Stages of anesthesia and control of anesthesia depth

Features of local anesthesia

Local anesthesia is understood as temporary anesthesia of a small area of the body due to the effect of external drugs on it or injection of a medicinal solution. In the definition one can immediately see a large classification of types of local anesthesia: superficial and internal. The latter, in turn, is divided into several more subtypes depending on the area of influence (epidural, conduction, spinal, infiltration).

Local anesthesia has found use in almost all areas of medicine, but the most striking example is dentistry. Today, almost all manipulations are performed with anesthesia. And if previously the patient had to endure 10-20 minutes while the doctor drills the tooth, cleans the canals, and puts a filling, now all pain is reduced to a second tingling sensation from the insertion of a thin needle.

How is it carried out?

All types of local anesthesia have their own characteristics, but on average it is something like this: a person is injected with medicine into a specific area. After a few minutes, sensitivity in this area is lost, and doctors can begin manipulation. The patient remains conscious, but he does not feel anything, not even the touch of a cold instrument. The general condition is also stable, although some admit to experiencing mild nausea and dizziness. But doctors attribute this more likely to anxiety than pain relief.

By the way! Sometimes, before inserting a needle, the skin is first numbed with external anesthetics to reduce pain from puncturing soft tissue. The result is a combined local anesthesia. It is used, for example, during epidural anesthesia.

How does anesthesia wear off?

The amount of anesthetic administered and the choice of its type are calculated based on the complexity of the operation and the patient’s physique. But the medicine is always taken with a reserve so that the anesthesia does not suddenly wear off during medical procedures if they require more time. Accordingly, after the end of the operation, the patient has a few more minutes (sometimes even a little more than an hour) for the anesthetic to stop working.

Sensitivity returns gradually, but quite quickly. First, a person begins to feel the touch, and after a minute or two he feels pain at the site of the manipulation. If it was a dental procedure, then the area where the gum was punctured or the hole after the extracted tooth may ache.

When treating caries, as a rule, no pain is felt after the anesthesia wears off. If it was a more complex operation, for example, to remove an ingrown nail, then the operated finger may begin to hurt quite severely because there was a violation of the integrity of the tissue. But these pains can be relieved with analgesics.

Possible complications

Some people are allergic to certain types of medications. Local anesthesia involves the use of Lidocaine, Novocaine, Bupivacaine, etc. And a person may experience a reaction to them in the form of:

These reactions appear immediately after administration of the drug. And if the first two are quite tolerable, then the last three require termination of the operation and hospitalization of the patient. You can find out if it is available by first conducting an allergy test.

Some people note certain reactions after the local anesthesia wears off: dizziness or headache, weakness, sleepiness, and fever. But it is impossible to say for sure whether this is an allergy to the medicine or consequences after the operation.

Features of general anesthesia

A more complex type of anesthesia, which involves immersing the patient in a narcotic sleep and completely depriving him of not only sensitivity, but also consciousness. It is difficult for people who have never been exposed to this in their lives to imagine such a state. Therefore, many people are afraid of their first operation under general anesthesia.

General anesthesia is also successfully used today in all areas of medicine. Moreover, sometimes this is the only chance to perform the operation. In dentistry, this type of pain relief is also used when a person (usually a child) is unable to overcome his fear of going to the dentist.

There are two main types of general anesthesia: inhalation (through a mask) and. Sometimes combined anesthesia is used. What it will be in a particular case is decided by the doctor, depending on the specifics of the operation and the physiology of the patient.

What is it made up of?

General anesthesia consists of three “components”: analgesia and muscle relaxation. In essence, a person simply falls asleep, but in fact completely different changes occur in his body. During normal sleep, breathing is calm, the body is relaxed, but reflexes are preserved.

And if you prick a person with a pin or simply pat him, he will wake up. And narcotic sleep also implies analgesia - suppression of the body’s autonomic reactions to all types of interventions: punctures, incisions, manipulation of internal organs, etc.

The third “component” of general anesthesia – muscle relaxation – is necessary to facilitate the work of surgeons during surgery. Due to the presence of muscle relaxants in the medicinal solution, the patient’s muscles are as relaxed as possible and also cannot reflexively react to interventions (contract, tense).

How is it carried out?

If this is general anesthesia of the inhalation type, then a mask is put on the patient’s nose and mouth, through which a gas-narcotic mixture is supplied. A person is required to breathe evenly and not resist the onset of sleep. Using sensors connected to the body, the anesthesiologist determines when the anesthesia has fully taken effect and signals this to the surgeons.

Involves the administration of drugs through the skin. This anesthesia is considered deeper and more reliable, while inhalation anesthesia is used for simple operations. If a difficult and lengthy intervention is ahead, then combined anesthesia is used: first, then a mask is added.

By the way! During general anesthesia, doctors must monitor the main indicators of the body’s vitality, thanks to equipment and external signs. The patient’s skin color, body temperature, heart function, pulse - all this allows you to monitor the course of anesthesia and the person’s condition.

How long does it take to recover from general anesthesia?

People sometimes fear for their well-being when they come out of general anesthesia after surgery because it is a complex process. Although, it is difficult for the anesthesiologist, but rather unpleasant for the patient. It's like waking up from a very heavy sleep. In this case, the following sensations may be noted:

If the general anesthesia was light, then the patient after the operation goes to the ward and “wakes up” on his own. After deep anesthesia, a person must be “awakened” by an anesthesiologist. This can happen directly in the operating room, or in the intensive care unit after some time.

