Can anesthesia harm the brain? Is local anesthesia better than general anesthesia? The doctor tells the truth...

Expert of this article: Zhang Zhijian, Master of Anesthesiology, Harbin Medical University

This article was reviewed by Zhang Yu, PhD in Anesthesiology, First Affiliated Hospital, Zhejiang University School of Medicine

It is inevitable that people will suffer from illness throughout their lives, and may even undergo major and minor surgeries.

As we all know, before many operations, we have to go through a crucial step - anesthesia.

As for anesthesia, some people are a little scared, worried that anesthesia will have other negative effects on the body. In life, many people have also heard that "anesthesia will make the brain stupid"...

What exactly happens to our bodies when we are under anesthesia? Does it really cause damage to the brain? This article gives you the answers.

What is general anesthesia and local anesthesia?

General anesthesia is the abbreviation of general anesthesia. During general anesthesia, anesthetic drugs enter the human body through different administration methods to act on the central nervous system, that is, our brain. According to the different administration methods, general anesthesia can be divided into inhalation general anesthesia, total intravenous anesthesia and combined intravenous inhalation general anesthesia.

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Local anesthesia, as the name implies, is to make a part of the body or a local area lose sensation, but the patient is still conscious. In a broad sense, local anesthesia includes spinal anesthesia, nerve block anesthesia, regional block anesthesia, local infiltration anesthesia, surface anesthesia, etc. Spinal anesthesia is also known as "semi-anesthesia". Due to its wide range of anesthesia, it is no longer classified as local anesthesia in clinical practice.

What will happen during local anesthesia?

Since we are awake during local anesthesia, we only need to follow the anesthesiologist's instructions to adjust our body position, communicate in time, and express our true feelings. Since anesthetic drugs need to be injected into the area around nerves with the help of a puncture needle, and nerves often run along with blood vessels, we should stay as still as possible during the anesthesiologist's operation to avoid accidental injury to nerves and blood vessels by the sharp needle.

During the anesthesia process, you may experience abnormal sensations such as pain, electric shock, and fever in your limbs. Do not panic or move around. Tell your anesthesiologist, who will handle the situation accordingly. If you experience palpitations, shortness of breath, dizziness, nausea, tinnitus, or blurred vision, you should also tell your anesthesiologist in a timely manner.

What will I experience during general anesthesia?

General anesthesia goes through three stages: induction phase, maintenance phase, and recovery phase.

During general anesthesia induction, the anesthesiologist often injects anesthetic drugs through an open intravenous channel. We will fall asleep within a few minutes. Generally, there will be no discomfort during this process. A few people may feel slight pain at the injection site, which is due to the short-term stimulating effect of the anesthetic drugs.

When anesthesia is maintained, we are no longer aware of the outside world and will not feel any pain or other discomfort during the operation. We may even have a sweet dream under the effect of the anesthetic.

During the recovery period, we will gradually regain consciousness after the operation. When we first wake up, we will feel a little choking and unable to speak. This is because the laryngeal mask or endotracheal tube is inserted during general anesthesia to ensure the safety of our respiratory tract. The anesthesiologist will decide when to remove the laryngeal mask or tube based on the recovery of our spontaneous breathing. We will feel slight discomfort, but no pain. A few people will have slight throat pain after the operation, but it will disappear within a few hours or the next day.

What will the anesthesiologist do during surgery?

In reality, anesthesiologists do not just give patients an injection and then leave it at that. Their work only begins after anesthesia. Anesthesiologists monitor the changes in our vital signs through a number of monitoring parameters. When vital signs fluctuate greatly, they must deal with them in a timely manner to keep our body in a safe physiological state.

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In addition, the anesthesiologist will adjust the depth of anesthesia according to the progress of the operation. If there is a sudden massive bleeding, cardiac arrest or other unexpected situations during the operation, the anesthesiologist will be the first to take charge and quickly perform rescue and resuscitation work. So there is this saying: surgeons treat diseases, anesthesiologists save lives!

Does anesthesia make your brain stupid?

During local anesthesia, the time effectiveness will vary due to the different configurations, administration methods, and dosages of local anesthetics, but it will usually be completely metabolized within a few hours and will not affect the brain, so we don't need to worry.

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In comparison, more people are worried about the safety of general anesthesia, especially whether children’s brains will become dumber after general anesthesia?

In fact, after more than a hundred years of development, modern anesthesia has developed various types of precision anesthesia instruments and many new short-acting anesthetic drugs that are metabolized quickly and leave no residue. With the clinical application of these technologies and the increasingly systematic and standardized training of anesthesiologists, the safety of clinical anesthesia has been greatly improved. In recent years, the domestic intraoperative anesthesia mortality rate has dropped to less than one in 100,000, and the incidence rate is even lower in large tertiary hospitals.

According to the results of a large-sample epidemiological study of people over the age of 3, no damage to the brain has been found with general anesthesia. Generally, general anesthesia drugs are completely metabolized in the body within a few days or even hours, and it is difficult to have a lasting effect on our brain.

However, big data shows that there is a "333 principle" for children under the age of 3, that is, if a child under the age of 3 undergoes more than 3 surgeries, each of which lasts more than 3 hours, it may affect the child's memory and cognition. Therefore, if it is not an emergency or time-limited surgery, it is recommended that children over the age of 3 undergo surgical treatment.

Choice of anesthesia?

Generally speaking, any surgery can be completed under general anesthesia, and there are no absolute contraindications to general anesthesia. However, general anesthesia is more suitable for the following situations:

Patient factors: high mental stress before surgery; younger children or patients with mental illness who are unable to cooperate with the surgery; some critically ill patients who need emergency treatment, etc.

Surgical factors: major surgeries such as neurosurgery, cardiothoracic surgery, and other surgeries with severe circulatory fluctuations; laparoscopic surgeries; surgeries that take a long time and require special body positions, which are difficult for patients to tolerate when they are awake.

Other factors: The surgical site is special and the surgery is difficult to perform under local anesthesia, such as head and face surgery; there are situations where local anesthesia is contraindicated; local anesthesia fails or is ineffective. In these cases, general anesthesia can be used instead.

Since general anesthesia can meet all surgical needs, is it the perfect choice?

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In fact, compared with general anesthesia, local anesthesia also has many advantages. Local anesthesia uses less anesthetic drugs and has less impact on the body, so patients recover faster, have fewer complications, and have shorter hospital stays.

Of course, sometimes the choice between general anesthesia and local anesthesia is not either one or the other. The combined use of different anesthesia methods can bring greater benefits to patients. Therefore, the choice of anesthesia method is not absolute. The anesthesiologist will make a scientific choice based on the patient's demands, basic physical conditions, and the surgeon's surgical needs.

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