Intravenous anesthesia is a state of inhibition of the central nervous system caused artificially by introducing narcotic drugs into the human body, accompanied by a loss of consciousness, relaxation of the skeletal muscles, weakening or switching off of some reflexes and the disappearance of pain.
Used during surgery. In Israeli clinics, specialists use the latest generation of drugs that provide the necessary effect on the patient’s body.
Effect of intravenous anesthesia
The main advantage of this type of general anesthesia, compared to other types, is its immediate effect, which is practically not accompanied by a stage of excitement, and the same rapid recovery of the patient from the effects of the drugs administered to him.
Depending on the drug administered, one dose of the drug, on average, renders a person unconscious for 20 minutes. Based on this, if the operation is carried out over a long period of time, the anesthesiologist gradually adds the required amount of medication to prolong the patient’s unconscious state.
Intravenous anesthesia, from a technical point of view, is a very simple procedure that provides a very fast and reliable result. But in this case, complete relaxation of the muscular system cannot be achieved and the risk of drug overdose is quite high. Based on this, during long-term operations, a combined anesthesia of several types is mainly used. Intravenous is an introductory one, bringing the operated person into an unconscious state without the occurrence of a stage of excitation. Intravenous mononarcosis is used extremely rarely.
Intravenous anesthesia indications
Almost any patient's condition that requires immediate (emergency) or planned surgical intervention is an indication for the use of intravenous anesthesia. Preference is given to operations that do not take much time. Otherwise, the type of anesthesia is selected individually, taking into account the patient’s condition.
Anesthesia in gynecology
As in other areas of surgery, anesthesia in gynecology comes in four types: general anesthesia (or anesthesia), sedation, regional anesthesia, local anesthesia.
Minor surgical interventions in gynecology are performed under local anesthesia, sedation or intravenous anesthesia. Major operations in gynecology are performed under anesthesia (general anesthesia) or regional types of anesthesia (spinal, epidural anesthesia).
Vacuum (vacuum aspiration), taking an aspirate from the cavity, puncture of the posterior fornix, curettage of the uterus (separate diagnostic curettage) or abortion are most often performed under local anesthesia or intravenous anesthesia.
With local anesthesia, tissues around the cervix are infiltrated (paracervical anesthesia) with a local anesthetic, which subsequently blocks pain during manipulation of the cervix. When performing local anesthesia in gynecology, the most commonly used local anesthetics are lidocaine, novocaine or ultracaine.
Considering some risk of local anesthetic solution entering a blood vessel when performing local anesthesia in gynecology (in particular, paracervical anesthesia), some gynecologists do not use this type of anesthesia, and the minor surgical interventions described above are performed under some sedation or without any anesthesia at all. Gynecologists do not have the skills to conduct classical sedation (this requires special knowledge), which is why the word “some” is used in the phrase “some sedation”. This sedation is either an intramuscular injection of a tranquilizer (diazepam), which somewhat relieves the feeling of anxiety, but not pain, or an intramuscular injection of an analgesic (ketorolac, diclofenac, promedol), which provides only a slight reduction in pain during surgery.
Intravenous anesthesia, which is a type of general anesthesia used in gynecology, causes the patient to fall asleep and feel no pain during surgery.
Large-scale gynecological operations (laparoscopy, surgery on the uterus and its appendages, treatment of urinary incontinence, etc.) are most often performed under general anesthesia, less often under regional anesthesia. The implementation of these types of anesthesia in gynecology is no different from their implementation in other surgical specialties, so their detailed description can be read in the sections: general anesthesia, regional anesthesia. The choice of anesthesia will be determined by the specific type of surgery and the patient's condition.
Contraindications to the use of intravenous anesthesia
If emergency surgery is necessary, there are no absolute contraindications for intravenous anesthesia. Israeli anesthesiologists will select the type of medications that will have the most gentle effect on each individual organism.
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In the case of a planned operation, there are several contraindications to this type of anesthesia:
- Disruption of the cardiovascular system - severe heart rhythm disturbances, myocardial infarction, if little time has passed since the onset of its development (less than a month), stable or unstable angina, characterized by a severe form of the course, heart failure (uncompensated).
- Acute diseases of the nervous system.
- Acute infectious diseases of the respiratory tract, in particular bronchial asthma during exacerbation, pneumonia, acute bronchitis or chronic bronchitis in the acute stage.
- Infectious diseases.
In addition to contraindications of this nature, there are also contraindications to the use of one or another drug used during anesthesia. Each drug has its own. Individual intolerance of an individual organism to barbiturates administered as an anesthetic should not be excluded. If there is one, a disruption of the cardiovascular system or the functioning of the respiratory system may develop. Based on this, during each operation there are all the necessary drugs and devices to normalize the functioning of the patient’s organs and ventilation of the lungs.