By the way! Some people recover from general anesthesia for hours, experiencing the full range of symptoms listed above.

Possible consequences

General anesthesia is stress for the body, which during its action actually balances on the brink of life and death. Yes, everything happens under the control of a medical team, but still breathing almost stops, there are no reflexes, the heart beats very weakly. Therefore, consequences associated with disruption of the normal functioning of the cardiovascular and respiratory systems are not uncommon. This is manifested by a decrease or increase in pressure, spasms of the larynx and bronchi, sputum production, and hiccups.

Combined general anesthesia

The previous chapters described mainly various options for single-component anesthesia - mononarcosis, in which the necessary components of anesthesia (turning off consciousness, anesthesia, blockade of reflexes, muscle relaxation) are achieved with one narcotic substance. Achieving all of these components is only possible if deep, far from safe anesthesia is used with one of the powerful anesthetics, for example ether, fluorotane or barbiturates. Nitrous oxide, even in a 4:1 ratio with oxygen, cannot achieve good muscle relaxation. More superficial mononarcosis relatively easily provides a hypnotic effect (narcotic sleep) and moderate analgesia (blockade of pain reflexes). That is why single-component mononarcosis is used either for anesthesia of short-term interventions, or in cases where, during the operation, good muscle relaxation and blockade of pathological reflexes that arise in response to manipulations in reflexogenic zones are not required.

Combined anesthesia is a general anesthesia that uses various anesthetics, analgesics, tranquilizers, and muscle relaxants. Moreover, each of the components ensures the achievement of one or more necessary effects without inhibiting the vital functions of the body. For example, intravenous administration of barbiturates or other non-inhalational anesthetics can easily provide induction of anesthesia without arousal within a few minutes, and other anesthetics should be used to maintain narcotic sleep and pain relief. It is easy to maintain unconsciousness with nitrous oxide, but it is difficult to provide the analgesia that is easily achieved with central analgesics.

An important circumstance is that when different anesthetics are combined, their narcotic effect increases significantly and the effect cumulates (intensifies). Therefore, when

combination, for example, of nitrous oxide with oxygen and fluorotane in a concentration of up to 1.0 vol% (non-toxic concentration) can achieve the same effect as with a more dangerous concentration of fluorotane of 2.0-2.5 vol%, if it is used in "pure" form.

Very important components of combined anesthesia are central analgesics: morphine, promedol, dipidolor, fentanyl. These drugs provide analgesia relatively easily and in safe doses, and narcotic sleep is achieved with the help of safe doses of general anesthetics.

Depending on the patient’s condition, the nature of the surgical intervention, the experience and professional habits of the anesthesiologist, as well as technical capabilities, a variety of options for combined general anesthesia are used. Below we will consider only the main, most common options.

Combined inhalation anesthesia using a hardware-mask method.

Carry out with nitrous oxide and oxygen with the addition of fluorothane or ether. Introduction to anesthesia is carried out with nitrous oxide and oxygen in a ratio of 4:1 or 3:1, and then in

Combined non-inhalation and inhalation anesthesia using a hardware-mask method.

It has become most widespread in the anesthesia of operations of short and medium duration and trauma, when mechanical ventilation is not required.

The most commonly used anesthesia regimen is:

1. A 2% solution of sodium thiopental or hexenal is administered intravenously until the patient becomes confused.

2. For 40-60 seconds with a mask, 100% oxygen is inhaled.

3. Set the supply of nitrous oxide in a ratio with oxygen. 3: 1, and after another 60-90 s - inhalation of fluorotane, starting with minimal concentrations (0.4 vol%), which are gradually increased and brought to 2.5-3, 0 vol% until the surgical stage of anesthesia occurs.

4. The administration of barbiturates is stopped, and anesthesia is maintained with nitrous oxide with oxygen in a ratio of 3:1 and 2:1 and fluorotane (0.8-1.5 vol%). Ether can be used instead of fluorotane. The administration of small doses of promedol (a total of 0.3-0.4 mg/kg body weight) during surgery and anesthesia enhances the analytical effect.

For patients experiencing severe fear of the operating room environment, induction of anesthesia can begin in the ward or in the anesthesia room by injecting ketamine (4-5 mg/kg body weight) into the muscles. Sleep occurs within a few minutes, and the patient is necessarily taken on a gurney to the operating room, where inhalations of nitrous oxide, oxygen, and fluorotane begin. Ketamine can be administered repeatedly at a dose of 2-3 mg/kg intramuscularly or intravenously.

Instead of barbiturates, sodium hydroxybutyrate can be used at a dose of 120-150 mg/kg body weight. However, induction anesthesia does not occur so quickly.

Related articles: Combined endotracheal anesthesia using muscle relaxants Artificial ventilation Non-inhalation anesthesia Local anesthesia What types of anesthesia are there?

Is it possible to make recovery from anesthesia easier?

You can reduce the intensity of discomfort if you properly prepare for surgery. To do this, you need to openly tell your doctor about the illnesses you have suffered and your concerns, follow a diet, and conscientiously take the prescribed medications. If the patient is self-willed in preoperative preparation, eats in secret from doctors, runs around smoking or takes some pills, then this will create problems during surgery. Moreover, they will be associated not only with immersion in and recovery from anesthesia, but also with the course of the operation itself. It is necessary to follow medical recommendations even after general anesthesia has stopped working. If your doctor allows you to get up and walk, you need to do this to prevent thromboembolism (blockage of the venous vessels). Some people are advised to simply move their legs for the same reason. It is not recommended to grab a book or smartphone immediately after waking up: it is better to rest and think about something good, for example, that everything is behind. And under no circumstances should you ignore the doctor’s instructions, which may vary depending on the type of anesthesia and the operation performed.

