General anesthesia.

General anesthesia.

Alisher Agzamov MD PhD.

Introduction

General anesthesia is a treatment that puts you into a deep sleep so you do not feel pain during surgery. When you receive these medications, you will not be aware of what is happening around you.

Description

You will receive general anesthesia in a hospital or outpatient office. Most times, a doctor called an anesthesiologist will put you to sleep. Sometimes, a certified registered nurse anesthetist will take care of you.

The doctor will give you medication into your vein. You may be asked to breathe in (inhale) a special gas through a mask. Once you are asleep, the doctor may insert a tube into your windpipe (trachea) to help you breathe and protect your lungs.

You will be watched very closely while you are asleep. Your blood pressure, pulse, and breathing will be monitored. The doctor or nurse taking care of you can change how deeply asleep you are during the surgery.

You will not move, feel any pain, or have any memories of the procedure because of this medicine.

Why the Procedure Is Performed

General anesthesia is a safe way to stay asleep and pain-free during procedures that would:

·         Be too painful

·         Take a long time

·         Affect your ability to breathe

·         Make you uncomfortable

·         Cause too much anxiety

You may also be able to have conscious sedation for your procedure, but sometimes it isn’t enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel.

Risks

General anesthesia is usually safe for healthy people. The following people may have a higher risk of problems with general anesthesia:

·         People who abuse alcohol or medications

·         People with allergies or a family history of being allergic to medicine

·         People with heart, lung, or kidney problems

·         Smokers

Ask your doctor about these complications:

·         Death (rare)

·         Harm to your vocal cords

·         Heart attack

·         Lung infection

·         Mental confusion (temporary)

·         Stroke

·         Trauma to the teeth or tongue

·         Waking during anesthesia (rare)

Before the Procedure

Always tell your doctor or nurse:

·         If you could be pregnant

·         What drugs you are taking, even drugs or herbs you bought without a prescription

During the days before the surgery:

·         An anesthesiologist will take a complete medical history to determine the type and amount of anesthesia you need. This includes asking you about any allergies, health conditions, medications, and history of anesthesia.

·         Several days before surgery, you may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.

·         Ask your doctor which drugs you should still take on the day of your surgery.

·         Always try to stop smoking. Your doctor can help.

On the day of your surgery:

·         You will usually be asked not to drink or eat anything after midnight the night before the surgery. This is to prevent you from vomiting while you are under anesthesia. Vomiting during anesthesia can be dangerous.

·         Take the drugs your doctor told you to take with a small sip of water.

·         Your doctor or nurse will tell you when to arrive.

After the Procedure

You will wake up tired and groggy in the recovery or operating room. You may also feel sick to your stomach, and have a dry mouth, sore throat, or feel cold or restless until the anesthesia wears off. Your nurse will monitor these side effects. They will wear off, but it may take a few hours. Sometimes nausea and vomiting can be treated with other medicines.

Follow your doctor's recommendations while you recover and care for your surgical wound.

Outlook (Prognosis)

General anesthesia is generally safe because of modern equipment, medications, and safety standards.

Most people recover completely and do not have any complications.

A target-controlled infusion (TCI) Propofol in major trauma patients.

A target-controlled infusion (TCI) Propofol in major trauma patients.

Alisher Agzamov, A. M. Al Qattan, M. Hashti, M. Bahzad.

Department of Anesthesiology & ICU, Al Aabah & Zain Hospitals, MOH, Kuwait City, Kuwait.

BACKGROUND:

Many pathophysiologic alterations in major trauma patients can cause changes in the distribution of, and perhaps response to, drugs commonly used in anesthesia practice. This study was conducted to assess changes in bispectral index (BIS) caused by increasing the target Propofol effect-site concentration during a target-controlled infusion (TCI) in major trauma patients.

METHODS:

120 patients, ASA physical status II, III - IV, aged from 19 to 65 years old, weighing 50-170 kg, with poly multiple major trauma, scheduled for emergency surgery less than a 2 – 10 hours after injury were recruited. A further 120 ASA physical status class II, III - IV, emergency non- trauma surgical patients, age, sex- and weight-matched adult patients scheduled for emergency surgery under general anesthesia were recruited as controls. During anesthesia induction, target propofol effect-site concentrations were increased by increments of 0.5 mcg/ml  up to 5.0 mcg/ml. The BIS responses to each target concentration using TCI were compared in both groups.

RESULTS:

In the trauma group, significantly greater BIS values relating to increasing propofol TCI were noted at deeper anesthesia when compared with controls; at > or =3.0 – 5.0 mcg/ml; mean BIS remained at a plateau of about 40. Patients with traumas had higher cardiac indices, and lower hemoglobin and albumin concentrations than the controls. They consumed more cisatracurium to maintain the same degree of neuromuscular blockade than the controls.

CONCLUSIONS:

In major trauma patients, the final biphasic BIS responses appeared to be determined by numerous other variables such as BIS algorithm, TCI performance, and altered Propofol pharmacokinetics and pharmacodynamics.

According to our results the importance of an individually tailored approach, including careful anesthetic titration, based upon the patient's clinical condition and responses can not be overemphasized.