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GENERAL ANESTHESIA


REGIONAL ANESTHESIA


LOCAL ANESTHESIA


LABOR ANALGESIA


SURGERY and PAIN


MALIGNANT HYPERTHERMIA


ANESTHESIA and HERBS


ANESTHESIA SIDE EFFECTS


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DICA 33 MOTORE DI RICERCA



QUESTIONS AND ANSWERS

ANESTHESIA

What is anesthesia?

The word itself means "without feeling." Anesthesia is a branch of medicine whose role it is to create a safe state of painlessness during surgery. That state is created by the careful choice of various drugs called anesthetics.


Is it Safe?

Yes! In fact, anesthesia makes your operation even safer by reducing physical shock and emotional stress. Most major operations could not be successfully performed without the aid of anesthesia.


May I choose my anesthesiologist?

This question is a very common one as today more and more patients search for medical specialists. Many people find their doctors through recommendations from other doctors or through family and friends and the same situation exists when choosing your anesthesiologist. You do have a choice as to who your anesthesiologist will be. However, you must make that choice known in advance so that arrangements may be made to honor your request. In most situations where no request exists, the surgeon who has scheduled the operation will arrange the services of an anesthesiologist with whom he or she is familiar. However, if for any reason you are not comfortable with the recommended anesthesiologist, you may request a different anesthesiologist.


May I request what type of anesthesia I will receive?

Yes, in certain situations. Some operations can be performed using different anesthetic procedures. Your anesthesiologist, after reviewing your individual situation, will discuss any available options with you. If there is more than one type of anesthetic procedure available, your preference should be discussed with your anesthesiologist in order for the most appropriate anesthetic plan to be made.


Will I wake up during the operation?

No! If you have general anesthesia, you will remain asleep during the surgery, and will gently be returned to consciousness by the anesthesiologists only after you are in the recovery room.


Why are so many questions asked about my past and present medical conditions?

Because anesthesia and surgery affect your entire system it is important for your anesthesiologist to know as much about you as possible.
      You already realize that your anesthesiologist is responsible for your anesthesia to make you comfortable, but in addition, he or she is also responsible for your medical care during the entire course of surgery. Therefore, it is important to know exactly what medical problems you have and any medications you have been taking recently since they may affect your response to the anesthesia. You also should inform your anesthesiologist about your allergies, any hard drug or alcohol usage, and past anesthetic experiences.
      Your anesthesiologist must be very familiar with your medical condition so that the best anesthetic and medical care may be provided throughout your operation. This important knowledge will allow your anesthesiologist, as a doctor, to continue your current medical management into surgery which will help prevent complications, and expedite diagnosis and treatment of any medical problems should they occur. Your continued medical management during surgery is necessary to help facilitate your speedy recovery.


If I have an underlying medical problem, how will it be handled during surgery?

Frequently, people requiring surgery may also have some underlying condition such as diabetes, asthma, heart problems, arthritis or others. Having taken your medical history prior to the operation, your anesthesiologist has been alerted and will be well prepared to treat such conditions during surgery and immediately after. As doctors, anesthesiologists are uniquely suited to treat not only sudden medical problems related to surgery itself, but also the chronic conditions that may need attention during the procedure, because their medical training involves a firm grounding in the principles of internal medicine and critical care.


ANESTHESIA and LEG PAIN

Hi, I had same day throat surgery(polyp on larynx)and the next dayi could hardly walk because of leg pain. Any ideas why?
Thank's


It's very difficult to give you an answer to your question. The information are scarse . What I can say is certainly not related to anesthesia


ANESTHESIA and ARM NUMBNESS

I had a laporascopy for removal of ovaries and tubes. It is my understanding that adhesions were wrapped around my intestines and the procedure took 3 hours verses 50 minutes as planned. Its my left arm between the shoulder and elbow, my age is 41 and my health is pretty good other than endometriosis and acid reflux. On my leg it is the top of the left leg more towards the right side of it. I didn't know if the gas that they use could be the cause either. My Dr.'s appointment is for Monday for the Dr. that did the operation. Thank you again for your time.

What you are describing could be due to many factors, probably. What I can suppose is that these symptoms could be the consequence of stretching on your leg and arm for an uncomfortable position during the operation (it last more than three hours). In case of this hypothesis, your symptoms will be giving up in 2-3 weeks.
Please speak with your Doctor. He knows very well your situation and your health conditions


ANESTHESIA and ETOH

A question has come up in our paramedic refresher class about ETOH abuse and anesthetics. Is it harder to put someone asleep that has an outstanding history of alcohol abuse and is it more difficult to keep them asleep? An off the cuff guess is that the majority of the anesthetic is metabolized in the liver and the alcohol demand retards the efficiency of the anesthetic. Does the alcohol damage the receptor sites, or am I in over my head and have no business trying to figure this out?

