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Why is anesthesia dangerous? Anesthetic agents. Complications of anesthesia

Patients are more afraid of anesthesia than the operation itself, this is a fact. I created this project to dispel fears, doubts and myths about anesthesia. Allow me to introduce myself, my name is Sergey Evgenievich Danilov, I am a practicing doctor of the highest category, an anesthesiologist-resuscitator. On the pages of this site I will tell you about everything related to my profession, and you can ask questions.

So let's start with the basics. Let's understand two concepts: what is anesthesia (it is often called “general anesthesia”) and what is anesthesia (it is mistakenly called “local anesthesia”).

What is anesthesia and why is it “general”?

Anesthesia is a state of drug-induced sleep in which reversible inhibition of the central nervous system occurs; it is achieved through the gradual use of a whole complex of medications.

Often this condition is often called, but there is no point in specifying it, because anesthesia is always general (i.e. the person sleeps). If the person is conscious, then we are talking about anesthesia.

How does it work?

Anesthesia is done in stages, it all starts with. And then anesthesia acts in this way: a person experiences loss of consciousness, loss of sensitivity (pain relief), relaxation of skeletal muscles, in addition to this, respiratory depression occurs, and, in some cases, depression of cardiac activity.

All this happens under the control of an anesthesiologist and a large amount of monitoring equipment. Special devices monitor breathing, heart function, and during long-term operations, also kidney function. In addition, the anesthesiologist is always ready for any “emergency” situations. That is why anesthesia can be carried out ONLY in an operating room and ONLY by an anesthesiologist.

Who invented it?

Who invented anesthesia? On October 16, 1846, William Thomas Greene Morton first demonstrated the effects of ether anesthesia in a clinic in Boston. On this day it is customary to celebrate a professional holiday -

What happens?

The most common answer to this question is “general and local”, but no, friends, as I already wrote, there cannot be local anesthesia. Therefore, I bring to your attention the correct classification of anesthesia (we will not go into too much detail, since the main audience of our project is people without medical education, to whom I want to tell the basics of this branch of medicine).

So, anesthesia can be carried out with one drug - mononarcosis, or a combination of several drugs - combined multicomponent anesthesia.

Also, according to the method of drug administration, we can distinguish:

(Intubation);

What is anesthesia and why is it not the same as anesthesia?

During anesthesia (local anesthesia), no switching off of consciousness and breathing, anesthesia acts on a limited area of the face and body. It can be performed without the participation of an anesthesiologist (except for epidural and spinal).

There are many types of anesthesia, the most common are:

Anesthesia can be performed by a surgeon or dentist without the participation of an anesthesiologist, this is absolutely normal.

Why do people die on the operating table?

You can find a lot of scary stories on the Internet and on TV that frighten even calm, adequate patients. Of course, an operation is stressful, but the situation is even more aggravated when the patient read something on the Internet that during the conversation before the operation I see a frightened person who is almost sure that he will die today.

Why is this happening? Yes, because all these low-quality articles and video reports are prepared by journalists who have nothing to do with medicine. They care about sensation and the scarier the better. And then people tell it to each other, discuss it on a bench, without understanding the essence of the issue. Very often this is presented precisely as “death from anesthesia.”

What's in reality? Yes, death on the operating table, alas, does happen, BUT! Die specifically from anesthesia At the current level of development of medicine it is almost impossible! Death may occur due to the severity of the disease itself, because The patient's initial condition was extremely severe.

Anesthesia itself does not pose a great danger; rather, on the contrary, it is anesthesia that allows surgical intervention to be carried out as safely as possible. It allows the patient not to feel pain or stress, and gives the surgeon the opportunity to calmly and efficiently carry out the necessary manipulations. I wrote more about mortality during anesthesia in my other article.

But what about - you ask? Yes, the medical literature describes cases of the development of rapid allergic reactions to certain anesthesia/anesthesia drugs with a fatal outcome, but the frequency of such cases is negligible.

The anesthesiologist is prepared even for such cases, and if the allergy is known in advance, then appropriate preparation will be carried out.

During the conversation with the anesthesiologist, be sure to tell about all possible allergic reactions and diseases that you suffered even in childhood. Don't hide anything!

Every patient must understand that any intervention, even vaccination, is always small, but there is a risk. And, for example, anesthesia is a complex of complex medical procedures, but the anesthesiologist is ready to carry it out competently even in the presence of any concomitant diseases that complicate his work.

Is anesthesia harmful to humans?

