Anaesthesia in practice

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The word “anaesthesia” comes from the Greek “aisthesis” :

an = without

aisthesis = the ability to perceive the senses.

The field of medicine covering the studies and practice of anaesthesia is called anaesthesiology. It is a recent medical specialisation and has been a most important factor in improvement and progress in quality surgery.

Anaesthesia covers the various techniques used to eliminate the pain caused by instruments during surgery, obstetrics or medical examinations (endoscopy, radiology...). There are two types of anaesthetic: general anaesthetic and local-regional anaesthetic.

General anaesthetic

Tray of medicines for injectable anaesthetics

General anaesthesia is a similar state to sleep and is induced by the intravenous injection of medicines and/or by breathing anaesthetic gases, using the appropriate equipment. The medicine used is usually morphine-based (painkiller), a narcotic (narcosis, artificial sleep) or sometimes a muscle relaxant (curare) according to the type of surgery.

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Loco-regional anaesthetic

A loco-regional anaesthetic interrupts the feeling of pain carried by the nervous system. The injection of a loco-regional anaesthetic in a particular spot, using various different techniques, will numb the part of the body undergoing surgery. A general anaesthetic may become necessary if the loco-regional anaesthetic proves insufficient.

Spinal anaesthesia or epidural are two special types of loco-regional anaesthetic where the anaesthetic is injected close to the spinal cord and its attendant nerves.

An anaesthetic induces a more or less complete loss of autonomy necessitating the presence of the anaesthetist to cover the needs of the patient for breathing, cardiac activity and circulation.

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Disadvantages and risks of a general anaesthetic

Nausea and vomiting after surgery have become less common with new techniques and new medication. Problems with vomiting and choking are now extremely rare, especially if the « nil by mouth » rules are followed carefully.

Intubation



The introduction of a tube in the trachea (intubation) or in the throat (laryngeal mask airway) ensuring respiration during anaesthesia may cause a sore throat or temporary partial voice loss.




Damage to teeth may occur. For this reason it is important to notify the anaesthesia team if you wear any form of dental plate or if your teeth are fragile in any way.

A painful redness may occur where the medication has been injected. This will disappear within a few days.

Prolonged immobility on the operating table may cause compression, particularly of certain nerves, and this may cause a numbing sensation and very occasionally a temporary paralysis in an arm or a leg. In the vast majority of cases this is resolved within a few days or a few weeks.

Slight temporary memory loss or problems of concentration may occur in the hours following the anaesthetic.

Life-threatening unforeseen complications, such as a serious allergic reaction, asphyxiation or cardiac arrest are extremely rare, with only one case of serious complications per hundreds of thousands of anaesthetics.

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The disadvantages and risks of loco-regional anaesthetics

After spinal anaesthesia or epidural, headaches may occur. This may sometimes mean several days' rest and/or an appropriate local treatment.

Temporary paralysis of the bladder may necessitate the fitting of a urinary catheter.

Pain may occur at the puncture point. In a difficult procedure it may be necessary to use a second puncture point. Itching may be caused by the use of morphine or its derivatives. Very occasionally a temporary partial loss of hearing or sight may occur. According to what other medication is used the patient may be slightly confused for a few hours following the anaesthetic.

More serious complications such as convulsions, cardiac arrest, permanent paralysis or extensive loss of feeling are extremely rare. Very few cases occur whereas hundreds of thousands of successful anaesthetics of this type are carried out every year.

During a loco-regional anaesthetic for eye surgery, damage to the eyeball is exceptionally rare.

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