Thanks for your time and considerations.

Dear xxxxxxx,
your question is a big question and the story is very long. Some few short information

ETOH acts on membranes of cells by affecting the lipid component and proteins that constitute receptors or enzyme systems. The inhibitory GABA receptor appears to be primary site of action for ETOH. GABA is a site of action for barbiturates and benzodiazepines, which may help to explain their ability to produce cross tolerance .

Chronic alcohol use induces an acceleration in hepatic microsomal metabolism of a number of drugs. ETOH will potentiate hypnotic and sedating drugs, narcotics, antidepressants and neuroleptic drugs, antihistamines.
Patients under acute ETOH intoxication can be regarded as partially anesthetized, decreasing the dose requirement for an induction agent. On the other hand, chronic exposure to ETOHl also results in tolerance to anesthetic agents, often requiring increse doses of anesthetics to avoid the phenomenon of awareness.

If you want, try this web site:
http://gasnet.med.yale.edu/

alcohol-anesthesia/


ANESTHESIA and ALLERGY

May I know what is the drug that is administered to the patient to check if he is allergy to a particular kind of local anesthesia.
thanking you,


There is no specific drug to check if a patient is allergic to any kind of local anesthetic. What is important is an history of previous allergic reactions and an allergic habitus. It is possible to test for each local anesthetic to check for allergy or intolerance.


ANESTHESIA and PLASTIC SURGERY

How long is safe for having Plastic Surgery with General Anesthesia?

There are o lot of plastic surgical procedures that can be done without general anesthesia and on ambulatory basis. Some require, for many reasons, the use of general anesthesia. If you are in a good health condition, the risk of having general anesthesia is very low. You can check this at the following web address

http://www.brandianestesia.it/english/

genanesth.html#anchor_risks

Yours Sincerely,


MULTIPLE SURGERY and ANESTHESIA

I am xxxxxx old and I have had about 25-30 surgeries for craniofacial anomolies. I was just wondering if the anethesia or the prescription drugs I've been given all my life will have an effect on my liver or kidneys? Or any other organs for that matter?

Thank you for your time.


To day, the drugs used for anesthesia are very safe for liver, kidney and other organs. Some problems could derive from chronic use of some anesthetics delivered by breath (Inhalation Anesthetics). In case of new surgeries, I suggest you to ask for total intravenous anesthesia, or to perform surgeries, if it is possible, with local anesthesia and sedation (MAC). Please, contact your anesthesiologist for any suggestion.


ANESTHETIST AND ANESTHESIOLOGIST

What is the difference between a anesthesia technologist and anesthesiologist

These are the differences:
Anesthesiologist is a physician specializing solely in anesthesiology and related areas, an individual with a doctorate degree who is board-cerified and legally qualified to administer anesthetics and related techniques.

Anesthetist is one who administer an anesthetic, whether an anesthesiologist, a physician who is not an anesthesiologist, a nurse anesthetist, or an anesthesia assistant.

Yours Sincerely


REGIONAL ANESTHESIA

hello,
my question is : Regional anesthesia how far it can go.
thanks

It depends on the type of surgery. Nowadays, it is possible to perform regional anesthesia lasting many hours (4-6 hours). You must take in consideration that long regional anesthesia brings the problem of uncomfortable position on the operating table for the patient.

You are welcome


LOCAL OR GENERAL ANESTHESIA

I am considering breast augmentation and wanted to know if local anesthesia was commonly used for this procedure. Will I feel any pain with this type of anesthesia?
Thank You

Yes, it is possible to perform breast augmentation under local anesthesia (anesthetizing only the area of the surgical procedure) without any pain. It depends on the surgeon experience in performing this kind of operation under local anesthesia. Usually, it is advisable to use drugs to reduce the perception of pain and to induce sedation (drowsiness). It is advisable to perform this procedure with the presence of an anesthesiologist. Anyway, this surgical procedure can be performed also under general anesthesia in day surgery.