I am also asked this question very often, they tell me scary stories about memory loss, hallucinations and even hair loss... Anesthesia itself now does not cause any harm to the body. Yes, the drugs we use in our work are deadly, but in skillful hands they do not have a significant effect on the body, anesthesia can be repeated as many times as necessary.

It is better to think about what harm the disease for which you need to perform manipulation will cause you. There is no need to be afraid of anesthesia.

Hallucinations are also very rare today. Glitches and the well-known “light at the end of the tunnel” are more of a fiction. Most patients say that they simply slept, felt light, and some dreamed.

After all, we, anesthesiologists, have a very difficult task - we observe the patient before, during and certainly after the operation. If suddenly after the operation we see that a person’s vital functions have not sufficiently recovered, then we transfer him to the intensive care unit and monitor him there until he fully recovers.

People are always afraid of situations in which they cannot control themselves. And perhaps anesthesia is one of the most common phobias. What do we know about anesthesia and why do we doubt whether general anesthesia is harmful to the human body or not? Let's try to understand.

Narcosis: what is it?

Anesthesia, or general anesthesia, is an artificially induced but reversible state of the body in which pain sensitivity disappears, reflexes are dulled, muscles relax, and the patient falls asleep.
During the operation he does not feel anything, and when he comes out of anesthesia, he does not remember what happened to him in the operating room.
Unlike local anesthesia (when a specific area of the body is numbed and numbed), general anesthesia completely turns off a person’s consciousness. However, it is resorted to only in extreme cases.
General anesthesia is given either by intravenous injection or using an inhalation mask.

Does anesthesia really take years off your life?

In fact, no one has yet proven that anesthesia reduces life expectancy, although there are rumors that each general anesthesia takes from 2 to 5 years. Perhaps they have roots in the past, when morphine was used for anesthesia. However, modern anesthesiology uses a combination of drugs that are completely safe with the correct dosage and calculates the rate of anesthesia based on the individual characteristics of the patient (weight, contraindications, etc.).

Negative effects of anesthesia on the human body

But how is anesthesia harmful to the human body and why is it so feared? Fears about what can be seen during anesthesia in the “other world” are unfounded. Anesthesia and clinical death are completely different conditions! Some patients are afraid of waking up during surgery or not waking up after. But this is always monitored by an anesthesiologist or a whole team of specialists. They will not allow early awakening (they won’t wake you up on purpose), and after the operation they will properly wake up the patient.

Anesthesia and children: is it possible?

When wondering whether anesthesia is harmful for a child, first of all you should think about whether a condition that requires surgical intervention is harmful to the body, and is it worth exposing the child to the agony of “live cutting”? There is no scientific basis to believe that a child’s body cannot cope with anesthesia, and age under 3 years is not a contraindication to its use.

Anesthesia is needed - everything is clear, entry is free, but exit is paid!

Since the central nervous system is inhibited during anesthesia, many patients experience short-term (very rarely long-term) memory loss, decreased mental acuity, dizziness and nausea. Usually a person recovers within 24 hours. American studies have found that the immune system suffers from anesthesia. After all, during anesthesia, the nerves do not “sleep”, but feel pain, and the stress hormone is released into the blood. And this can provoke a weakening of the body’s defenses. At the same time, there is an opinion that in cancer patients, anesthesia provokes the division of tumor cells. That is why there are absolute contraindications to general anesthesia:

Hormone-dependent diseases;

Heart rhythm disturbances;

Alcohol and drug intoxication;

Pathologies of internal organs;

Myocardial infarction within six months before anesthesia.

Anesthesia is a fainting state that is induced artificially with special drugs. It is used to block pain during surgery and painful procedures. Due to the unusual effects, the question: “how does anesthesia affect the human body” was and remains relevant.

Types of anesthesia

According to the degree of influence, the principle of administration and impact, two types of anesthesia are distinguished:

General anesthesia, also called anesthesia. It is used to relieve pain, relax muscles, and ensure human immobility during operations. It is carried out in two ways - through a vein, into which a gaseous anesthetic is supplied. The depth of unconsciousness directly depends on the amount of anesthetic administered. If a major operation is planned, the anesthesiologist increases the amount of the substance through an IV or mask;
Local anesthesia. This is the injection of an anesthetic where manipulations will be performed. For example, if a person breaks his finger, the doctor injects the substance there. The area injected with the drug becomes numb, the patient weakly feels the touch, and remains completely conscious.

The dangers of anesthesia

People often worry about waking up during surgery. Unfortunately, such a possibility exists. Anesthetics work and keep a person’s consciousness under control in 99% of cases, but there is always 1% left when something can go wrong.

