Anesthesia

What is anesthesia?

Anesthesia is a medical procedure that allows surgery or a painful or annoying diagnostic examination to be performed with maximum safety and comfort for the patient. The anesthetic act consists of three well-differentiated phases:

• Preoperative
• Intraoperators
• Postoperative

What are the functions of the anesthesiologist?

The anesthesiologist is a doctor specializing in Anesthesiology, Resuscitation and Pain Therapy whose functions are:

• At preoperative: assess the patient's state of health and medical history, optimize their condition and sometimes the collaboration of other specialists is necessary
• During the intervention: the anesthesiologist applies the most appropriate anesthetic technique to monitor the safety and well-being of the patient, by monitoring their vital signs (pulse, blood pressure, heart rate, respiration, oxygenation, temperature, etc.). To perform these controls properly, you need to use drugs, various materials (needles, cannulas, probes, etc.) and appliances (monitors, respirators, etc.). In this way he is able to detect most problems and act accordingly.
• At the end of the intervention it also controls the immediate postoperative period until the full recovery of its vital signs.

What types of anesthesia exist?

There are several types of anesthesia:

• Anesthesia local: injection of the anesthetic near the area to be operated
• Anesthesia regional: the patient remains conscious and anesthetizes only a part of the body by injecting the anesthetic near the nerve roots
• Anesthesia general: is one that acts on the whole body, the patient is in a situation similar to normal or physiological sleep. The types and doses of drugs are calculated according to the weight, age, type of surgery and accompanying diseases that the patient may have. Drugs or medications are administered intravenously or by inhalation.
• In addition to locoregional anesthesia, a sedative intravenously to ensure that the patient is calm, indifferent and comfortable in the operating room.

The anesthesiologist will report the most convenient type of anesthesia in each particular case.

Is the anesthetic act safe today?

Currently anesthesia is very safe. However, and as with any medical procedure, there may be complications that the anesthesiologist is prepared to resolve. The risks involved are of two types:

• Surgical risk: it is associated with the type of intervention and the surgeon will inform you in detail. It depends on the complexity of the intervention, technical difficulty, etc.
• Anesthetic risk: very directly related to the state of health prior to the operation. The range of complications after an anesthetic-surgical procedure is very wide and ranges from some mild discomfort to major complications.

What are the risks associated with anesthesia?

In general, the risks associated with anesthesia depend, not so much on the anesthesia itself, but on the patient’s physical condition and the severity of the intervention itself. There are some commonplace risks such as: sore throat, cough, hoarse voice, nausea or vomiting after general anesthesia; back pain or headache after spinal anesthesia or bruising after local anesthesia. Others, very rarely, can be extremely serious and can consist of:

• Widespread or local adverse reactions to drugs used.
• Injuries secondary to difficult airway control (tracheal intubation, artificial respiration, etc.).
• Injuries to the central or peripheral nervous system (in the case of spinal / epidural and / or locoregional anesthesia).
• Cardio-respiratory or other vital organs that can cause a coma or death of the patient (incidence 0.7 / 10.000).

How can the patient collaborate?

La Patient collaboration is critical. When you go to the pre-anesthetic visit it is important that provide as detailed information as possible about:

• Current and / or previous illnesses (hospital admission reports, etc.).
• Usual medication ("chronic medication card").
• Previous surgeries.
• Allergies.
• Experiences in previous anesthesia.
• Analysis, electrocardiogram, x-rays and other complementary tests requested by your surgeon or other specialist if you have them.
• Toxic habits and / or drug addictions. After studying the particular medical history, the anesthesiologist will indicate how the physical condition can be improved before surgery.

What happens in the operating room?

As a general rule, a tranquilizer is administered in the room. The patient is transported on a stretcher to the prescribing room, where his identity, pathology and surgery are confirmed and a venous access ("serum") is placed with a sedative. He then enters the operating room where the monitoring of vital signs begins with the appropriate technology that allows continuous monitoring throughout the surgical process. The anesthesiologist then performs the previously agreed anesthetic technique.

Postoperative control

What happens after the operation? After an operation a recovery period (one to several hours) is required which takes place in a room next to the operating room. This room is specially prepared for continuous monitoring, until the patient is in perfect condition to return to his room or to his home.

Depending on the type of surgery or the patient's condition, more specialized care is needed, which is performed in special units (critical care) that receive different names according to each hospital (Resuscitation, ICU, ICU, RPQ, etc.). In these units, if the patient requires it, invasive treatments, artificial respiration, etc. are applied.

Answer to doubts during the pre-anesthetic visit

During the anesthesiologist-patient interview, they should stimulate questions and resolve them. The written or visual information should have already suggested doubts in the patient.

What is the Informed Consent Document?

Autonomy (right to decide about oneself) is a fundamental right recognized in the Constitution and therefore protected by law. As for medical action, it is about the right to decide the actions that take place on one’s own body. This means that there is the possibility to choose between different alternatives proposed (medically correct or equally indicated) or to refuse a certain treatment. It should be noted that there are not always several alternatives for a given issue. Autonomy does not give the right to request interventions not indicated. The doctor, in this case the anesthesiologist, knows the therapeutic possibilities on each occasion, as long as the patient knows himself, his fears, his preferences or his scale of values.

During the clinical interview the patient can and should request sufficient information to enable him or her to be involved in any “informed” decision. And although renouncing to be informed is also a right, ("doctor whatever you consider") should be made explicit to avoid misunderstandings. The best alternative in each case will be one that "by mutual agreement", doctor and patient adopt. Law 21/2000 of the Parliament of Catalonia obliges this process to be made explicit in a signed document. This is the INFORMED CONSENT DOCUMENT.

The signing of the document does NOT mean an exemption from liability, but on the contrary, the confirmation that there has been an adequate communication process, that both parties have understood the expected benefits of a given action, the risks that exist and are agree on the process to follow.