General information about anesthesia

What is anesthesia?
Anesthesia is loss of sensation resulting from pharmacological depression of nerve function or from neurological dysfunction.

Who is the man behind the surgeons?
An important physician specialist, the anesthesiologist is a vital member of the surgical team. He has the responsibility for your welfare when you undergo anesthesia. He is your advocate in the operating room. It's more than just "going you to sleep." He cares for your breathing, your brain, your heart, your circulation, and other important functions during an operation. He gives you anesthesia to ensure unconsciousness, prevent and treat pain, and relax your muscles during surgery so the operation can be done. He cares for you so that your surgeon can focus on the operation. Because of the anesthesiologist’s involvement, surgery or diagnostic procedures can be performed safely, without pain and stress.

What is done before surgery?
Anesthesia and surgery affect your body systems so, it is critical for your anesthesiologist to know as much about you as possible. He will carefully evaluate you and your medical history and will inquire about your recent medications. If you have not met your anesthesiologist during a preoperative interview, you will meet immediately before your surgery. At this time, your anesthesiologist will review your entire medical chart for a clear understanding of your needs and medical condition.

What is done during surgery?
Your anesthesiologist is responsible for your well-being during your surgical procedure. In the operating room, he will direct the anesthesia and functions like heart rate, blood pressure, heart rhythm, body temperature and breathing. He is also responsible for fluid and blood replacement, when necessary. Frequently, the patients suffer diabetes, asthma, high blood pressure, arthritis or heart problems. Because of your preoperative evaluation, he will be alert to these conditions and well-prepared to treat them. Your continued medical management during surgery is necessary to help you have a speedy recovery.

What is done after surgery?
The anesthesiologist continues to be responsible for your care in the recovery room, often called the post-op care unit. Here, he directs specially trained staff members who monitor your condition and vital signs as the effects of the anesthesia wear off. Your anesthesiologist will determine when you are able to leave the recovery room.

Are there any different kinds of anesthesia?
General speaking there is general, regional and local anesthesia.

General Anesthesia is a technique during which the patient is unconscious. General Anesthesia provides analgesia (you have no pain), amnesia (you are unaware and have no memory) and relaxation (your muscles are relaxed). G. Anesthesia is usually started and maintained by giving the patient an intravenous drug, an inhalation drug, or a combination of both. The anesthesiologist will monitor the progress of the surgery, the depth of your anesthesia and the cardiovascular and respiratory status. The depth of anesthesia can be changed by increasing or decreasing the amount of drug given. As the surgeon ends the procedure, the anesthesiologist reduces the depth of anesthesia so the patient will awaken at the end of the procedure or shortly thereafter and will regain consciousness.

Regional Anesthesia involves blocking sensations to one part of the body. By injecting local anesthetic around a group of nerves, the anesthesia provider can block the sensation from one part of the body. The patient is given sedation before and during the procedure. A regional block can often give the patient several hours of pain relief after surgery. Regional anesthesia can be given alone, with sedation or, in combination with General Anesthesia. Use of this technique will depend on the type and length of the surgery.

Do I need preoperative examinations before surgery?
The anesthesiologist will review the medical history, and order any necessary laboratory test,electrocardiogram (EKG) and chest X-ray. He will make sure that any medical conditions, which might complicate the anesthetic, are being treated as well as possible. The history should include past and current medical problems. A family history of adverse reactions associated with anesthesia should also be obtained. lnformation about the anesthetic that the patient considers relevant should also be documented. On the morning of surgery, the patient has nothing to eat or drink.

Spinal anesthesia
Spinal anesthesia is referred to injecting local anesthetic in the patient's back to anaesthetize the lower part of the body. It is usually very safe and effective. It may be associated with less blood loss, and less risk of dangerous blood clots, than general anesthesia. Spinal anesthesia is suitable for many procedures in the lower half of the body. In general, spinal anesthesia provides excellent pain relief during all these procedures. Major orthopedic surgery may include cutting bone and hammering to insert artificial joints, and some patients dislike the noise that this causes.

Peridural anesthesia
Epidural or peridural anesthesia uses a larger volume of anesthetic, positioned in the fat and veins further away from the spinal cord. This block takes effect more slowly, which can be an advantage in some cases. For example, an epidural is less likely to produce a severe drop in blood pressure than a true spinal block. While a true spinal block only lasts a few hours.

PLEXUS BLOCKS
There is a wide variety of other nerve blocks, including blocks at the ankle, around the groin, in the buttocks, at the arm, at the leg

AXILLARY BRACHIAL PLEXUS BLOCK.
This block is used for procedures of the hand, forearm, and elbow. An injection is given in the patient's axilla into a space that surrounds a bundle of nerves that supply feeling to the lower arm. This is usually done with the patient awake with sedation, but can be done with the patient under General Anesthesia.

INTERSCALENE BLOCK OF THE BRACHIAL PLEXUS.
This block is used for procedures on the arm and shoulder. An injection is given into a space around a group of nerves on the side of the patient's neck. These nerves supply feeling to the shoulder and arm. This block can be done with the patient sedated prior to surgery or after General Anesthesia.

SCIATIC NERVE BLOCK.
Any procedure on the lower extremity when combined with the lumbar plexus or femoral nerve block. Any surgery on the leg bellow the knee when combined with the saphenous nerve block. Any surgery on the ankle and foot as a sole anesthetic.

FEMORAL NERVE BLOCK.
Common indications for use of femoral nerve block for surgery include knee arthroscopy, patella tendon repair, ORIF of patella fracture, long saphenous vein stripping, muscle biopsy, skin grafting from the anterior aspect of the thigh, or as a supplement to sciatic or popliteal nerve block

POPLITEAL BLOCK.
Popliteal nerve block can be used as a sole anesthetic (or in combination with femoral or sciatic block) for any operations below the knee.

Local anesthesia
Local anesthesia refers to temporarily numbing a small area by injecting local anesthetic into the skin so that minor procedures like stitching cuts can be done painlessly. Anyone who undergoes a painful procedure may be a candidate for local anesthesia. This type of anesthesia is usually used for minor procedures.

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