This is due to individual characteristics, which can have a unique effect on the effect. During the operation, the patient’s condition is monitored - heart rate, blood pressure, breathing - down to the smallest detail, so if the doctor senses something wrong, he will have time to take action.

Is there a risk of dying from anesthesia? Alas, yes, but with the development of technology and changes in the composition of the anesthetic substance, it decreased by 6 times. The risk of death from it is several times lower than dying in a car accident. Youth and the absence of chronic diseases reduce the possibility of dying several times more.

How can anesthesia affect a child?

The experience of anesthesia affects, first of all, the functioning of the brain:

Speed of thinking;
Memory impairment;
Decreased concentration levels;
Hyperactivity;
Desires and abilities to learn.

The risk of destruction of neural connections and brain cells in a child is associated with the fact that at a young age he is just developing.

Scientists suggest that anesthesia given before two years of age can seriously affect the development of the baby. The study is still open, so a safe, time frame for the child, during which his mental abilities will not be affected by anesthesia, has not yet been established.

The dangers of memory anesthesia?

The first thing that general anesthesia affects is the brain. The most terrible consequence is asthenic syndrome, characterized by disorders of the central nervous system.

The manifestation of asthenic syndrome should be divided into two categories - primary symptoms, secondary (weakly expressed)

The primary ones include:

Sleep disorder – insomnia or restless sleep;
Decreased performance. Many people complain of fatigue;
Apathy, mood swings.

Secondary:

A person becomes distracted, it is difficult for him to concentrate on one thing;
Poor memory is the result of poor concentration;
Deterioration in learning ability.

The syndrome makes itself felt in the first three months from the date the anesthetic enters the body. So far, there are only theories regarding the cause of the syndrome:

Painkillers lower blood pressure. A short-term critical condition provokes a micro-stroke, which may be almost unnoticeable;
An imbalance between neurotransmitters and molecules in the brain causes nerve cells to die;
The collision of the immune system and inflammation. This phenomenon is observed when the patient refuses antispasmodics during the postoperative period.

What increases the risk of developing asthenic syndrome:

Age – children, elderly;
Presence of chronic diseases;
Poorly developed intellectual abilities;
Prolonged presence of painkillers in the body;
Large dose of anesthetic;
Serious postoperative injury.

How does anesthesia affect the body, namely the heart? For example, if a person already suffers from serious pathologies - atrial fibrillation, coronary artery disease, cardiac asthma, tachycardia.

The doctor will send you for a full diagnosis, based on the results of which he will assign a risk score for surgical intervention, and will also determine which type of painkiller is right for you.

The effect of anesthesia on the heart is a purely individual matter. Some feel fine and recover quickly, others fall victim to asthenic syndrome.

If you have a constricting feeling in your chest, colitis, pain, burning, rapid heartbeat, or slow heartbeat, you should immediately talk to your doctor.

The effect of anesthesia on a woman’s body?

The female body is unique and can be in a variety of states - puberty, menstrual cycle, pregnancy. Therefore, it is easiest to judge the consequences based on the state of the body at the time of the operation.

If you are in a position, anesthesia is not at all advisable. Any type of painkiller is toxic; it can negatively affect the health of the child and the expectant mother.

It is not recommended to use anesthesia in the first and second trimester; the most dangerous period is from the 2nd to the 10th week, when the baby’s vital organs are still developing. The ingress of an anesthetic substance slows down the process of development and nutrition, which can lead to external/internal anomalies.

The middle of the third trimester is also not a good time for anesthesia. During this period, the placenta and uterus are compressed even more, the peritoneal organs are in a tense state, the anesthetic substance can provoke a miscarriage, premature birth, and cause bleeding. Also, don’t forget about, you can read on our portal.

Caesarean section with anesthesia gives consequences in the form of symptoms:

Headache attacks;
Dizziness;
Nausea;
Muscle spasms;
Poor concentration and clouding of consciousness;
Back muscle spasms.

A woman outside of these conditions with an established menstrual cycle may experience disruption. It is caused by:

Overvoltage. Any anesthetic substance is a burden on the human body, and women are no exception, the whole process slows down, all efforts go towards stabilizing the functioning of the organs;
Changing your diet. Some types of surgical interventions require a therapeutic diet, which affects the number and frequency of menstruation;
Surgery on the pelvic organs. Any gynecological operation temporarily disrupts the functioning of the genital organs; you need to wait until they recover again;
Infection. The operation is associated with risks, including infection. This can happen not only during surgery, but also after, when the body is weakened.

How can anesthesia affect the body?

General anesthesia greatly affects the entire organ system, so the risk of complications cannot be completely excluded.