Disadvantages and contraindications
For intravascular anesthesia, narcotic drugs are used, for example, derivatives of barbituric acid; their long-term use is unacceptable, as it causes severe respiratory depression. They are administered in small doses (100 ml of 1% solution) and normally act for a short time (15-20 minutes). In view of this, it is necessary to have a ventilator available for use in case of apnea. The use of barbiturates is contraindicated if there is a risk of shock, collapse, severe respiratory failure and anemia. Other drugs such as: sodium hydroxybutyrate (10-15 g/kg), sombrevin (10mg/kg), ketaral (2-5 mg/kg) and Viadryl (15 mg/kg) are dangerous due to the development of such consequences as phlebitis and thrombophlebitis, hypotension and hallucinosis. The main contraindication is an allergic reaction to the components of the drugs. However, in gynecology it is better to give preference to intravascular anesthesia over local anesthesia.
Important: before surgery, if it is not an emergency, it is necessary to undergo an examination of organ systems. The type of anesthesia will depend on the functional state of your body.
General contraindications for anesthesia are acute untreated conditions and depletion of body systems. Such conditions include acute infectious diseases, severe rickets, acute neurological conditions, exacerbations of chronic pulmonary diseases and others. Even a short-term effect of drugs can critically aggravate the patient’s condition and lead to serious consequences. In gynecology, intravenous anesthesia is more often used than mask anesthesia. Intra-arterial administration of anesthetics leads to quick results, but in a certain situation, contraindications carry more weight and it is better to protect yourself and the patient from serious consequences.
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Drugs used for intravenous anesthesia
To carry out this type of anesthesia, various intravenous anesthetics are used: natural brain metabolites, steroids, barbiturates and their derivatives:
- propanidide;
- Viadryl;
- ketamine;
- sodium hydroxybutyrate.
All types of intravenous anesthesia have a pronounced hypnotic effect on the patient’s body, as well as a narcotic effect with a weakly expressed analgesic effect. They provide a quick and pleasant sleep for the patient and do not cause arousal. Therefore, they are an ideal option for induction of anesthesia. If their concentration exceeds the required norms, the respiratory center is depressed and a depressive state develops.
When this group of drugs is administered intravenously, only 1/3 of the drug has a narcotic effect on the patient’s body. The remaining 2/3 binds to plasma proteins. Based on this, patients characterized by hypoproteinemia may develop too deep anesthesia. Protein binding depends on how quickly barbiturates enter the blood. The faster their introduction, the greater the connection with proteins. Therefore, in order to avoid complications of intravenous anesthesia, such drugs are administered extremely slowly.
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Features of drugs used for intravenous anesthesia
- Barbiturates (metahexitone, sodium thiopental, hexonal). They are used to obtain basic anesthesia. Undesirable consequences of the administration of these drugs include inhibition of the patient’s cardiac and respiratory activity.
- Ketamines. They have clear advantages over other drugs, namely the absence of a depressing effect on the cardiac and respiratory systems. Used by anesthesiologists for both introductory and main anesthesia. During the patient's recovery from anesthesia, loss of coordination of movements and severe hallucinations may occur.
- Viadryl, sodium hydroxybutyrate, propanidide. These drugs are mainly used for induction of anesthesia with the use of other drugs.
In what cases is local anesthesia prohibited?
Local anesthesia is another type of pain relief used during surgery. It consists of local injection of an anesthetic drug into the area of the intended surgical intervention in order to reduce its sensitivity. The patient remains fully conscious after the administration of the anesthetic drug.
Local anesthesia rarely causes complications, so it is considered the least dangerous among all types of pain relief existing today. It is widely used for short-term and small-volume operations. Local anesthesia is also used in persons for whom any other methods of pain relief are strictly contraindicated.
The use of local anesthesia during surgical interventions is prohibited if the patient has:
- hypersensitivity to local anesthetics (Lidocaine, Bupivacaine, Benzocaine, Ultracaine, etc.);
- mental disorders;
- state of emotional lability;
- respiratory dysfunction.
In early childhood, the use of local anesthesia is impossible due to the fact that a small child does not know how to remain motionless for a long time. After using local anesthetics, a person may experience complications in the form of allergic reactions (urticaria, itching, Quincke's edema), loss of consciousness, and the occurrence of an inflammatory process at the site of injection of the drug under the skin.
Before any surgical intervention, specialists conduct a thorough examination of the sick person, based on the results of which they decide on the possibility of using one or another type of anesthesia. This approach allows them to perform successful operations with minimal risk to the patient’s health.
How dangerous is general anesthesia for a child? In some cases, it is simply impossible to do without it, especially when it comes to surgical intervention to save a life. But there are also negative aspects to drugs that provide medicinal sleep.
Every parent whose child is awaiting surgery asks doctors not only about how dangerous surgery is, but also about the negative impact of anesthesia on the child’s body. Often it is the consequences of anesthesia that frighten parents. You can learn about them from the anesthesiologist, who will prepare the baby for surgery. You can also get answers to your questions from our article, where we will try to highlight the problems of post-anesthesia consequences for the child’s body.
