Anesthesia: general anesthesia, spinal anesthesia and epidural anesthesia

What is anesthesia?
Anesthesia is the administration of a drug to suppress the sensation of pain during surgery or other invasive procedure that causes pain (such as closure of the wound by means of surgical sutures or removal of a wart).

Anesthesia eliminates the sensation of pressure, heat and pain during surgery, and also blocks muscle activity.

A person who has to undergo surgery knows that the thought of being unconscious or temporarily losing sensitivity can be quite irritating.
The anesthetic can be administered as an injection or by inhalation of a gas and vapor.
Anesthesia acts on the nervous system in various ways by blocking the nerve impulses and thus the pain.
In today’s clinics and surgical centers, the highly qualified specialists (anesthesiologists) have an extensive range of safe and modern medicines at their disposal. In addition, they use advanced techniques for monitoring. The anesthesiologist is a doctor who specializes in administering and managing anesthetics, which are drugs that numb an area of the body or help it fall asleep.

In addition to administering medications, the anesthesiologist must:

  • vital signs (breathing, heart rate and heart rhythm. monitor body temperature, blood pressure and oxygen levels in the blood) during surgery;
  • solve any problems that may arise during the operation;
  • treat possible pain that may occur after surgery;
  • calm the patient largely before, during and after the operation.


Are there different types of anesthesia?

There are three main types of anesthesia: local, regional and general.

Local anesthesia: The anesthetic is injected into the tissue to numb only a specific area of the body before surgery, for example, the hand, foot, or tooth. It is a puncture that, as a rule, does not hurt.Spinal and regional anesthesia: The anesthesiologist places an injection near a group of nerves to numb the area of the body to be operated on. The patient stays awake, but he can be given a relaxing drug, such as a sedative.
There are several types of regional anesthesia. The most used are the spinal (or lumbar), the epidural or brachial, which are made with great precision at certain points of the back.
Usually, these forms of anesthesia are preferred in prostate surgery, caesarean section and orthopedic procedures such as meniscus, etc.

General anesthesia or general anesthesia: The patient becomes unconscious and is unconscious and without sensation of pain.
There are various drugs to perform general anesthesia. Some of these are gases or vapors that are inhaled through a mask, while others are introduced directly into the body through a vein.
During anesthesia, the specialist must monitor, control and treat the patient.
A tube can be inserted for ventilation via the mouth or directly via the trachea to enable correct ventilation during the operation.
The duration and depth of anesthesia are calculated with great precision and are constantly regulated. At the end of the operation, the anesthesiologist reverses the process and the patient regains consciousness in the recovery room and wakes up.

The type and amount of anesthesia are calculated to the personal needs of the patient and depend on various factors, including age and body weight, type and area of surgery, possible allergies and the current clinical situation.

Is anesthesia safe?

In recent decades and with advances in patient safety, the risks of anesthesia have become very low.
Over the past 25 years, deaths associated with anesthesia have roughly decreased from 2 cases per 10,000 anesthesia to one death per 250,000 anesthesia.
Some types of disease, such as heart disease, arterial hypertension (high blood pressure), and obesity can increase the risks of anesthesia.
Nevertheless, anesthesiologists make it possible to perform a safe operation even for very sick patients.
General or regional anesthesia can also be performed during pregnancy, but it is always advisable to tell the doctor about pregnancy.

What are the risks of anesthesia?

All surgeries and all types of anesthesia have their risks, which depend on many factors, including the type of surgery and the clinical condition of the patient. Fortunately, side effects occur very rarely. The anesthesiologist will take all necessary precautions to prevent a health problem from occurring.
It is important to talk to the treating anesthesiologist about the risks that can occur with anesthesia.

What training does an anesthesiologist have?

Anesthesiologists must study medicine at a medical faculty of a university, after which they must undergo specialist training (continuing education) in anesthesiology for four years. In addition, some anesthesiologists decide to become a specialist or to specialize in a particular field over the course of another year, such as pain management, cardiac anesthesia, pediatrics, neurology, obstetrics, etc.

To work in the dental area, anesthesia is administered directly by the dentist in the form of local anesthesia.

Do I have to continue taking the medication you take regularly before the operation?

It is important to inform the doctor about the medications you are taking before surgery so that they can decide whether to stop taking them or continue to take them. Some examples of drugs that are commonly taken:

Aspirin and Plavix are medications that are taken to prevent blood clots.
These drugs are used in the treatment of patients with certain heart diseases and vascular diseases.
Aspirin and Plavix can cause heavier bleeding if the patient cuts or undergoes surgery. If one of these drugs is taken, you should talk to your doctor about it so that you know if you should stop taking it before the operation.
When deciding to stop taking aspirin or Plavix, it is necessary to consider how important it is for the patient in the current situation, but also what are the possible risks of heavy bleeding from surgery.