How anesthesia can negatively affect the body:

Choking, swelling of the respiratory tract;
Vomiting. In pregnant women, the gag reflex may begin during surgery, and there is a risk of dying from vomit entering the respiratory tract;
Arrhythmia;
Brain swelling;
Diseases of the respiratory system, breathing disorders;
Inflammation;
Kidney failure;
Deterioration of cerebral circulation;
Asthenic syndrome.

Video: what is anesthesia (shock)

Any surgical intervention is impossible to imagine without the use of anesthesia. allow any operation to be performed, but it is impossible to predict how anesthesia will affect the body. The danger is that negative consequences may appear some time after the use of anesthesia.

What is general anesthesia

General anesthesia is anesthesia and the introduction of the patient into an unconscious position and subsequent removal from it. Used to block impulses from pain receptors during any surgical procedures.

It is possible to achieve a complete shutdown of the patient’s consciousness by using special anesthetic agents selected in a certain dosage.

History of anesthesia use

The first to use anesthesia was Avicenna. He had an interesting method: he cooled the limbs until sensitivity was lost. Ambroise Pare caused loss of sensitivity by pinching nerves and blood vessels. In Ancient Egypt, they used special sleepy tubes soaked in herbs with narcotic effects.

True anesthesia began to be used only at the end of the 19th century. The first drug was Cocaine Hydrochloride, but given its high toxicity and high number of deaths, it was quickly abandoned.

During the war years, they even used ethyl alcohol to bring a person to extreme intoxication, when sensitivity was dulled as much as possible.

Requirements for anesthetic agents

Drugs used in surgical practice for anesthesia must meet certain requirements:

Purpose of using anesthesia

Before finding out why anesthesia is dangerous, it is important to understand what goals are pursued by the use of drugs to put a person to sleep, and they are as follows:

Carry out surgical intervention in a high-quality manner and in full.
Avoid discomfort and stress for the patient’s body during surgical procedures.
Monitor the patient’s condition as much as possible during treatment and after completion of therapy.
Eliminate the risk of developing mental disorders.

Impact on the body

After administration, the anesthetic affects the body in several stages:

Gradual loss of sensation and loss of consciousness.
The stage of excitement, but it is not typical for all drugs.
Complete loss of consciousness and loss of all types of sensitivity.
Awakening with the return of pain and consciousness.

You can also distinguish the stages of anesthesia:

Superficial anesthesia.
Easy.
Deep.
Super deep.
Agonal stage.

Types of anesthesia

To answer the question of why anesthesia is dangerous, it is necessary to understand its types. Depending on the route of penetration of the anesthetic into the human body, the following are distinguished:

Comparison of epidural and spinal anesthesia

There is a difference between these two types of anesthesia and it is necessary to know it. If spinal anesthesia is used, the agent is injected through the spinal cord and arachnoid membrane; with epidural anesthesia, the anesthetic is injected over the dura mater of the brain.

Some other differences can be mentioned:

The doctor decides which type of anesthesia to choose in each specific case, taking into account the severity and volume of the upcoming surgical intervention.

The dangers of anesthesia

The use of modern means allows us to guarantee pain relief in 100% of cases. During surgery, the anesthesiologist is nearby and monitors the patient's condition on the monitors of medical devices.

Many patients ask doctors the question: why is anesthesia dangerous and can you die from it? It is impossible to predict the body's reaction to the drug, so an anesthesiologist talks with each patient before surgery. Modern technologies have made it possible to significantly reduce the risk of death, but complications of general anesthesia cannot be completely prevented.

After anesthesia, how long it takes to recover from anesthesia depends on the type of drug used, most often patients complain of:

Nausea.
Unpleasant and painful sensations in the throat.
Convulsive syndrome.
Loss of orientation.
Headache.
Pain in the lumbar region after spinal anesthesia.
Muscle aches.
Lack of clarity of consciousness.

Such symptoms, as a rule, disappear a day after the operation, but some complications of anesthesia can be identified that accompany a person for a long time:

Attacks of fear.
Memory problems.
Heart rhythm disturbance.
Increased heart rate.
Increased blood pressure.
Disorders of the liver and kidneys.

With the increasing level of development of medicine, the mortality rate after using anesthesia has decreased to 1%.

How does anesthesia affect the body?

For each patient, the type of anesthesia is selected individually, but how anesthesia affects the human body depends on its individual characteristics. In adult patients, the consequences may be as follows:

Sleep disturbance.
Speech problems.
Migraine.
Hallucinations.
Cerebrovascular accident.
Development of renal failure.
Brain swelling.
Suffocation.
Fatigue quickly.
Decreased performance.
Decreased concentration.
Development of asthenic syndrome.