Every person who is about to undergo surgery under general anesthesia experiences natural anxiety and curiosity. These worries are understandable, since even today’s advanced advances in medicine do not make it possible to predict 100% the consequences of both the operation itself and general anesthesia. People have individual tolerance to anesthesia, which affects everyone differently, so it is impossible to predict exactly what sensations the patient will experience after anesthesia.

How general anesthesia can affect the body, and what the recovery from it will be, depends on a number of factors:

age;
hormonal status;
presence of chronic diseases;
proper preparation for surgery;
presence of bad habits;
allergic reactions.

Each person handles general anesthesia differently.

A large degree of responsibility falls on the shoulders of the anesthesiologist, who must carefully study the patient’s medical record and make the right choice regarding anesthetic drugs and the method of their administration. The anesthesiologist is obliged to conduct a conversation with the patient about the proper preparation of the body for the upcoming surgical intervention. The doctor should give the most complete answer to the patient’s questions about how long and exactly how he will recover from general anesthesia, without hiding the likelihood of complications.

It is important to remember that going into medicated sleep under general anesthesia is a justifiable risk. However, it has been experimentally proven that if the patient properly prepares his own body for surgery, anesthesia works reliably and recovery from it is not accompanied by severe symptoms.

Pros and cons of general anesthesia

Despite the fact that recovery from anesthesia is often unpleasant, this procedure is necessary. Anesthesia is widely used in many areas of medicine. During the operation, a person in a state of artificial sleep does not experience pain and lies motionless on the operating table, providing surgeons with ideal working conditions. The absence of many reflexes, relaxed muscles and peace of mind of the patient give specialists the opportunity to perform even the most complex manipulations effectively and efficiently.

General anesthesia has a number of advantages, which makes it indispensable during surgery. A person who is in a deeply inhibited state receives protection from painful shock, which would otherwise cause irreparable damage to his physical and mental health. The absence of a sense of panic and fear is beneficial for the patient himself and for those who treat him.

General anesthesia helps doctors to perform the operation calmly

Before the upcoming operation, you need to talk with the anesthesiologist, who should be told about all your fears.

In the recent past, highly toxic drugs have been used to promote medicated sleep. However, today in developed countries only anesthetics that are gentle on the body are used. The patient’s main task is not to hide information from the anesthesiologist that may be important when choosing an anesthetic drug. False shame about illnesses suffered in the recent past or about taking illegal drugs leads to sad consequences.

The disadvantages of coming out of artificial sleep include the fact that after anesthesia the following unpleasant sensations are possible:

visual hallucinations;
auditory hallucinations;
nausea;
vomit;
stomach pain;
headache;
severe dry mouth;
sore throat;
feeling very tired.

In each case, there are ways to reduce the risk of developing unpleasant symptoms after anesthesia. To do this, it is important to honestly follow the recommendations of the anesthesiologist before surgery. All the doctor's questions must be answered truthfully. If these conditions are met and the drug combination is correctly selected, patients recover from anesthesia quickly and without complications.

How do you come out of anesthesia?

After surgery, people recover from general anesthesia individually and unpredictably. How long this period lasts depends on the specific circumstances each time. Some patients emerge from artificial sleep a few minutes after the end of the operation. After half an hour they regain consciousness, and an hour later they take their first sip of water. Other patients recover from general anesthesia for hours, while experiencing not the most pleasant experiences in life.

A person’s condition after anesthesia depends on a number of factors.

How long it will take to recover from anesthesia after surgery depends on its type and duration. For simple surgical interventions, if the patient’s body condition allows, the anesthesiologist “wakes up” him after the operation right in the operating room. In this case, after 5 or 6 hours the patient comes to his senses. He is able to eat liquid broth, communicate with other people and even move independently.

Coming out of anesthesia is often accompanied by a feeling of severe pain in the area injured during surgery. Patients should report any pain symptoms that occur during recovery from this state. There is no need to endure and suffer. A warning about the sensations experienced will allow doctors to promptly relieve excessive pain and help make recovery from anesthesia less difficult for the body.

What to do during a long recovery from anesthesia?

Surgical operations are planned. The person who is prescribed such an intervention receives enough time from the doctor for the most thorough preparation. The quality of this preparation largely determines how long and exactly how the patient will recover from anesthesia.

Most people who have been operated on under general anesthesia for a long time (from 3 hours) come to their senses within 1–3 days from the moment the effect of the anesthetic drugs wears off. Since the same anesthetics have different effects even on patients with similar histories, the likelihood of accurately determining the time is low, but rough estimates can be made.

While the patient is emerging from unconsciousness, he periodically regains consciousness. At these moments, the health worker asks the patient questions about his well-being, which are important to answer without hesitation. There is no need to endure pain, severe nausea or gag reflexes, since medicine has sufficient ways to correct these problems.

Before and after surgery, a person experiences an uncontrollable feeling of fear. However, you should not fight panic on your own. If there are obsessive experiences, a consultation with a psychologist is necessary even before the operation begins. If the patient’s relatives take part in his fate, they also need a conversation with a psychologist. The support of relatives, with proper support, will help the patient prepare for the upcoming surgical treatment and allow him to more easily endure the consequences of anesthesia.

