A team,which can competently carry out anesthesia applications (General Anesthesia, Regional (Zonal) anesthesia, Spinal Anesthesia, Epidural Anesthesia, Numbing Environmental Nerves (peripheral nerve blocks), Surface hand (local) anesthesia, is serving for 24 hours in our hospital. Anaesthesia technicians of our hospital, which are trained to help doctors, constitute an important part of the team .The surgery team in our hospital, which is able to make any surgical intervention to the patients from one day newborn to advanced ages, carry out these operations 24 hours and in every emergency conditions with the support of anesthesia and intensive care unit doctors.
What is Anesthesia?
The first thing, which comes to mind when anesthesia is called, is general anesthesia. General anesthesia is still the most common one used today. Another heading, which should come to mind when anesthesia is called, is regional anesthesia. While the patient is completely asleep under general anesthesia, in regional anesthesia methods, the anesthesia is provided for certain parts of the body according to the place where the operation or attempts will be made. For example, In the method which is called as spinal anesthesia or epidural anesthesia in elective caesarean section and is colloquially known as numbing from the waist for the person is awake. The operations are carried out by numbing the below part of the umbilicus level with injection shot to the waist. On the other hand, many operations are carried out without general anesthesia that is, without being asleep for example: numbing from axillary cavity for an operation related to the hand or the regional anesthesia of the certain nerves by injection given to cervix for shoulder operation. So, the pain or unpleasant sensations during the surgery are removed with anesthesia no matter which method is used. In the meanwhile, the main purpose is to keep patients safely and making their operations with the minimum risk.
The anaesthesiologists and surgeons are prepared to operations of the patients in the most comfortable and safest way to carry out this aim.
While the preparations are made, anaesthesiologists attempt to protect the patients from all of the medical problems which may occur before, during or after the surgery. For this reason, anaesthesiologists begin to examine the patients before the operation.
What is done before the anesthesia?
In the pre-operation evaluation; the major diseases of the patients, allergies, smoking or other habits of the patients, the drugs used by the patients and if the patients have been in anesthesia before or not, are questioned in detail.
Meanwhile the patients are examined. All necessary examinations such as; laboratory or chest x-ray are performed.
Sometimes, consultations are requested if it is necessary to ask for an opinion of another specialists.
After all preparations are completed, the anesthesia risks are determined according to the current status of the patients and these risks are shared with the patients’ relatives and the patient.
Finally; the pre-operation preparations are largely completed after which method of anesthesia during surgery will be used and what the patients should pay attention before the operation have been determined.
After taking the informed consent of the patient and the patients’ relatives for the anesthesia, the patient is directed to the related doctor for the planning of the operation appointment.
Today’s anesthesia practices are carried out quite safely and with very few problems by making all these preparations carefully.
Why people are afraid of the anesthesia?
In the 1980s, one in every 1,500 anesthetized people died depending on the anesthesia however; today specially in the recent years this rate could be reduced up to one in every 250 000 anesthetized people, in parallel with the experience and developments acquired recently. This is an unbelievable progress. In spite of all these developments, the problems have not been completely removed.
Most of the fears of patients about anesthesia are originally based on past years. As I mentioned above, the anesthesia-related deaths and serious problems have been significantly reduced. I think, the fact that news which appears on the media about the anesthesia-related deaths is less than the previous year’s confirms what I told. However, the risks have not been reduced to zero in spite of all these positive developments.
What are the potential risks related to general anesthesias?
No medical intervention is entirely risk-free. These risks change depending on the operation reason, associated disease, age, lifestyle of the patient and the other factors. The anaesthesiologists anesthetize the patients by taking all kind of precautions and preparations. Therefore, despite everything the operating room is the best equipped intervention area when a negative situation is faced.
Common risks; Sore throat, hoarseness, nausea, vomiting, increased and decreased in pulse rate etc.
Rare risks; Neck pain, back pain, lips, tongue, teeth and throat damage, being awareness under anesthesia, aspiration (escape of stomach contents to the respiratory tract), such as allergies and nerve damage, etc.
Very rare risks; Vocal cords, trachea, alimentary canal, and cervical vertebrae damage, burns related to the cautery device, heart attack before during or after the surgery, drugging to the artery, severe allergic reactions, surgically tube placement to the trachea, embolism to vital organs, malignant hyperthermia (extreme high fever ), need of intensive care unit and death.