Diuretics are often prescribed to treat elevated blood pressure. This class of drugs can cause changes in electrolyte levels, such as potassium. If diuretics are taken, the anesthesiologist may arrange for some blood tests before surgery.
Usually, patients with diabetes are treated with insulin injections or tablets. The anesthesiologist may lower the dose of insulin in the morning or stop taking the tablets before surgery.
You should always tell the anesthesiologist or doctor what medications are currently being taken before surgery.

Why do you need to be fasting before surgery?

It is very important that the patient is fasting before any type of surgical procedure or medical procedure that requires anesthesia.
When anesthetics are administered, normal reflexes usually weaken.
As a result, gastric contents easily reflux through the esophagus into the mouth, even into the trachea or even into the lungs. Because the stomach contains acid, if the stomach contents reach the lungs, it can cause severe pneumonia called aspiration pneumonia.

What are the different types of sedation?

Sedation allows the patient to remain calm during the scheduled medical procedure or surgery.
Sedation can relieve the pain and anxiety that accompanies some treatments or diagnostic tests.
With mild or moderate sedation, patients are awake and able to respond appropriately to instructions.
With deep sedation, however, patients usually fall asleep and do not remember what happened.
A high dose of sedative can slow down breathing, so an oxygen mask is often applied to improve breathing.

What is a blood transfusion?

Blood transfusion is an important medical treatment that can save lives. If you lose a lot of blood during surgery or trauma, plasma is transfused to replace the lost blood. This fluid is necessary for the heart and circulation. But it does not contain platelets and proteins that are needed to transport oxygen to tissues, close wounds and fight infections. Only a blood transfusion provides these elements.

Who needs a blood transfusion?

People who have lost a lot of blood during surgery or after trauma need a blood transfusion.
In particular, those who have a low blood cell count and people with heart disease, circulatory problems or other serious illnesses are more likely to receive a blood transfusion.

Do anesthesiologists perform blood transfusions?

In the United States, anesthesiologists perform about half of blood transfusions and are experts in collecting risk assessment and the necessary benefits during a transfusion.
Anesthesiologists are obliged to use the available blood responsibly.
How to prevent surgery on the wrong side? An operation on the wrong side is very rare, anesthesiologists know that even a single case would be too many.
The most important thing a patient can do to avoid this mistake is to ensure that the consent form is completed and the operating area is marked.

What is a spinal blockage or regional anesthesia?

Spinal blockage is often used to help patients with a painful procedure.
Regional anesthesia consists of inserting a small injection needle into the cerebrospinal fluid space, which contains cerebrospinal fluid. A local anesthetic causes temporary paralysis of the lower part of the body.

What is an epidural?
Epidural anesthesia is often used to control pain after surgery or during childbirth. Epidural anesthesia consists of inserting a small injection needle into the back, after which a small drain (catheter) is positioned near the nerve outlets into the spinal cord.
The drugs administered through the catheter temporarily paralyze an area of the body. Epidural anesthesia and spinal anesthesia are often confused.
When performing spinal anesthesia, the anesthesiologist positions a small injection needle in the back and the needle tip reaches the fluid surrounding the spinal cord.
In epidural anesthesia, the tip of the needle is located outside the dural sac in the area where the nerves exit the spinal cord.
The procedure is unpleasant, but not painful.
Epidural anesthesia is the one used in childbirth.

What are the side effects of spinal blockage or epidural anesthesia?

The side effects of spinal blockage or epidural anesthesia are: back pain, headache or discomfort when urinating.
Other and less common side effects include: bleeding or infection of the injection site and very rarely nerve damage.

What is anaesthesia mobilization?

Some patients who have been immobilized for a long time or suffer from adhesive capsulitis (frozen shoulder) have limited mobility.
Anesthesia mobilization is a medical procedure in which anesthesia is used to move a joint without causing pain and stiffness.

What are the risks of anesthesia?

Nowadays, anesthesia is very safe. In rare cases, anesthesia can lead to complications (for example, cardiac arrhythmias, breathing problems, allergic reactions to medications and also death).

The risks depend on the type of procedure, the condition of the patient and the type of anesthesia used.
You have to talk to the doctor, surgeon or anesthesiologist to get all the necessary explanations about it.
Usually, most complications can be avoided by giving the anaesthetist all the information regarding:

  • the current and past clinical condition (including recent conditions such as runny nose or other conditions such as snoring or depression);
  • any medications (prescription and over-the-counter), dietary supplements or natural remedies that are taken;
  • possible allergies, especially to food, medication or latex;
  • whether you smoke, drink alcohol or take any drugs;
  • possible previous reactions that the patient or a family member of his/her had in connection with anaesthesia.

In order to ensure the greatest possible safety during the surgical procedure or medical procedure, it is extremely important to answer all questions conscientiously and in detail to the anesthesiologist.

Information that may seem unimportant can be crucial to knowing how to respond to anesthesia.
It is important to follow the doctor’s instructions about the things not to do before surgery.
You are probably not allowed to eat or drink anything (usually from midnight of the previous day) and it may be necessary to stop taking other medications or herbal substances for a certain period of time before surgery.

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