When organizing care for surgical patients, it is necessary to keep in mind that any surgical intervention is accompanied by the development of stress in them, and most operations are performed under general anesthesia. Both circumstances require close attention to the patient in the coming hours after surgery.

With complete restoration of consciousness, stabilization of breathing and hemodynamics, the patient can be transferred to a specialized department. In the same case, when there is the slightest doubt or the likelihood of a complication, the patient is transferred to the postoperative (post-anesthesia) ward, which should be directly adjacent to the operating unit. If there is no such ward, then the patient is transported to the intensive care unit.

The patient is transported on a gurney, accompanied by an anesthesiologist who performed anesthesia. During transportation, cardiac and respiratory arrest may occur, during which resuscitation measures are immediately carried out.

In the ward, the patient is placed on his side, thereby preventing vomit, saliva or mucus from entering the respiratory tract in case of vomiting. After restoration of protective reflexes and consciousness, the patient is given the desired position. The patient, who is in a state of excitement, is secured with soft straps. Then the monitoring equipment is connected. Monitoring of patients is organized by an anesthesiologist-resuscitator and conducted by a nurse anesthetist

The main
patient
management in the immediate future after surgery are:

 prevention of respiratory failure;

 prevention of circulatory and homeostasis disorders;

 relief of pain syndrome;

 prevention of infectious complications.

Respiratory depression may occur in the postoperative period

due to the ongoing effect of substances that were used during anesthesia (anaesthetics, narcotic analgesics, muscle relaxants). Weak diaphragmatic breathing and paradoxical movements of the chest (during inhalation it is the chest) are indications for artificial ventilation.

Restoration of synchronous respiratory movements of the chest and abdomen (diaphragmatic breathing), as well as sufficient muscle strength, when the patient can shake hands, raise his head and hold it in this position for at least 2 seconds, indicates the cessation of the influence of medicinal substances.

During the period when the patient recovers from anesthesia, oxygen starvation (hypoxia) may be observed, the most important symptom of which is cyanosis (bluish tint) of the skin, but its absence does not exclude hypoxia. The main cause of hypoxia is a violation of the free patency of the respiratory tract. Vomiting and regurgitation of gastric contents are especially dangerous. Vomit

occurs due to the action of anesthetics and narcotic analgesics, as well as as a result of hypoxia during anesthesia and in cases where the stomach is full.
When the patient lies horizontally or with the head down, regurgitation
(fluid flow in the direction opposite to the physiological) of gastric contents may occur, i.e. its passive flow into the oral cavity.

If vomit enters the respiratory tract, i.e. during their aspiration

, occlusion of the bronchial tree may occur.
Patients experience mechanical asphyxia, which ends in respiratory arrest and death. This complication is prevented by emptying the stomach
with a tube before surgery, and after the operation is completed, the contents are removed from the stomach again.
By placing the patient in a lateral position after surgery,
aspiration of gastric contents is prevented, as well as
tongue retraction
, which can also lead to asphyxia. This situation does not completely exclude the occurrence of these complications and is standard when transporting unconscious patients. As an exception, it is applicable when, when removing the patient from anesthesia, protective reflexes are not sufficiently restored. To prevent the tongue from recessing, they use an air duct or resort to the so-called triple Safar maneuver (throwing the head back, pushing the lower jaw forward and opening the mouth slightly).

If this complication occurs, the head end of the patient's body is lowered down. Then the mouth is cleaned with a napkin or suction. The trachea is freed from vomit by pressing from the sides on the chest. The patient is intubated and the bronchial tree is washed in small portions with a solution of baking soda and the liquid is suctioned, or a sanitation bronchoscopy is performed.

Increased pain in the surgical area limits the depth of breathing and prevents coughing up mucus. Insufficient ventilation of the lungs, including when bronchioles are blocked by mucus, leads to the formation of atelectasis

when part of the lung loses its airiness, collapses and inflammation develops here.
To prevent this, rational pain relief
.
Breathing exercises
are important , every hour the patient must take 5 deep breaths and exhalations, also
change body position
,
early active movements
up to standing up and chest massage.
When sputum is discharged once every 3-4 hours for a few minutes, the patient is given a postural position
(on one side or another, on the back), in which the mucus moves well into the large bronchi and is coughed up relatively easily. If there is a large amount of sputum, direct laryngoscopy is performed, a thin catheter is inserted through the glottis and the mucus is actively aspirated.

Circulatory disorders

in the postoperative period is often associated with hypovolemia (decreased fluid in the body), which exists before or occurs during and after surgery. In order to prevent these disorders, the missing fluid is replenished by transfusion of electrolyte solutions and plasma substitutes. To determine the required volume of infusions, an accurate record of the fluid excreted in urine, feces, vomit, through drains, fistulas, gastric and intestinal tubes is kept.

To carry out infusion therapy, venipuncture or venesection is performed. The most optimal method is catheterization of the main vein. The catheter can be a conductor of infection, and when caring for it, promptly change the contaminated material that is used to fix it to the skin. In case of phlebitis, infusion into this vein is stopped and the catheter is removed. The venous catheter becomes thrombosed, and blood clots form around it. Thrombus rupture leads to thromboembolic complications,

to avoid which, the catheter is regularly, 2-3 times a day, washed with saline solution with heparin.

