Anesthetics: What can you expect?

Dr. Medha Huilgol, Consultant - Anesthesiology, Columbia Asia HospitalHeadquartered in Kuala Lumpur, Columbia Asia is one of the world’s leading hospital & healthcare chains offering a wide range of healthcare & diagnostic services across Heart Care, General Surgery, Nephrology, Urology, Gynecology, ENT, Endocrinology, Neurology, and many other areas.

Anesthesia is the medicine used to ease the feeling of pain during surgery. Anesthesia affects the nervous system in various ways by obstructing the nerve impulses and, hence the pain gets reduced. It is induced into the human body through injections or inhaled gases and vapors.

Anesthetists form the single largest hospital medical specialty and their skills are used in all aspects of patient care. Hospitals and surgery centers today, have highly trained professionals and use modern medications, with varied safety measures enabled. The types of anesthesia are:

Types of Anesthesia
. General Anesthesia: The primary form of anesthesia which acts on the brain and the central nervous system help the patient fall unconscious or unaware.

. Local Anesthesia: For minor surgeries, local anesthesia is induced. Here the patient remains conscious, and the medicine is just to stop the sense of pain.

. Regional Anesthesia: It involves the injection of the local anesthesia, which is given to a limited part of the body. Main types of regional anesthesia are:

a) Spinal
b) Epidural, and caudal anesthesia
c) Nerve blocks

Whilst the perioperative anesthesia care of the surgical patient is the core of this specialty (and this includes all types of surgery to the most complex in patients of all ages, including the premature newborn), many anesthetists have a much wider scope of practice, which includes:

The Perioperative Preparation of the Patient: The preparation of a perioperative procedure is implemented based on the diagnostic workup and the nature of the expected operation. It is essential to know that 'perioperative' risk is a multifactorial function and the type of anesthetic directed, preoperative medical condition of the patient and the insensitivity of the surgical procedure. The ultimate goal of this is to decrease the patient’s anesthetic and surgical perioperative mortality or morbidity and to bring him to normal functioning as quickly as possible.

The resuscitation and stabilization of the patients in the emergency department, where the anesthesiologist help with the provision of analgesia for many painful conditions, and anaesthesia for minor ambulatory surgery such as suturing of lacerations, incision and drainage of abscesses and manipulation of fractures and dislocations.

Pain Relief in Labor for Obstetric Patients: As the anesthesiologist enables the painless performance of surgical and medical procedures that would otherwise cause severe or intolerable pain to an unanesthetized patient. Anesthesia may be categorized as:

• Systemic Analgesia - parenteral and inhalational agents
• Neuraxial Anesthesia/analgesia – Epidural and spinal analgesia/anesthesia

• Alternative Regional anesthesia – Para cervical block, pudendal nerve blocks perineal infiltration

• Non-pharmacologic Analgesic Techniques – Hydrotherapy, transcutaneous electric nerve stimulation, acupuncture, acupressure, hypnosis touch and massage therapy, therapeutic use of heat and cold

Complications Occurred: The likelihood of a complication occurring is proportional to the relative risk of a variety of factors, including:
• Co-morbid related to the patient's health
• Complexity of the surgery being performed
• The type of anesthesia

Of the three factors mentioned above, the person’s health prior to surgery has the greatest bearing on the probability of a complication occurring

Educating the patient about the surgery, anaesthesia, intraoperative care and postoperative pain treatments helps in reducing anxiety and facilitates fast recovery

• Acute Pain Medicine & Its Management Anesthesiologist manage post-operative pain up to 96 hours using multimodal modalities like epidural analgesia, intrathecal narcotics, peripheral nerve blocks, intravenous and or oral analgesics, patient controlled narcotic analgesics.

• Chronic & Cancer Pain Management
Anesthesiologist play an active role in managing chronic /cancer pain by using WHO step ladder pain management protocol. The perioperative assessment and management of the opioid-tolerant chronic pain in patients are the growing concerns for the anesthesiologist.

• The Endowment of Anesthesia for Patients Outside Operation Room
The provision of sedation and anesthesia for patients undergoing various procedures outside the Operation Room such as endoscopic procedures, interventional radiology, dental surgery and so on. Anesthesiologist provide sedation and anesthesia for procedures outside operating room following the same guidelines as done for procedures in the operating room i.e. pre-anesthesia evaluation, intra procedural monitoring, recovery guidelines, and others.

The minor risk factors of anesthesia include Sore throat, shivering, nausea, vomiting, blurred vision and headache, and the major risks include Paralysis, long term memory loss, cognitive dysfunction, heart attacks and pulmonary embolism.

Some essential parameters to check before anesthesia is administered in a patient’s body:
• Documentation of the condition(s) for which surgery is needed - A physical examination should be done on the information gathered during the medical history. At a minimum, a focused pre-anesthesia physical examination includes a complete mention of vital signs including an assessment of the airway, lungs and heart. Before elective surgery any unexpected abnormal findings should be investigated

• A detailed check of Patient’s medical history - A patient's medical history should include past and current medical history, surgical history, family history and social history i.e. use of tobacco, alcohol and illegal drugs. A history of allergies, current and recent drug therapy, unusual reactions or responses to drugs and/or complications associated with previous anesthetics should be documented.

• A detailed examination of drug history in the patient- A history of use of medications should be obtained in all patients, especially in the geriatric population as they consume more systemic medications than any other group. Numerous drug interactions and complications arise in people above 65 years of age and hence special attention should be paid to them

• Check for cardiac and pulmonary complications - Myocardial infarction, pulmonary edema, ventricular fibrillation, primary cardiac arrest, or complete heart block include major perioperative cardiac complications and should be identified before administering anesthesia.

• Laboratory investigations - Lab tests should be ordered based on information obtained from the history and physical exam, the age of the patient and the complexity of the surgical procedure. It should not be ordered on a routine basis but only when indicated by the patient’s medical status, drug therapy, or the nature of the proposed procedure.

• Increasing patient's comfort level - Educating the patient about the surgery, anaesthesia, intraoperative care and postoperative pain treatments helps in reducing anxiety and facilitates fast recovery