anaesthesia will be decided for each individual case. There is no risk-free surgery, but with modern drugs and techniques, surgeries have become highly successful compared to the past.