When dehydration occurs, negative central venous pressure is observed; its suction effect contributes to the entry of air through the dropper into the vascular bed and the occurrence of air embolism

. To prevent it, during infusions, monitor the absence of air bubbles in the system and its tightness at the junction with the catheter. After the end of the infusion, the catheter cannula is closed with a special plug.

Upon learning about the upcoming operation, and therefore anesthesia, any patient experiences excitement. Every person understands perfectly well that anesthesia is performed specifically for pain relief, but the stories of friends and acquaintances about how hard the human body endures this procedure frighten patients a lot. We'll tell you how long it takes to recover from anesthesia and what causes this condition.

Stages of anesthesia and control of anesthesia depth

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When general anesthetics are introduced into the body, a natural phasing pattern has been established in the clinical picture of general anesthesia, which is most clearly manifested during mask general anesthesia with ether. This scheme of stages of anesthesia was proposed by Guedel in 1937.

The first stage - ANALGESIA STAGE - begins from the moment the general anesthetic is administered and continues until loss of consciousness. Characteristic: gradual darkening of consciousness; at first there is a loss of orientation, patients answer questions incorrectly; speech becomes incoherent, the state is half-asleep. The skin of the face is hyperemic, the pupils are the original size or slightly dilated, and actively react to light. Breathing and pulse are slightly increased, blood pressure is increased. Tactile and temperature sensitivity and reflexes are preserved, pain sensitivity is sharply weakened, which allows short-term surgical interventions and manipulations (rausch anesthesia) to be performed at this stage. At this stage, it is proposed to distinguish three phases according to Artusio (1954): the first is the beginning of euthanasia, when complete analgesia and amnesia have not yet occurred, the second is complete analgesia and partial amnesia, the third is the development of complete analgesia and complete amnesia. The duration of the analgesia stage depends on the general condition of the patient, his age, premedication and the general anesthetic used and varies from several seconds (when using non-inhalational anesthetics) to 10 minutes (when using inhalational anesthetics).

The second stage - EXCITATION STAGE - begins immediately after loss of consciousness and continues until the patient relaxes. The clinical picture is characterized by speech and motor agitation. The skin is sharply hyperemic, the eyelids are closed, the pupils are dilated, their reaction to light is preserved, lacrimation and swimming movements of the eyeballs are noted. The muscles are sharply tense (trismus), cough and gag reflexes are strengthened, pulse and breathing are rapid, arrhythmic, blood pressure is increased. Sometimes there is involuntary urination, coughing, vomiting, and heart rhythm disturbances. No surgical interventions are allowed at this stage due to increased muscle tone and reflexes. The duration of this stage depends on the individual characteristics of the patient and the general anesthetic used and can range from a few seconds (when using non-inhalational anesthetics) to 10 minutes (when using inhalational anesthetics).

The third stage - SURGICAL STAGE - occurs when, as the body is saturated with anesthetic, inhibition occurs in the cerebral cortex and subcortical structures. Clinically, against the background of deep sleep, loss of all types of sensitivity, muscle relaxation, suppression of reflexes, slowing and deepening of breathing are noted. The pulse slows down and blood pressure decreases slightly. The skin is pale pink and dry. To control the depth of general anesthesia and prevent overdose, four levels are distinguished at this stage.

Level 1

– level of movement of the eyeballs – against the background of restful sleep, muscle tone and laryngeal-pharyngeal reflexes are still preserved. Breathing is smooth, pulse is slightly increased, blood pressure is at the initial level. The eyeballs make slow circular movements, the pupils are evenly constricted, they react quickly to light, the corneal reflex is preserved. Superficial reflexes (skin) disappear.

Level 2

– level of the corneal reflex. The eyeballs are fixed, the corneal reflex disappears, the pupils are constricted, and their reaction to light is preserved. The laryngeal and pharyngeal reflexes are absent, muscle tone is significantly reduced, breathing is even, slow, pulse and blood pressure are at the initial level, the mucous membranes are moist, the skin is pink.

Level 3

– level of pupil dilation. The first signs of an overdose appear - the pupil dilates due to paralysis of the smooth muscles of the iris, the reaction to light is sharply weakened, and dryness of the cornea appears. The skin is pale, muscle tone sharply decreases (only sphincter tone is preserved). Costal breathing gradually weakens, diaphragmatic breathing predominates, inhalation is somewhat shorter than exhalation, pulse quickens, blood pressure decreases.

Preparing for anesthesia

Anesthesia is an anesthesia of the body, which is accompanied by artificial sleep. Under the influence of the administered drugs, the human body loses pain sensitivity. High-quality anesthesia and rapid recovery from anesthesia largely depend on the anesthesiologist, whose task is to select the appropriate combination of narcotic drugs, depending on the individual characteristics of the patient, and therefore with minimal risk of adverse consequences.

Combined anesthesia

General anesthesia, carried out by sequential or simultaneous use of anesthetics administered in different ways, is called combined.

Combinations of drugs from different groups are used - tranquilizers, central muscle relaxants, narcotic analgesics, general anesthetics. At the same time, the amount of administered drugs is reduced, therefore, their toxic effect is reduced.

