What is it - a modern anesthesia? Five whales of
What problems are solved by the anesthesiologist, “giving an anesthesia“? On the first place - an analgeziya, anesthesia . Pain - the main thing frightened in surgery and the main real danger.
On the second - protection of mentality by switching off of consciousness - “dream“ . The patient should not be present at own operation.
On the third - relaxation of skeletal muscles - a muscular relaxation . If muscles are strained or even just are in a condition of a normal tone, performance of operation is very complicated, if at all perhaps.
Once long ago all these objectives were achieved by use of one substance: nitrous oxides, ethyl air, chloroform... So-called monoanaesthesia .
However enough the contradiction came to light soon: at achievement of depth of an anesthesia sufficient for safe carrying out operation, troubles began. Violations of breath, heart rhythm, differences of arterial pressure and a lot more other side effects nullified protective function of an anesthesia and became a source of complications and even a cause of death.
The anesthesia from the defender turned into an aggressor, into an artful and dangerous aggressor.
Here from those, already far times roots of modern fears grow.
Besides, the inhalation monoanaesthesia did not allow to work safely in a thorax. And that is why.
Lungs are filled and emptied not in itself. The internal surface of each half of a thorax is covered by a special cover - the pleura passing below to a diaphragm dome - the main respiratory muscle, and an external surface of a lung. The closed cavity turns out hermetically. During the lowering of a diaphragm and expansion (at the expense of pectoral muscles) a thorax in a pleural cavity there is negative pressure. The lung as if sticks to a pleura and extends. Now there is negative pressure in the easiest and there through a trachea air directs - there is a breath.
At an exhalation everything occurs upside-down.
And so if tightness of a pleural cavity is broken (and it is inevitable in any attempt of surgical access to a lung) this mechanism of breath breaks. There is a terrible complication - pheumothorax at which the lung is fallen down - in accuracy as the punctured tire, - and ceases to participate in breath. Pheumothorax - the state, life-threatening, and bilateral pheumothorax - is unconditional, is deadly.
Heart and bodies of a sredosteniye are out of pleural cavities, but the risk is very big during operation to wound the most delicate pleura and... Chopin`s march.
All right only it! I already mentioned that for successful work of the surgeon skeletal muscles have to be relaxed, so it that auxiliary respiratory muscles - a thorax and an abdominal tension relax.
And if at the same time the movements of a diaphragm are limited? Let`s tell, the diaphragm is propped up by the inflated guts or a pregnant uterus, or just fat paunch?
At few - malsk a deep anesthesia the patient will die of respiratory insufficiency. Will die of an anesthesia. Also died... in times provolochno - gauze masks.
From the anesthesiologist (then also the specialty such was not, nurses or surgeons, free from operations gave an anesthesia) great art was required: to balance on a knife edge between depth of an anesthesia, necessary for operation, and ability of the patient to provide itself with oxygen.
Well, and to any art there is a limit...
The doctor the witness, I did not want to get into history! But how differently to show greatness of the fourth whale on which the modern anesthesia keeps: artificial ventilation of lungs (AVL) ?
IVL solves a set of problems at once. Their transfer would take too much place, but the most important - the medicine had an opportunity directly and directly to operate one of the major vital signs! And all body - and any “prohibited zones“ became available to surgeons! The strong organism or weak, is pheumothorax or not - breath is provided.
It would seem, what is simpler: thrust a tube into a trachea and pump air there. In total and del - that! All appeared not so simply.
To you sometime the crumb “not into that throat“ got? And you quietly sat, continuing a small talk... And if not a crumb, but a rubber pipe thickness about a finger?
And here the deep anesthesia from the enemy becomes the ally. It suppresses protective reflexes, and the organism quietly suffers a foreign matter in a trachea, resignedly allowing to provide itself with oxygen and to relieve of carbon dioxide (that though less, but too is vital).
Endo - inside. The trachea - does not need the translation.
The Endotrakhealny anesthesia opened unlimited opportunities for surgery and (I do not undertake to tell in what set of times) reduced risk of the general anesthesia.
With acceptance of an endotrakhealny anesthesia the new medical specialty - anesthesiology was born in daily, routine clinical practice .
All this is good and fine, but... French say that but can drive all Paris into one .
Deep radio, and it is more of that, the chloroformic anesthesia is oh not a gift for an organism!
By then when “the second level of the third stage of an anesthesia“ is reached (interestingly who else remembers this classification now?) allowing an intubation of a trachea and carrying out serious surgical interventions - regulatory systems of an organism are already strongly disorganized.
The rhythm of warm reductions is broken, it is almost uncontrollable the arterial pressure (or, on the contrary, climbs under clouds somewhere) decreases, bronchial tubes spazmirutsya unexpectedly, clogged with slime, the nervous system creates it... Stories about how the patient “behind a mask of“ terribly uses foul language and as he of kittens, scatters hefty hospital attendants...
All this was, was... Generally, before the patient reached demanded for an intubation (a tube zasovyvaniye in a trachea) anesthesia depths, he freely could become the client of the pathologist. And it is necessary to us?
The solution came from a jungle of Amazonia.
When studied action of a terrible curare - poison with which Indians greased tips of arrows, understood that this awful tool of murder can become the savior of millions of lives. And it became that.
It turned out that the terrible curare will paralyze skeletal muscles. Its bulky molecule puts in a synoptic crack ( a synapse - some kind of contact device for transfer of nervous impulses with one cage on another) between a nerve and a skeletal muscle and interrupts a stream of impulses from nervous system, the managing director of a muscle, and that will be paralyzed, relaxes.
If such disgrace the arrow smeared with a curare - the victim makes in the jungle curtains. Even the most slight wound will lead to death from paralysis of respiratory muscles and respiratory standstill. (And on smooth muscles of bodies of a curare does not affect a cardiac muscle in any way.)
But if struck with the poisoned arrow to carry out an artificial respiration, curare molecules gradually leave a synoptic crack and the muscle work is completely restored.
The solution of action of a curare opened truly a new era in medicine.
Everything was ready to its arrival: means of shutdown of consciousness and painful sensitivity, tools and a method of an intubation (introductions of a tube are not so - that simply) tracheas, devices for an artificial respiration.
With the advent of a curare need long and painfully to lull the patient with a radio mask disappeared, trying to obtain a deep anesthesia with all its troubles.
Was to achieve simple shutdown of consciousness enough, to give a curare intravenously, against the fullest relaxation of muscles to enter a tube into a trachea, to adjust the operated ventilation of lungs and... And to provide to the surgeon to work in ideal conditions.
So, the fifth whale of modern anesthesiology - a muscular relaxation emerged .
There was it in 1942. This year can be considered as date of birth of modern of the multicomponent balanced endotrakhealny anesthesia.
To what the newborn in almost seventy years - in the following articles grew.