The severity of complications of anesthesia depends not only on the characteristics of the body, but also on the presence of concomitant diseases, the type of anesthesia and the drug used for this.

Types of anesthesia in pediatric practice

There are situations when it is simply impossible to do without the use of anesthesia during medical manipulations on a child’s body. If drugs have a negative effect on an adult, then what can be said about a child in whom all systems are being formed.

In children's practice they use:

Inhalation anesthesia.
Intravenous or intramuscular. It is rarely used, since the doctor does not have the ability to control the duration of the anesthesia. It has been proven that the drug Ketamine, which is most often used for these purposes, is unsafe for children.

The most commonly used method is hardware-mask anesthesia. If the operation is long, then inhalation anesthesia is combined with intravenous anesthesia. The following groups of drugs are used:

Analgesics, but not narcotics.
Muscle relaxants.
Sleeping pills.
Infusion solutions.

Before choosing the type of anesthesia for a child, the doctor must talk with the parents and find out:

There are no absolute prohibitions on the use of anesthesia, but there are relative contraindications to anesthesia in children:

The presence of a chronic disease in the acute stage, which can negatively affect the condition of the body.
Structural anomalies, for example, hypertrophy of the thymus gland.
Diseases that cause breathing difficulties.
Inhalation anesthesia is contraindicated if there is a deviated nasal septum, enlarged adenoids, or chronic rhinitis.
Allergy to anesthesia drugs.
After suffering an infectious disease, it is necessary to postpone surgery until the body has fully recovered.

After anesthesia, the child should be monitored with special care so as not to miss the development of complications.

Main groups of drugs used for anesthesia

Among the inhaled drugs used during surgery are:

"Sevoran".
"Propofol", the instructions will be discussed further.
"Ftorotan".
"Nitrous oxide."
"Ether".

These funds have the following effect:

Skeletal muscles relax.
Pain sensitivity disappears.
Losing consciousness for some time.
Loss of reflexes.

Among the intravenous drugs used in medical practice:

"Thiopental sodium." Instructions for use contain detailed information.
"Hexenal."
"Seduxen".
"Ketamine."
"Fentanyl."

Intravenous administration of the drug causes a rapid effect; one dose allows you to switch off a person for 20 minutes.

In a medical institution, all anesthesia drugs are subject to strict reporting and are stored in a special room in a safe. A log of their consumption must be kept.

Let's look at the characteristics of the most commonly used tools.

"Ether"

The use of "Ether" is quite common because the drug has many advantages:

Gives a strong effect.
Relatively safe.
No special equipment is required for use; just the drug and a gauze pad are enough.

It is necessary to note the disadvantages of the product:

Falling asleep occurs slowly.
After inhaling Ether, increased motor activity is noted in the first 15-20 minutes.
The patient slowly comes out of anesthesia.

"Ether" for anesthesia has side effects:

The vapors of the drug irritate the mucous membranes, which leads to coughing and vomiting.
Pneumonia often develops after surgery.

"Nitrogen Oxide"

The drug also applies to gaseous agents. Medical Nitrous Oxide has minimal toxicity and virtually no side effects. But among the disadvantages, it should be noted that there is little activity, so the drug is combined with other drugs.

"Sodium thiopental"

The drug is a powder with a subtle smell of sulfur. After intravenous administration, it begins to act within a minute. The effect lasts for 20-30 minutes. Given the route of administration, the doctor has no ability to influence the nature of the drug’s effects.

The product has its disadvantages:

Small range of therapeutic effects.
Considered a weak analgesic.
The drug depresses breathing.
Weakly relaxes muscles.
Possible laryngospasm.
After administration of the drug, muscles may twitch.

"Sodium thiopental" instructions for use recommend administering it slowly, as depression of the respiratory and vasomotor centers, as well as respiratory arrest, is possible.

"Propofol"

This drug is a short-acting drug; the duration of such anesthesia is only 15 minutes. The instructions include the following advantages of Propofol:

Rapid onset of effect.
The patient quickly recovers from anesthesia.

But we must also take into account the disadvantages of the product:

The drug has low analgesic activity, so it is often combined with other drugs.
Possible decrease in blood pressure.
There is a risk of temporary respiratory arrest.
After recovering from anesthesia, the patient experiences nausea, headache, and possibly vomiting.
Thrombosis or phlebitis may develop.

Do not use the product for heart failure, serious pathologies of the liver and kidneys.