The following methods of anesthesia are distinguished:

Neuroleptanalgesia. The combination of narcotic analgesics and neuroleptics gives rise to a specific state of the body, characterized by a decrease in motor and mental activity and loss of pain without a change in consciousness (neurolepsy). The drugs selectively act on the hypothalamic-pituitary system and inhibit the reticular formation, due to which such changes occur. This method is widely used in brain surgery.
Ataralgesia is a pain management technique in which the main component of anesthesia is the use of analgesics and tranquilizers. When they are administered, anesthesia and a condition called ataraxia occurs.

What types of anesthesia are preferred for hypertension and why? If it is impossible to use local anesthesia, they resort to neuroleptanalgesia, since antihypertensive drugs are taken for its implementation.

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Feelings after anesthesia

In most cases, after anesthesia and surgery, the patient is transported to the department where he was before the operation. Only in exceptional situations, when the health condition is considered serious or even extremely serious, is he sent to intensive care.

Indeed, after anesthesia and surgical manipulations, the body needs some time to recover. The duration of recovery will be different for each person, because it depends on many factors, such as: duration of anesthesia, complexity of the operation, gender of the patient, his initial condition and characteristics of the body. Usually, a day after anesthesia, the patient ceases to feel the effects of the administration of anesthetics.

In the first minutes after waking up, the patient feels lethargy, disorientation in space, lethargy and rigidity of thinking. It is difficult for a person in this state to concentrate and formulate his thoughts. These sensations may fade and recur, but after a few hours consciousness becomes clearer and clearer.

Some effects of anesthesia last for several hours. Thus, the patient becomes sleepy, feels weak in the muscles, and experiences difficulty coordinating movement. If the patient has undergone spinal anesthesia, then for some time after waking up he will be overcome by severe weakness and a feeling of numbness in the limbs, “pins and needles” in the legs, and a frightening inability to perform any actions. In fact, there is no need to panic, as physical activity will return within a few hours. Let's consider other effects that occur after anesthesia.

Painful sensations

The level of pain relief after recovery from anesthesia rapidly decreases, which means that pain at the operation site increases. The pain can be severe and often leads to increased blood pressure and increased heart rate. You should report your feelings to your doctor or nurse, who will give you an anesthetic injection and help alleviate your condition.

Knowing how long it takes to recover from anesthesia, and what a person who has undergone surgery feels, each patient will be more relaxed about this procedure. Good health to you!

Before the planned operation, in addition to how everything will go, the patient is concerned about one more question: what will the recovery be like after general anesthesia and how to quickly get out of this state? These experiences are quite understandable, because there are often cases when a person reacts quite severely to the drugs administered.

Anesthesia is an artificial sleep caused by certain drugs (anesthetics), during which reflexes and some body functions are inhibited and switched off. The muscles relax, the reaction to pain disappears, and consciousness turns off.

Clinical use[edit | edit code ]

The main purpose of anesthesia is to slow down the body's reactions to surgery, primarily the sensation of pain. At the same time, drug-induced sleep, with which the concept of “anesthesia” is most often associated, is only one component of anesthesia. When performing anesthesia, it is also important to suppress or significantly reduce the severity of the body’s autonomic (automatic) reactions to surgical trauma, which are manifested by an increase in heart rate (tachycardia), an increase in blood pressure (arterial hypertension) and other phenomena that can occur even when consciousness is turned off. This suppression of autonomic reactions is called analgesia or analgesia. The third component of anesthesia is muscle relaxation, or muscle relaxation, which is necessary to ensure normal working conditions for surgeons.

Pain and the fight against it are a priority: if there is no pain, the physiological (in the context of pain, which takes on a pathological meaning) defense mechanisms will not start. This is the main task of the anesthesiologist: to prevent such developments.

How long does it take to recover after anesthesia?

Almost everyone who is about to undergo surgery asks themselves and doctors this question, but it is unlikely that anyone will be able to answer unequivocally how long the anesthesia takes to wear off and how it is removed. Recovery lasts from a few minutes to a certain number of hours. Therefore, how to quickly recover from anesthesia depends on several factors:

Duration of the operation. If it is complex and lasts several hours, then coming out of anesthesia will be more difficult.
Dosage of anesthetics. It is directly related to the time spent on the operation: with a multi-hour surgical intervention, the amount of the administered drug is correspondingly greater and its tolerability may be more difficult.
General health of the patient. A strong body is able to tolerate anesthesia more easily and recover from it faster.
Patient's age. Older people usually have a more difficult time with anesthesia.

Recovery from anesthesia is accompanied by the restoration of vital processes and the return to functioning of all functions. On average, this takes from 1.5 to 5 hours. The anesthesiologist continues to observe the patient after the intervention is completed, monitoring how the person returns to normal and whether there are any complications.

Indications for MRI under anesthesia

It is worth doing an MRI under general anesthesia in the following cases:

Excruciating pain syndrome that does not allow you to lie down for a long time (for example, with radiculitis)
The presence of pathologies that cause involuntary body movements
The need for MRI in infants and toddlers
Epilepsy
Presence of severe mental disorders
Severe form of claustrophobia

Do you recognize yourself in one of the listed points? Do not despair! Anesthesia will allow you to perform an MRI in the most difficult cases.

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Possible side effects of anesthesia

How the body will cope with anesthetics and how the patient will recover from their influence is of particular concern to the patient. Everyone has their own reaction to the administered drugs: some come out of this state almost immediately, while others experience side effects:

Headache, dizziness. Anesthetics sometimes lower blood pressure, which leads to dizziness. Head pain is common after an epidural, but it goes away within a few hours.
Sore throat. If you had to use a breathing tube or intubate the patient, then this side effect is possible. Usually goes away within 2 days.
Nausea, sometimes with vomiting. The most common occurrence. The feeling of nausea directly depends on the drugs administered.
Confused consciousness. This usually affects older people.

