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Depending on the scope of anesthesia, it can be divided into the simplest forms of local anesthesia, general anesthesia, and sleep anesthesia or sedation.
The difference between sleep anesthesia and general anesthesia is general anesthesia when the anesthetic drug administered is high dose, and sleep anesthesia when the dose is low. Under general anesthesia, the patient is unable to maintain the airway on their own and breathing is suppressed, whereas in sleep anesthesia, an endotracheal tube is not placed because this is possible.
In most cases, sleep anesthesia is a surgical procedure that can be performed with local anesthesia, but it is used to make the procedure or surgery more comfortable for the patient.
General anesthesia requires four blocks.
The simplest way to describe general anesthesia is "drug-induced reversible* coma." What is completely different from coma is that anesthesia is 100% reversible. The anesthesia is kept in a coma, and when you recover, you will be fully awake very quickly. To put it simply, the moment you receive general anesthesia is the closest you get to death. If you put in a little bit more capacity, you're going to be brain dead.
*Reversible: A state of matter that can be changed once and then returned to its original state.
In the past, surgery had to be performed, so many primitive methods of anesthesia were used, including:
1. Use morphine-based herbs
2. Drinking too much alcohol
3. Carotid artery compression (strangulation renders you unconscious)
4. Tabak
5. Cold anesthesia (freezing the area to be operated on)
In the process of general anesthesia close to modern times, the discovery of two gases had a great influence. Ether and nitrous oxide. In fact, Crawford W. Long (1815-1878), a surgeon who is credited with using anesthetic gas to treat patients for the first time, used it to remove tumors in his clinic after seeing that people who inhaled ether at a party did not feel pain.
In the case of nitrous oxide, a dentist named Horace Wells (1815-1848) was the first to attempt a public demonstration. This is where the shortcomings of nitrous oxide as an anesthetic are revealed. Surgery was attempted, but anesthesia failed. The reason for this is that nitrous oxide is difficult to maintain a high depth of anesthesia.
Because ether is flammable, it is not suitable for use in electrocautery, which is used in almost all modern surgeries. Thus, the anesthetics used in modern times are products that have been modified by modifying the chemical structure of ether components
The probability of anesthesia failing is 1/100,000~1/150,000, which is similar to the probability of an airplane accident.
The stages of general anesthesia are as follows:
1. After the patient is placed on the operating table, a monitoring device such as a blood pressure monitor, electrocardiogram and pulse saturation monitor is attached to the body.
2. Induction of anesthesia with fluids.
3. When anesthesia is inducted, propofol is administered for about 15 seconds to cause loss of consciousness.
4. Neural tube blockers are administered, and oxygen and inhaled gas are administered through the mask.
5. Endotracheal intubation is performed to secure the airway.
6. Observe the patient's vital signs and begin surgery.
Q. Can general anesthesia cause memory loss?
If you are within the normal age range, the anesthesia process itself has nothing to do with memory. However, problems can arise if the blood pressure drops significantly during surgery or if the brain is damaged due to poor oxygen supply.
However, in the case of children under the age of 2 and the elderly over 80, there are studies that show that repeated administration of general anesthetics or prolonged anesthesia can affect the cranial nerves proportionately, resulting in a permanent decline in cognitive function and dementia.
Q. Is there a case where anesthesia is not possible?
There is only a difference in the degree of anesthesia depending on the dose considering the constitution, physical condition, weight, etc., and there are no cases where anesthesia is impossible.
Q. I've heard that general anesthesia lasts for 2-3 days, but is it a relative decrease in cognitive ability and other functions compared to usual?
Yes yes. During general anesthesia, it takes 2-3 days for the anesthetic gas to completely leave the body, so it is likely that your reflexes will not be normal during this period. Sleep anesthesia may also prevent cognitive function from returning to normal until several hours after awakening. Therefore, it is best to avoid driving or exercising at a high intensity after anesthesia, as it can be dangerous.
Q. Why does anesthesia with ventilate* cause bradycardia and hypotension?
In the case of normal breathing, when you inhale, you inhale with negative pressure and when you exhale, you go out with positive pressure, but when you use a ventilator, you put oxygen into the lungs with positive pressure, so the lungs expand, and the heart is compressed, reducing the blood flow back to the heart.
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