"Sevoran"

The drug is a colorless, odorless liquid. In anesthesiological practice, the drug is most often used for induction of anesthesia, as well as during surgical interventions that do not require much time.

Sevoran is widely used in pediatric anesthesiology due to its many advantages:

Does not irritate the respiratory tract.
Does not affect hemodynamics.
It is poorly soluble in the blood, so it is excreted from the body almost unchanged.
The patient quickly falls into sleep and just as quickly comes out of it, as soon as the drug is stopped.
You can regulate the flow and save product consumption.
The anesthesiologist can control the depth of anesthesia.
The patient easily recovers from anesthesia with minimal negative symptoms.

Anesthesia with Sevoran does not always cause consequences, but among them it is possible:

Increased sleepiness.
Apathy towards everything.
Dizziness.
Increased agitation upon recovery from anesthesia.
A sharp decrease in blood pressure.
Depression of the respiratory center.
Nausea and vomiting.
Itching of the skin.

The manifestation of negative consequences after anesthesia cannot be predicted. Everything depends not only on the skill of the anesthesiologist and the type of anesthesia and drug used, but also on the characteristics of the body and associated chronic pathologies. Therefore, it is impossible to answer unequivocally why anesthesia using a particular drug is dangerous.

Each body is individual, so the process of recovery from anesthesia is different for everyone. The duration of this period is influenced by the following facts:

General health of the patient.
Depth of anesthesia.
Difficulty of surgery.

If the operation was not complicated, the doctor is highly qualified, then recovery from anesthesia takes about 6 hours. For surgery that lasted more than 3 hours, adaptation after anesthesia may take about three days.

Contraindications to anesthesia

General anesthesia should not be used if patients have the following conditions and pathologies:

Serious heart disease.
Infectious pathologies in the acute stage.
Bronchial asthma.
Vital functions are depressed.
There is an allergy to anesthesia.
The patient is taking drugs.
There is a mental disorder.
Immediately after vaccination.
There are deviations in the hormonal system.

Many patients may have such pathologies, so the choice of anesthesia is made on an individual basis.

In order to endure anesthesia as easily as possible and recover from it without serious consequences, you must adhere to the following recommendations:

You can only obtain accurate and comprehensive information about the effects of anesthesia on the body and the rules for recovery from it from a specialist who will give recommendations taking into account the individual characteristics of the body.
Before an operation using anesthesia, it is better to switch to a diet with light meals a couple of days.
After recovering from anesthesia, drink plenty of fluids to remove the drug as quickly as possible.
A month before surgery, stop drinking alcohol and smoking.
Stop therapy using drugs that relieve muscle spasms.
After anesthesia, if you experience tremors in your limbs, you can cover yourself with a warm blanket or blanket.
To eliminate headaches, use analgesics.

Modern drugs for anesthesia make it possible to carry out the most large-scale operations on human internal organs. The highly qualified doctor and careful selection of the type of anesthesia and means will allow the patient to quickly recover from this state with minimal consequences.

How not to die from anesthesia? Is lidocaine really dangerous? How do modern anesthetics work? Is it true that substances similar to curare poison are used for pain relief?

The whole truth about AiF anesthesia was told by the head of the department of anesthesiology and intensive care of the City Clinical Hospital No. 1 named after. N. I. Pirogova Vladislav Krasnov.

Yulia Borta, AiF: Recently, there have been cases when people die during surgery from anesthesia in beauty salons and dental clinics. In Saransk, a six-year-old child died during the removal of adenoids, and in Omsk another died during dental treatment. Last year, the choreographer of the Mariinsky Theater died, again in the dentist's chair. Is anesthesia so dangerous?

Vladislav Krasnov: I assure you: anesthesia always increases the safety of the operation and the patient’s chances of survival if the decision is made to undergo surgery. We have the following motto: “When I manage, I protect.” Security consists of several components. The first is the elimination of all kinds of stress, including pain, fear, and discomfort. The second is to ensure comfortable work for the surgeon. Then the doctor will perform the operation as efficiently as possible and in the shortest possible time. And all this must be done in such a way as to preserve the patient’s vital functions: breathing, heartbeat, blood pressure, kidney excretory function, etc. Paradoxically, the anesthesiologist, while ensuring the safety of the operation, uses extremely dangerous means. Undoubtedly, all our drugs are actually poisons that can kill the patient if used incorrectly. But once the patient has come to the decision to undergo surgery, it means that all the risks have been assessed: surgery, abstinence from it and anesthesia.

— How then to explain the cases when people die from anesthesia, in particular, lidocaine? Suddenly the heart stops, the person falls into a coma and dies.