These are the main, most common side effects of anesthesia. There are several more severe reactions of the body, but they are less common:

hallucinations;
speech or hearing impairment;
chills;
slow thinking;
numbness of the limbs;
sleep disturbance.

In any case, it is not at all a fact that the listed reactions to anesthesia will necessarily occur. Most of them can be avoided if you take into account a number of simple conditions.

What a person may feel when coming out of general anesthesia

Until the narcotic drugs are completely removed from the patient’s body, he will feel their effects. On average, this process takes about four hours. When anesthetics are removed from the body, sensitivity to pain returns, so the first day after the operation, or even two (depending on the degree of complexity of the surgical intervention), the patient is administered strong painkillers, sometimes tranquilizers, according to the schedule, this makes the patient lethargic and lethargic. Typically, the infusion of medications continues at this time.

For the first hours after the end of the operation, the patient is prohibited from drinking; you can only wet your lips or rinse your mouth. After 3-6-10 hours, water is allowed to be drunk, starting with a few sips, gradually this dose increases and after a day or two reaches the usual volume.

On the first day the patient may complain:

For dizziness and headache. It is associated with the effect of anesthetic drugs on the central nervous system. In addition, medications used to suppress pain can lower blood pressure, which is manifested by dizziness of varying degrees of intensity. Another cause of headache is the use of epidural anesthesia, but it goes away after a few hours.
For painful sensations in the throat when swallowing and breathing. These phenomena may be caused by injury to the pharyngeal mucosa during intubation. As a rule, it takes two to three days to recover.
For nausea and vomiting. These are the most common complaints upon recovery from anesthesia; they directly depend on the type of drug used. To prevent this condition, you need to take your time to drink water, and if this happens, then there are medications that can cope with this problem. You just need to ask the nurse to give you an injection.
For chills. Very often, after regaining consciousness, patients complain of trembling; this is a consequence of a thermoregulation disorder. To normalize the condition, it is enough to cover the patient warmly and cover him with warm heating pads.

General rules: how not to aggravate the effects of anesthesia, prevention

To help yourself and more easily survive the so-called “coming-off” from anesthesia, you need to follow several rules that doctors always warn about:

The day before surgery, you should absolutely not eat heavy foods. Dinner should be light, and no later than 18-19 hours (the doctor will say more precisely, it depends on the type of operation and its expected duration).
On the day of the operation (before the start), you can eat 6 hours (no later), and drink at least 2 hours or more. In each specific case, the possible time of eating will be more accurately determined by the anesthesiologist.
The anesthesiologist must know absolutely everything about the patient’s condition in order to select the correct dose of the drug or cancel the operation. This is especially true in cases where the patient’s well-being suddenly changed shortly before the intervention. It is very important!
You can drink no earlier than an hour later, and only with your doctor’s permission. You should not drink sweet or carbonated drinks: this can cause bloating or vomiting. It is better to drink plain boiled water or warm tea.
If drinking does not cause vomiting, after a few hours, with the consent of the doctor, you can eat some light and liquid food: fermented milk products, cream soup, jelly, vegetable puree. It is especially important to adhere to such a diet for those who have undergone surgery on the abdominal or pelvic region: these patients will experience disturbances in peristalsis for 2-3 days, so the food should be as gentle as possible and made from easily digestible foods.
If the operation was long and difficult, then in order to avoid memory impairment you will need to drink a lot of fluid: from 1.5 to 3 liters per day. This will help remove the drug from the body faster.
There is no point in enduring severe pain in the operated area, so you can always ask the doctor to prescribe a painkiller injection. But usually the patient who wakes up is given an injection immediately.

Side effects

General anesthesia often causes side effects such as:

nausea;
confusion;
dizziness;
headache;
shiver;
itching;
a sore throat;
back pain;
muscle pain.

General anesthesia during surgery often causes headaches. But most often it goes away on its own within a few hours.

In a third of all cases, general anesthesia provokes nausea. Therefore, after surgery, a person should not get out of bed or drink water or food for some time.

General anesthesia most often causes confusion in older people. This is manifested by memory deterioration and behavior different from usual. Typically, this side effect disappears as the body recovers.

A side effect of general anesthesia, such as dizziness, appears due to a decrease in blood pressure. This same side effect can be caused by dehydration.

Trembling is a side effect of general anesthesia that causes severe discomfort in a person. However, such a complication is not dangerous to the body. This side effect lasts only 20-30 minutes.

Itching is an adverse reaction of the body to anesthetics such as morphine. But itching can be a manifestation of an allergic reaction to medications, so it is best to immediately report its occurrence to your doctor.

A sore throat is a consequence that can disappear within a few hours after surgery or bother a person for several days. It can be mild, causing discomfort, or it can be severe and bother you when swallowing or talking.

Back pain can occur due to the fact that a person was in the same position for a long time during surgery. Complications of general anesthesia, such as muscle pain, often appear in young men. They are localized in the shoulders, neck, upper abdomen and can last for 2-3 days.

Which of the listed side effects will appear after surgery is not known in advance. It is best if the anesthesiologist tells the patient in advance about the most likely side effects and how they can be minimized.

