What is it - a modern anesthesia? “The doctor, and it is possible under local?“
Very much even often not only are possible, but also it is necessary. And it is even insistently desirable. Sometimes to the surgeon happens conveniently when the patient remains in full consciousness or, so to say, slightly pribaldevsh, but not so not to cooperate with the doctor at all and to lose ability to breathe normally. A set of operations and procedures do not demand full relaxation of muscles and the operated breath at all.
Tell on favor: if it is necessary to set a dislocated ankle or to open a felon - for what devil to disconnect brains? At simple interventions there is no sense to create conditions, potentially life-threatening, and then by heroic efforts to keep this life.
Any two-edged sword.
The anesthesia protects an organism, but it strongly discomposes it. When internal reserves are small (the old men weakened chronic patients, etc.) it is very hard to restore this lost balance, and sometimes and it is impossible. Here various types of partial anesthesia are also applied to such situations.
I will not give difficult professional classification of methods here. It is necessary to you? Let`s divide all this immensity into three parts:
1. Local anesthesia.
2. Conduction anesthesia.
3. Regional, or, beautifully speaking on - scientific, neuroaxial ( neuro ... it is clear, and aksis - an axis).
We will go one after another.
As appears from the name, is a method at which the anesthetizing substance (local anesthetic ) acts with on very limited site - where the section or other painful influence is made.
Anesthetic or impregnates tissues (infiltration), or is just put to the right place (application).
In skillful hands local anesthesia can work wonders. - turns harmless intervention in torture into inept, sometimes creating real threat for life.
Once local anesthesia was applied unfairly widely. It did a lot of harm. (A separate sensitive issue, on it we will not get stuck.)
At local anesthesia the patient usually feels the first prick, and then pain is replaced with feeling of a raspiraniye, tension - it is easily transferred. Through short time - there is peculiar “something do“, but is not sick.
At small operations on soft fabrics, like removal of small tumors, processing of the wounds which are not getting into cavities, during removal of superficially located foreign matters - the word, in “small surgery“ - local anesthesia is in every respect good, safe and quite effective.
It is absolutely inapplicable only in cases of a panic spirit of the patient, at an allergy to local anesthetic (the most allergenic - novocaine), least - lidocaine. But novocaine it is possible to pump up “though a bucket“, and or markainy it is necessary to be careful with lidocaine.
Local anesthesia at children is almost inapplicable. But for them the special counter is thought up: EMLA ointment.
If something painful is necessary to the child: to put a catheter in a vein is most often, smear with Emla, from above - a smart sticker (not to everyone such give!) and in four hours it is possible shpynyat absolutely without serious consequences (without forgetting to eulogize courage and valor of the young hero).
There is no sense in local anesthesia in the inflammation center. There in fabrics kislotno - alkaline balance is displaced in the sour party (fabric acidosis), and molecules of local anesthetics in such conditions do not work.
When needs “to switch off“ a certain site, and the infiltration is inapplicable (these are bone, eyes operations, etc. bodies and parts of a body where you will not pump up local anesthetic), conduction anesthesia is used.
Here it is possible to draw simple and very evident analogy.
The building is lit a set of bulbs in different rooms and recesses. The part of rooms should be darkened.
It is possible to wander about rooms and on one to unscrew bulbs.
It is possible to cut down the main knife switch is an analogy of an anesthesia.
And it is possible to find distributive guards and to accurately cut off power those rooms where it has to be dark at distance.
That`s it it is also done by anesthesiologists and surgeons.
From anatomy it is perfectly known what nerves provide with sensitivity these or those parts of the body and as they go there, in depth. There, at a respectful distance from future operational field, bring very moderate portion of local anesthetic to a nerve.
And everything, the wire is cut off power, a hand - a leg - an eye - an ear - tooth or even “the most delicate“ - is felt nothing. Knife it. Also cut, absolutely without serious consequences.
Conduction anesthesia by all is good, there are no words. But... It not always works. Even if the doctor perfectly knows topografichesy anatomy - it is an indispensable condition - and has a wide experience, this anatomy sometimes gives surprises in the form of any anomalies.
Always there is a chance to miss and not to block the necessary nerve. Or to wound a nerve with a needle, what is much worse. Or to wound a blood vessel... That too not sugar.
Therefore conduction anesthesia is applied not so often as it would be necessary, proceeding from its remarkable advantages.
Situation changed in recent years when began to apply the special equipment .
It is isolated (except the tip) needles and electroneurostimulators. Giving weak electric impulses on a needle, it is possible to define rather precisely the provision of a needle concerning a nerve.
Other innovation - the ultrasonic scanner - “ultrasonography“. (Not the automatic machine, upas, My God!) . On the screen of this device all necessary anatomical structures are visible: vessels, nerves, sheaves... and a needle.
The electroneurostimulation combination to ultrasound provides almost absolute efficiency - on condition of high qualification of the doctor.
An exception make of operation on a carotid . Here it is extremely important to know: the patient in full consciousness or not. It is more reliably than any devices shows whether blood supply of a brain is enough. Fortunately, in this place any anomalies were never seen before, and conduction anesthesia is carried out standardly, easily and simply, without any technical zababakh, and works always.
The same treats conduction anesthesia on a brush and foot . The simple syringe, a usual needle - and a full high at several o`clock.
Now it is clear where is inapplicable conduction anesthesia : at children, at patients with panic mood and in the absence of the listed equipment and the personnel able to use it.
However, at children and timid adults it is possible (and it is necessary!) to carry out the block at the end of operation under anesthetic. Then long there is no pain.
Sometimes in that place where blockade was carried out, leave wafer-thin (0,8 mm) a tubule, and on it then add local anesthetic as required within several days.
Already absolutely painless surgery turns out.
Will be a question of spinal and epiduralny anesthesia.
Around these in every respect remarkable methods of anesthesia it is wound horror stories and other nonsense hardly no more, than around an anesthesia.
I will not spend time for transfer personally to me known, and I will just tell what is it actually.
It is known that sensitivity of all body (except the person) is provided with the nerves going from a spinal cord. Each spinal nerve is formed from merge of two backs transmitting sensitive and motive signals.
The body is quite really divided into segments, according to an innervation (ensuring sensitivity with the corresponding nerve).
It is very simple to understand designations on an illustration: With - cervical department, T - chest, L - lumbar and S - sacral.
It is quite natural to seize such remarkable opportunity for anesthesia.