— Any medical procedure may not always proceed smoothly. Possible complications are described in the annotation for each medication and most medical products. The task of medical personnel is to know the likely side effects and be prepared to eliminate them and provide emergency care. The problem is not that the drugs cause side effects. The problem of mortality is that sometimes healthcare institutions (often commercial) are not ready to provide emergency care: they do not have appropriate resuscitation equipment or trained personnel. There is another point. You understand: hundreds, millions, and maybe billions of surgical interventions are performed annually with lidocaine anesthesia. And the statistics of complications are negligible. However, this routine use of the drug in an atmosphere of safety sometimes “dulls the vigilance” of the doctor. Imagine: a person has performed 10 million anesthesia with lidocaine and is accustomed to the fact that everything is going well. And for the first time in many, many years, his patient developed a complication. It is known to everyone, described in the literature. But the doctor is accustomed to the fact that this cannot be, and is not ready to eliminate the complication. The main cause of death is not the effect of the drug, but the inaction or incorrect action of the one who administers it.

— Can this complication be foreseen in advance? Let's say how with allergies there are allergy tests. Is it possible to carry out anesthetic tests by analogy to avoid anaphylactic shock?

— The horror of an allergic (and more often anaphylactic) reaction to anesthesia is that it is extremely difficult to predict it. Often these reactions develop when the body first encounters an allergen. Skin testing is not always safe because the occurrence and severity of an anaphylactic reaction does not depend on the dose of the allergen. Carrying out such allergy tests in itself is dangerous and will never protect anyone.

Unfortunately, every year patients die on operating tables due to anesthesia. In the USA this is 2.2 deaths per 1 million procedures, in Europe - 7. However, here the question arises: what is death specifically from anesthesia, and what is from other causes? Mark Twain He said beautifully: “Numbers are good when you do them yourself.”

Let me give you an example. We use muscle relaxants. As a child, everyone read books about Indians who spat arrows dipped in the legendary poison curare. So, formally, the drug has not undergone much change. It is still a curare-like drug, which in the absence of artificial ventilation leads to the death of the patient. The question is not that it is poison, but its rational use. You cannot predict all reactions. You need to know the effect of the drug, be prepared for possible complications, and inform the patient about them so that he can make an informed decision about surgery and anesthesia. Here's the guarantee.

- So what should patients do then to avoid falling into these sad statistics?

- It's very simple. The first thing the patient must be sure of is that he needs to perform the manipulation. Secondly, he must be aware of the medical institution, its capabilities, bed capacity, the availability of specialists who are ready to provide emergency care, possible complications, ways to eliminate them and prevent them. By analogy, we can give an example with choosing an airline. You want to fly cheaper. At the same time they tell you: listen, the plane is old, but it generally flies. And you make a choice, taking into account the degree of risk: is it worth saving? It’s the same in medicine. For example, you live in the village of Tsvetochnaya, where there is a first aid station. And the paramedic tells you: “I will remove the mole under local anesthesia, no problem.” Yes, it seems close to home, and the paramedic is familiar. And if you ask questions... Does the paramedic have a defibrillator? Oxygen? Does a paramedic know how to intubate the trachea? After this, you can decide to go to another medical facility where all this is available. Here is the fundamental point.

“I heard that cheap lidocaine is what causes the most complications. Maybe you just need to use other anesthetics?

— Yes, lidocaine is one of the most dangerous local anesthetics today. Local, I emphasize. Lidocaine is already over 100 years old. But it is the cheapest and most accessible. We know this and try to use it much less. Now on the market there is a colossal amount of safer local anesthetics that cause tens of times fewer complications associated with anaphylaxis, neurotoxicity, and cardiotoxicity. Another question is that they are more expensive, the forms of their use are different, they are not always available, or the medical staff does not know about their existence.

You shouldn't be so obsessed with lidocaine. This is a minuscule figure in the overall statistics of mortality due to anesthetic causes. The main problem is different: ensuring the safety of the respiratory tract, proper tracheal intubation, the reliability of anesthesia and respiratory equipment, the effect of inhalational anesthetics. There are surgical techniques that exclude the possibility of spontaneous breathing. To do this, you need to administer the same muscle relaxants that I talked about, then insert an endotracheal tube into the lumen of the trachea and connect it to the anesthesia-respiratory machine. This is not always possible. Today this is also a significant cause of mortality during anesthesia. We are fighting it. There are other reasons.

As for modern drugs, preference is now given to anesthetics that act as short as possible. If earlier we administered drugs that acted for 20-30 minutes, today we work with anesthetics whose half-life is 2 minutes. A special dosing device injects the drug, and as soon as its entry into the body stops, it is eliminated within minutes, the effect of anesthesia stops, and the patient wakes up.