Prevention of complications

In addition to the sometimes difficult condition after anesthesia, there is also a risk of postoperative complications. But they can be avoided if you follow simple conditions.

After surgery, the patient cannot always breathe deeply, which is usually fraught with depression of respiratory function, congestion in the lungs and subsequent pneumonia. Therefore, in order to catch his breath, the patient needs to perform breathing exercises. An exercise that simulates inflating a balloon will be useful.

2 hours after the surgeon finishes his work, you need to start turning over (with the doctor’s permission), after 5-6 hours you should try to sit up on the bed, and after half a day or a day you can walk. Physical activity is necessary to avoid the formation of blood clots due to a long lying position. Perhaps the doctor will prescribe physical therapy.

After operation

When to get up after surgery? The general rule is as early as possible! Don't linger! But of course, with the doctor's permission. Lying for a long time is fraught with the development of hypostatic pneumonia, acute thrombosis of the veins of the lower extremities, bedsores on the back, sacrum, and heels.

A case is described: a young patient, 23 years old, practically healthy, after a routine uncomplicated appendectomy, lay on his bed and did not want to get up (he was in pain, you see). On the third day I finally got up. Result: pulmonary embolism - instant death.

When can I return to normal work after anesthesia? After general anesthesia, after just two days, a person can perform normal work, work with complex mechanisms that require concentration, and drive a car! But the operating surgeons discharge the patient after 7-8 days, when the stitches are removed and the wound has healed. You can drink after anesthesia when your reflexes are restored and there is no nausea or vomiting.

We also recommend reading: The whole truth about anesthesia

You can eat it the next day, the diet is gentle: you can’t eat spicy, salty, fried, canned food, sausages, or alcohol. The Pevzner diet is usually followed.

Conclusion

The fear of going under the influence of anesthetics is understandable for many people. But this greatest invention gives doctors a unique opportunity to carry out any, even the most complex, operations and other actions without the threat of painful shock in the patient. Drugs that put the patient into a state of artificial sleep are constantly being improved, and perhaps someday a drug will be invented that does not cause negative reactions in the body.

But for now, it is important to understand that there are basic requirements to alleviate your condition after anesthesia:

thorough preliminary examination and compliance with the doctor’s recommendations before surgery;
correct actions after surgery regarding physical activity, breathing and nutrition;
a conversation with an anesthesiologist if there is panic or worsening of the condition before the operation, which will help the specialist select the appropriate drug depending on the health and psychological state of the patient, the anesthesiologist can also advise you how to quickly recover from anesthesia if you ask him about it.

And there is one more very important condition: do not listen to terrible stories about how hard and painfully one of your relatives or friends experienced the “recovery” from anesthesia. Everything will go differently for everyone, and over time, any sensations experienced at this time will still be forgotten.

First stage of anesthesia

Secrets of rhinoplasty by Liza Boyarskaya, photos before and after surgery

The first stage is the stage of analgesia (stunning) - the result of inhibition of the ascending activating section of the reticular formation of the brain stem. It is characterized by a decrease in pain, but preservation of tactile and temperature sensitivity, skeletal muscle tone and reflexes.

Stage of arousal of anesthesia. Second stage

The second stage - the stage of excitation - is a consequence of inhibition of the cerebral cortex, leading to the so-called rebellion of subcortical structures. If the anesthetic is irritating (diethyl ether), then the arrival of afferent impulses from interoreceptors enhances this excitation. This stage occurs only when slow-acting anesthetics are used. It is characterized by loss of consciousness, speech and motor agitation. Changes in the function of the cardiovascular, autonomic and endocrine systems often occur. The release of catecholamines from the adrenal glands increases, which leads to increased arterial and venous pressure, dilated pupils, and tachycardia. At this stage, many reflexes are strengthened, which can result in reflex vomiting, respiratory arrest, and cardiac arrest.

Third stage of anesthesia

The third stage - the stage of surgical anesthesia - is a consequence of inhibition of most parts of the brain (except the medulla oblongata) and the spinal cord. During this period, consciousness, pain, tactile and other types of sensitivity, spinal reflexes, and muscles are completely lost. The disappearance of reflexes from the cornea and circular movements of the eyeballs indicates that the depth of anesthesia has been reached at which the operation can begin.

Stages, types and levels of anesthesia

The third stage is divided into several levels depending on the degree of central nervous system depression.

First level: the pupils are constricted, react to changes in illumination, the corneal reflex and movements of the eyeballs are preserved, surface reflexes are suppressed, breathing is rhythmic, deep, the tone of the skeletal muscles is reduced. Second level: the pupils are constricted, do not respond to changes in illumination, the corneal reflex and movements of the eyeballs disappear. Breathing is even, but less deep. Blood pressure is below baseline. Skeletal muscle tone is significantly reduced. Third level: gradual dilation of pupils that do not respond to light, weakening of chest and predominance of diaphragmatic breathing against the background of increased respiratory movements. The pulse increases, blood pressure decreases. Level four: pupils are dilated and do not respond to light. Breathing is diaphragmatic, rapid. Blood pressure is low. Cyanosis of the skin appears. This level is critical.

Anesthesia stages of anesthesia drugs

With continued administration of the anesthetic, a stage of central nervous system paralysis may occur with respiratory arrest and cessation of activity of the cardiovascular system. When the administration of the drug is stopped, all functions are restored (recovery stage) in the reverse order: reflexes and muscle tone, tactile and pain sensitivity appear, and consciousness returns.