What is done during general anesthesia?
The patient is anaesthetized by using a variety of anesthetics, thus, the pain is removed and mostly muscles relaxation is provided. Meanwhile the patients are engaged to artificial respiration device through some apparatus mounted to their airways. The patients are provided to breath with these devices. The vital functions are continually monitored during the anesthesia period.
I suppose that one of the best ways of stating this process will be to give the airplanes as examples. Travelling by plane requires very long preparation whether you will travel short or long distance. Because many preparations both about passengers, airplane and also airport should be done.
We can associate anesthesia with this. Although the pre-operational preparations of the patients are completed, when they come to the hospital they pass from a series of preparations until they lie their services. Some other preparations are made in the service, as well. Meanwhile, both the preparation of devices and the preparation process of materials, which will be used during the operation, continue in the operating room. After all these preparations are completed, everything should be fully prepared when the patient is called from service to the operating room.
Providing that the preparations are completed, the patient can be anaesthetized. In other words, the airplane is flyaway.
Generally, when patients are requested from the service, one or more relaxing drugs performed to the patient. The patients come to the operating room with a serum attached to their vein. Generally the patient begins to sleep by giving a fast-acting anesthetic drug from the vein to which serum is attached. The process continues by giving the other anesthetics. Anaesthesiologist maintains this status with drugs during the operation. At the same time, conscious of the patient and the sense of pain, which will occur during the operation, are removed.
Adequate time anesthesia can be provided by simple and short time attempts, generally by giving an anesthetic drug to the vein. In the heavy and prolonged attempts, some other drugs are additionally used. Anesthesia drugs, which are in form of gaseous and oxygen, are given through bag valve mask, which is placed to cover the mouth and the nose (mask anesthesia), or bronchial tube, which is placed to the trachea (intubation tube).
In addition, some catheters (for example: stomach tube, urinary catheter, vein and artery catheters etc.) are placed for some operations when it is necessary.
During anesthesia, the anesthesiologist and anesthesia technicians constantly follow vital functions (pulse rate, blood pressure, respiration, heart rate, blood oxygen level, and many more functions). Anesthesia is terminated with the end of the operation. In this process, the medications are rapidly eliminated from the patients’ body and the patients wake up as if they were in a deep sleep.
The patients, which come out of the anesthesia, are kept under supervision in the recovery room until they wake up completely before they are sent to the service. One of the most disturbing issues for the patients after the operation is feeling pain. For this aim, the pains of the patients are tried to be relieved through a large number of painkillers and some pain killer methods as from the time that the patient wakes up.
Sometimes, the patients are taken to the intensive care units for a certain period to provide better treatment and observation after the operation, especially after long-lasting and serious operations.
Is everyone suitable for the general anesthesia?
General anesthesia is not suitable for everyone. Our most significant duty as doctors is not to harm the patients. In terms of anesthesia, there is no patient which can not be anesthetized. However, there may be patients who may not come out of anesthesia. For this purpose, one of the aims of the detailed evaluation of the patient before the operation is to determine the most suitable anesthesia method for the patient and medications to be used. For example, if a patient ,who has a severe lung disease, is not in a good condition in spite of the related treatments, it would be more accurate to make the operation by numbing from the back instead of general anesthesia, especially if the patient will have an operation related to the below of the umbilical part. However, if the operation is immediate or the part of the body related to the operation could only be anesthetized by general anesthesia, the patients could be taken into operation by taking necessary precautions and great care following related preparations and treatments. The patient and the relatives of the patients should be informed and confirmed about the risks which may occur in this situation.
Is it understood during anesthesia if the patient is allergic to anesthetic drugs?
It is questioned if the patient is allergic to any medications or substances during the evaluation which is before the anesthesia. The patients are asked whether they are anesthetized before or not. The status of the patient related to the allergy is understood in this evaluation process. The measure is taken by giving some allergy preventive medications to the patients, which are frequently allergic, before the operation.In addition, rarely, some patients with extreme allergic status are directed to the allergy centers to be determined if they have an allergic against the drugs to be used. The possibility of the damage to the patient is reduced by using anesthetic drugs having the least allergenic properties after all these information is obtained.