— Your opinion: is it worth treating teeth under general anesthesia (anesthesia)? Or is it better to endure the pain and come out alive?

— Each method has its own application. Of course, in routine dentistry, when it comes to fillings, scaling, cosmetic procedures, etc., general anesthesia is not required. However, regional anesthesia in the form of blockades is justified. Not all patients can tolerate the discomfort associated with the administration of a local anesthetic.

The big question is: are dental clinics ready to provide this service in a safe manner? I can say one thing: the patient should not be in pain under any circumstances, he should not experience stress. Stress gives birth to disease or intensifies it. When the patient is in a state of comfort, he is not afraid of the doctor, trusts him and is ready to cooperate with him. If a person is afraid of pain, he will avoid treatment and delay visiting a doctor until the last minute. And advanced and even incurable cases arise. When people come to our hospital with phlegmon of the floor of the mouth and neck (purulent inflammation in the soft tissues), it often turns out that the cause is a carious tooth. But the patient was afraid to go to the dentist and got to the point where he needed urgent surgery, otherwise he could die. After all, pus corrodes tissue, the infection enters the blood and spreads throughout the body.

— Are any unpleasant effects possible after anesthesia?

- Yes. There are residual effects of medications that are not recognized by staff in a timely manner. Remember, I talked about a drug that has a curare-like effect? If the patient is extubated prematurely, that is, the tube is removed from the trachea and weaned off the respirator, he may die from hypoxia (lack of oxygen and, as a result, depression of consciousness). Because his muscle tone has not yet been restored, he cannot yet breathe on his own. This phenomenon is called recurarization. This is the most dangerous situation after removing the tube from the trachea. To prevent this, in civilized clinics there are so-called “awakening wards”. In them, patients who have been administered curare-like drugs continue to be monitored by an anesthesiologist and nurse anesthetist, ready to provide emergency care. Today there are antidotes that block the action of curare-like drugs. If it is necessary for the patient to wake up faster, such a drug is administered to him. And the effect of the curare-like poison, which we introduced to prevent him from breathing, immediately stops.

— Do you have liver problems after anesthesia?

— Previously, about 25 years ago, we actually used drugs that were, in fact, hepatotropic poisons (fluorotane). And their overdose or regular use did not have the best effect on the liver function of the patient and, even more so, the staff. After all, a patient could undergo surgery once in his entire life, but a specialist anesthesiologist has several of them a day. Today we do not use such medications in routine practice. Modern drugs are so safe that we have stopped protecting the air in the work area. Although we still work today in conditions of ionizing radiation in the operating room. However, we consciously take this risk in order to realize our most important task, for which we all entered the profession: to treat people. Our predecessors tested vaccines against smallpox and plague, and the danger of their work was disproportionately higher than ours.

— They say that the most dangerous anesthesia is spinal, when the spinal cord is blocked.

— Of course, we encounter complications, but extremely rarely. For example, in the First City Hospital, out of 7.5 thousand spinal anesthesia cases per year, only 3 complications occur. This suggests that this technique is extremely safe and routine. We work with very thin needles with a diameter of three hairs, which do not injure the dura mater. Although there are serious complications: epidural hematomas, damage to the spinal cord, nerve root injuries. But this happens extremely rarely. And their occurrence is not always associated with the qualifications of the doctor. I'll explain why. The technique is blind. The doctor roughly knows where to insert the needle. And each patient has his own anatomical features. We, of course, can clarify them by performing, for example, magnetic resonance imaging. But this is an extremely expensive method. If we begin to routinely test all our patients in this way, we will first of all meet with the indignation of our patients. They will rightly be indignant: “Guys, we just want to operate on hemorrhoids, but you forced us into a magnetic resonance imaging scanner?!” Here again, the main thing is to recognize the developed complication in time and do everything to eliminate it.

— Is it true that during anesthesia the patient sees hallucinations, nightmares, or, conversely, light at the end of the tunnel?

— As a person who has been on both sides of the operating curtain many times, being both a patient and a doctor, I can say that terrible visions, like the light at the end of the tunnel or the feeling that the person himself is watching the operation from the side, are essentially imposed from the outside . Yes, many of the drugs that we use are, in fact, potentiators of hallucinations, visions, and vivid dreams. But with modern anesthetics this side effect is minimal. If the patient falls asleep in a calm state (for this purpose, special anxiolytic drugs can be administered to relieve anxiety and fear), then there will definitely be no scary dreams.