You are welcome

Thanks for responding to my note. So would you say that local anesthesia would be a good option? Would I be aware of what is being said and done during the surgery? I want to go this way but I am scared that I will be able to feel what the doctor is doing?
What are your thoughts on this procedure?
Thank You

My personal opinion and my personal experience with patients undergoing breast augmentation, is that 95% of the patients prefer to have general anesthesia. To days, general anesthesia is very safe. My suggestion is to discuss with your plastic surgeon and with the anesthesiologist about the opportunity to perform the surgical procedure with local anesthesia and sedation.

You are welcome


ANESTHESIA an ALOPECIA

I had surgery last year and several months after the surgery I noticed a lot of hair loss. Can this be caused by the Anesthesia that I had during the operation ?

I can give only a general answer to your question.
Any kind of serious surgery puts great stress on the body. The blood with all its nutrients is diverted to the essential organs during surgery thus depriving the less important areas like the skin and its hair follicles. If these cells are deprived of the nutrients they need even for several hours during surgery, this could trigger "telogen effluvium" or the progressive hair loss you've been experiencing. The general anesthesia you had could also have triggered telogen effluvium. Even though the anesthesia was administered for only several hours (you didn't say how long) this may have been enough to shut down hair cell production. Occasionally during prolonged surgery the head of the patient is in the same position for many hours. The pressure of the head on the operating table may cut off circulation to the skin where the head and table meet. This can cause a localized alopecia. However, the practice is to move the patient's head every so often so that this does not occur. Telogen effluvium is almost always temporary. It will take some months though for your hair to grow back. I hope you don't have any more serious operations planned.


ANESTHESIA and FOOD TASTE

My sister had surgery for a bypass for her legs. Ever since the surgery she has said her food all tastes burnt. Her mouth is all red.
In fact things like salt will burn her mouth. All her doctors can not find a reason for the burnt taste. Is it possible that somehow the anesthesia did something to her taste buds?
Any answers or directions you could give would be appreciated Thank you

From your information it is difficult for me to give a precise answer. Certainly, what you are describing has no relation with anesthesia. The reason could be some medications that your sister is taking, I suppose.
I apologize for this short answer, but information is scarse.

You are welcome


MOTOR SKILL PROBLEMS

My husband had mind loss after surgery and motor skill problems. That was three months ago.He can't sleep because when he relaxes, the muscles in his body jump and jerk. Is this anesthesia related?


May be! It depends on many variables before saying that the symptoms you describe can be related to the anesthesia itself. I suggest you to contact your doctor to figure out the cause of these motor skill problems.


MUSCULAR PAIN and ANESTHESIA

I recently had breast reduction surgery and general anesthesia was used... I am now feeling aches particularly in my elbows,shoulders and knees. Is this normal?

It depends. If your surgical procedure has been done in the last two three days, it is possible to explain your aches as a consequence of some medications used for anesthesia. In this case they will finish quickly. In case your aches last many days or weeks, there is no relationship with anesthesia.

Sincerely,


MEMORY LOSS and ANESTHESIA

I was wondering if there has been a study done on the longterm effects of anesthesia and memory loss on children who have had multiple surgries? I am 25 at present and have had 30 surgries under general anesthesia and have suffered significant memory loss. I had my first 13 before I was 9 yrs old.

Dear xxxxxxx,
In the most recent scientific literature, there are few EXPERIMENTAL STUDIES dealing with memory disturbances and anesthesia.
A team of researchers has found that drugs commonly used to anesthetize children can cause brain damage and long-term learning and memory disturbances in INFANT RATS. Similar results were obtained by other reasercher in AGED RATS. Moreover, there are few clinical studies (in humans) dealing with memory loss and anesthesia but they concluded that about 30% of patients present memory disturbances after surgical procedures and anesthesia, particular in the elderly.
Therefore, memory disturbances are possible with anesthesia per se.

You are welcome


LOSS of PHYSICAL ENDURANCE

After hip replacement surgery, I experienced bouts of panic attacks which were eventually mitigated by lorazepan and paxil. I now have a total loss of stamina and physical endurance. I feel sick to my stomach several hrs a day. All this has happened since my surgery on Feb 3, 2005. This has been blamed on my surgery's anesthetic. What happened to me, and what am I to do to correct this and get my life back?

Dear xxxxxxxx,
what are you reporting has no relationship with anesthesia per se after 7 months. I believe that your symptoms could be the consequence of your surgery. This is a phenomenon called "stress reaction" to surgical trauma and it looks like the "chronic syndrome fatigue". I do not know if you are taking any kind of medications that could induce sickness to your stomach. I suggest you to have a diet rich of proteins and with a high caloric intake and to refer to your family doctor for a complete check of your situation.

