General anesthesia, partial anesthesia or local anesthesia, who has the final say?

Produced by: Science Popularization China

Produced by: Xiaozhi_Eva

Producer: Computer Network Information Center, Chinese Academy of Sciences

"Doctor, what kind of anesthesia should I use for this cholecystectomy?"

“Is it better to sleep or stay awake during the operation?

"Doctor, I heard from my neighbor Lao Wang that he did not use general anesthesia when he had his appendectomy. He did the surgery while awake. I also had my appendectomy removed. Why did I need general anesthesia?"

Before surgery, doctors are always asked these questions about anesthesia. Let’s talk about the differences in commonly used anesthesia methods and experiences.

The commonly used anesthesia methods are general anesthesia, "half-body anesthesia" and local anesthesia.

General anesthesia: The surgery is done in a "sleep"

General anesthesia refers to the anesthetic drugs entering the patient's body through respiratory inhalation, intravenous injection, etc., which produces a central nervous system inhibitory effect, causing the patient to enter a functional inhibition state in which the patient loses consciousness and has no pain sensation. This inhibitory effect can be controlled and regulated, and is completely reversible.

Is general anesthesia simply about making people fall asleep?

During general anesthesia, the anesthesiologist mainly uses sedatives, analgesics, muscle relaxants and other drugs to maintain the patient's general anesthesia state to meet the needs of the operation.

Sedatives are drugs that make patients "sleep" and lose consciousness. Analgesics are drugs that reduce pain during surgery. Muscle relaxants are drugs that relax the patient's muscles to meet surgical procedures.

The depth of "sleep" of the patient during general anesthesia is deeper than the "sleep" when people usually sleep, and the patient will not be aware of or wake up from surgical operations, painful stimulation, etc.

Patients under general anesthesia usually need assisted breathing because muscle relaxants are often used during general anesthesia surgery, and the patient's spontaneous breathing will also be suppressed, so an external machine is needed to help breathing.

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During general anesthesia surgery, the anesthesiologist has a lot to do. He needs to pay close attention to the stimulation of the surgical operation on the patient and the changes in vital signs caused by the stimulation, and take corresponding measures in time, such as adjusting blood pressure to avoid drastic fluctuations, stabilizing heart rate to avoid myocardial ischemia and arrhythmia, keeping the airway open, and replenishing fluids and electrolytes in time.

In addition, anesthesiologists must deal with emergency situations in a timely manner, such as massive bleeding, cardiac arrest, ventricular fibrillation, anaphylactic shock and other critical situations.

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When would you choose general anesthesia?

Theoretically, all types of surgeries can be performed with general anesthesia, and general anesthesia is often the surgeon's first choice of anesthesia. It can not only meet the needs of different surgical operations, but also ensure patient compliance, reduce the psychological and physiological stress response of patients caused by surgery, and improve patient comfort.

Why don’t all surgeries require general anesthesia in clinical practice? Although general anesthesia is applicable to a wide range of surgeries and has many advantages, it is a bit of a waste of talent for smaller or superficial surgeries that can be completed with local anesthesia or spinal anesthesia.

“Half-body anesthesia”: You can know the process of your surgery

What people often call "half-body anesthesia" is actually called spinal anesthesia. The commonly used clinical methods mainly include subarachnoid anesthesia and epidural anesthesia, both of which belong to the category of spinal anesthesia. So where is the spinal canal? The spinal canal is a tubular structure formed by the vertebral foramina of all vertebrae, in which the spinal cord and other tissues "live".

During "half-body anesthesia", the anesthesiologist uses a puncture needle to operate on the patient's waist and inject anesthetic drugs into the cerebrospinal fluid or epidural space, thereby blocking the sensory conduction of the nerves and achieving the effect of "half-body anesthesia". This is what people often describe as "the anesthesiologist gave me an injection in my waist, and after a while I couldn't feel my legs."

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The patient under "half-body anesthesia" is conscious, that is, "not asleep", but the body in the blocked area cannot feel pain. This is because the anesthetic blocks the conduction of pain sensation in the surgical area, and other body functions are not affected.

Intraneurial anesthesia is mainly suitable for: surgery on the lower abdomen, pelvis, anus, perineum and lower limbs, cesarean section, labor analgesia, etc.

However, not all people who undergo the above-mentioned operations are suitable for "half-body anesthesia". This is why some people use "half-body anesthesia" while others use general anesthesia for the same appendectomy.

Who cannot undergo “half-body anesthesia”?

If the patient has the following conditions, "half-body anesthesia" is not suitable, including central nervous system diseases (such as spinal cord lesions), systemic infectious diseases, severe hypertension, shock, anemia, spinal trauma or deformity, significantly increased intra-abdominal pressure (such as huge abdominal tumors, large amounts of ascites), uncooperative patients (such as mental patients, children), etc.

Patients with these conditions are prone to nerve damage, serious systemic complications, or life-threatening conditions if they undergo "half-body anesthesia".

Therefore, for patients who are not suitable for "half-body anesthesia", general anesthesia is often used as a substitute.

Local anesthesia: more "precise", anesthetizing the area where the surgery is performed

Local anesthesia, also known as regional anesthesia, refers to the application of local anesthetics to a certain part of the patient's body, which temporarily blocks the nerve conduction function of local pain stimulation.

What are the situations where people often encounter local anesthesia? For example, tooth extraction, drinking a small bottle of local anesthetic before gastroscopy, removal of local superficial tumors on the body, upper limb surgery, foot surgery, etc., local anesthesia is often used.

Local anesthesia is simple and easy to perform, has few complications, and has little impact on the patient's physiological functions, but the applicable surgeries are also very limited.

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Therefore, different anesthesia methods have their applicable surgeries, and the anesthesiologist chooses the anesthesia method based on the patient's disease and surgical conditions. In most cases, surgeries that are not suitable for "half-body anesthesia" and local anesthesia can be performed using general anesthesia instead.

Now you can distinguish between general anesthesia, "partial anesthesia" and local anesthesia!