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Anesthesia
Over one hundred and fifty years ago, in the operating theatre on the top floor of the Massachusetts General Hospital's Bulfinch Building, one of the greatest discoveries in medical history occurred. On October 16, 1846, William T.G. Morton, a Boston dentist, experimented with the use of ether during a surgery, ending the pain and dread associated with a surgeon's knife. Dr. Morton used a specially designed glass inhaler with an ether soaked sponge inside of it. The patient was Gilbert Abbott, a printer with a vascular tumor on his jaw. After several minutes, Mr. Abbott became unconscious. A renowned surgeon of the time, John Collins Warren, MD, then surgically removed the tumor. After the procedure was completed, Gilbert Abbott informed the physicians and medical students he had experienced no pain. As Mr. Abbott was being carried out of the operating theatre, John Collins Warren, MD, turned and looked at everyone else in the theatre and said, "Gentleman, this is no humbug." These now-famous words declared the beginning in a new era for medicine. Within months of the discovery it was pronounced, "The greatest gift ever made to suffering humanity."
Anesthesiology has come a long way in over a hundred and fifty years. There are many different types of anesthesia. Which type of anesthesia you use depends on many factors such as the type of surgical procedure you are having and the state of health you are in. There are four basic divisions of anesthesia general anesthesia, regional anesthesia, local anesthesia, and sedation. Each type of anesthesia has an effect on a part of the nervous system.
General anesthesia affects the brain cells and causes a state of unconsciousness. In this state the patient is unaware of what is happening, pain-free, immobile and free from any memory of the period of time during which he or she is anesthetized. General anesthetics affect the spinal cord resulting in immobility, the brain-stem reticular activating system resulting in unconsciousness and affect the cerebral cortex. General anesthesia can be given to a patient by either an inhaled gas or as an injected liquid. There are many different types of drugs and gases that can be combined or used alone to produce general anesthesia. During a procedure the anesthesiologist continuously monitors the patient's heart rate, heart rhythm, blood pressure, respiratory rate, and oxygen saturation. Some patients may have even more monitoring due to the type of procedure being done or the state of the health the patient is in.
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Regional anesthesia is done when only a region of the body is anesthetized without making the person unconscious. One example of regional anesthesia is spinal anesthesia, which is often used on woman during childbirth.
Local anesthesia involves numbing a small area by injecting a local anesthetic under the skin just where an incision is being made. When used alone, this type of anesthesia has the least number of risks. Local anesthetics are thought to block nerve impulses by decreasing the permeability of nerve membranes to sodium ions. There are many different types of local anesthetics that differ in absorption, toxicity, and duration of action. One of the most commonly used local anesthetics is lidocaine (xylocaine). This can be given as an injection or placed topically on mucous membranes. Cocaine is another topical anesthetic primarily used to anesthetize nasal passages for surgical procedures.
Some of the drugs that produce general anesthesia in large doses can be used to produce sedation or "twilight sleep" in lower doses. Sedation can be given in many ways. A common example of anesthetic gas that is used for sedation is nitrous oxide or laughing gas. Liquid sedating drugs are usually given by injection, but some can be given orally. Ketamine and Versed are examples of sedating drugs that can be given by injection or orally. Some people, such as children or mentally handicapped, may refuse to drink medications and can also receive sedation through the rectum with a small lubricated tube or through the nasal passages by spraying in the nose. Regional and local anesthesia can be combined with sedation to make patients more comfortable during a procedure in which general anesthesia is not necessary, or when general anesthesia may be too large a risk for the patient.
The main goal of anesthesia is to keep the patient as safe as possible during a surgical procedure. Keeping a close eye on the patient and monitoring the patient on a frequent basis are essentials when using anesthesia. Proper monitoring of the patient greatly reduces the risks involved with anesthesia and surgery.
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