You are welcome


COLD and ANESTHESIA

I have a sore throat,cough and cold I am having surgery in 48 hours and I will be given general Anesthesia. What are the risk, i also just quit smoking.

You must postpone your surgery when you will be in good health condition. Continue quitting smoking.
Risk: to have respiratory complication after surgery

You are welcome


AFTER THYROIDECTOMY

My son had a Thyroidectomy on Tues the 26th of Oct. His speech is very mechanical and he has to concentrate extremely hard to speak. This frustrates him to the point of tears. He takes Oxycodone, Propanolol and Synthroid. What is going on?


Dear xxxxxxxxx,
what are you describing COULD BE a consequence of surgery. I suggest you, in case of the problem described persists, to refer to your surgeon. It could be a transient problem lasting few days. No relationship with medications that your son is taking.

You are welcome


OSSEOUS GRAFT and LOSS of HAIR

I had an osseous graft to the lower jaw done , i now finding that my hair is literally coming out ib bunches each time i comb is there a link between dental anaesthetic use and hair loss?


Dear xxxxxxxx,
I think that there is no relationship between your dental procedure and anesthetic and your loss of hair. This phenomenon you are describing sometimes may happen but especially after important surgical procedures or after important trauma. Anyway, I can give you some general informaton about this problem. Any kind of serious surgery puts great stress on the body. The blood with all its nutrients is diverted to the essential organs during surgery thus depriving the less important areas like the skin and its hair follicles. If these cells are deprived of the nutrients they need even for several hours during surgery, this could trigger "telogen effluvium" or the progressive hair loss. Telogen effluvium is almost always temporary. It will take some months though for your hair to grow back.
But I think that is not your problem.


SPINAL BLOCK

My wife had a c-section and the nurse anesthesist made several attemts to perform a spinal block or epidural. 10 months later she is still having problems and we do not know what to do. Over 20 attempts were made to deliver the local anesthesia. Eventually she had to have a general anesthetic. During these attempts, she felt shootng pain down her legs. Could this many attempts cause a problem? At what point would a person know to stop attempting the epidural and givee a general anesthesia?

Which kind of problems is she still having after 10 months? Could you please be more precise? 20 attempts are many, in my opinion; it depends on own skill and experience to decide when stopping the procedure. To feel shooting pain down the legs, may happen during spinal or epidural.


ANESTHESIA and LAPAROSCOPY

My surgeon is going to attempt to remove gallbladder same time as left liver resection for a tumour which he believes may be an adenoma by laparoscopic operation but he has warned me he may have to proceed to open surgery, I want to know that the will the anaesthetist ensure that enough anaesthetic is given when that event occurs as obviously one would need more for open surgery?

There are no differences in performing anesthesia for laparoscopic or open surgery of the abdomen.


SEDATION

When having an epidural with a spinal. Do they always give opaites in the mix? Does it have the same effect on you as when given in an IV? Do they HAVE to use the combo? I do not want to be sedated during my surgery (abdominal hysterectomy and vaginal repairs) and am very concerned that the reginol opaites may cause me problems also. I am trying to protect my autonmy and descsion making abilities while in surgery as much as possible. My surgeons and anesthesiologist are aware of my desires.
Thank in advance !

Dear xxxxxxx
it is not mandatory to give opiates with epdidural or spinal or combined procedures. It is possible to use only local anesthetics. The effects of spinal/epidural opiods are not similar when given iv. They potentiate the local anesthetic mixtures. The sedation during regional anesthesia could be useful, but If you want not to be sedated during surgery, your desire must be respected.

You are welcome


BLOATING and ANESTHESIA

Can bloating be a result of anesthesia? I had a breast augmentation 2 days ago and my belly is larger than usual. Others have suggested it's from the anesthesia and will subside.

It may be. It depends on the medications used during anesthesia, particularly narcotics. Sure, it will subside.


ANESTHESIA and FAINTING

I had a repair of a deviated septum in January and had general anestesia. The next day, I fainted as a result of low blood pressure and the day after that I was unable to unrinate with severe constipation. I will be having surgery again next month but the doctor insists on general. Will I experience these symptoms again? Any way to prevent them ? ( I am a healthy 34 yr old female. I also suffered from fatigue and grogginess. Please respond.
Thank you.

What are you describing sometime may happen after a surgical procedure. If you are in a good health condition, do not worry for your next surgical procedure and anesthesia. If you are scared about general anesthesia, speak with your anesthesiologist to figure out if it is possible to have regional anesthesia.



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