2009-11-25 10:30:00
“During surgery, what scares me the most is not waking up,” says Carole, 47, anesthetized before a hysterectomy (removal of the uterus). The purpose of general anesthesia is to temporarily suspend consciousness and sensitivity to pain for surgery. To accomplish this act, the anesthesiologist injects the patient with anesthetics intravenous route.
Millions of anesthesias are performed each year. “Unfortunately, it is customary to attribute to anesthesia a large majority of incidents or accidents occurring during surgery or its followingmath. The reality is fortunately quite different, because anesthesiologists have to primary objective is patient safety that they take care of”, explains Doctor Bruno Gomez, anesthesiologist in Paris. Accidents related to anesthesia are very rare todaythanks in particular to the measures that have been put in place.
The pre-anesthesia interview, mandatory before any intervention
The pre-anaesthetic consultation is mandatory and must take place one or two days before the operation. This interview gives rise to a precise questioning on the medical history of the patient, his possible treatments in progress, his specificities: diseases, allergies, wearing of prostheses or lenses, or any other element likely to interfere with the anesthesia.
Examinations (in-depth blood test, X-ray, etc.) may be requested. “They are not systematic: they depend on the patient’s history or state of health and the nature of the operation”, informs Doctor Jean-Pierre Lardeyret, anesthesiologist in Paris.
The opportunity for a dialogue with the anesthesiologist
This interview is important for both doctor and patient. He can ask the doctor regarding the duration and operation of general anesthesia, the products used and the risks involved in this medical act. Do not hesitate to share your apprehensions. “To feel confident, I had to know if it was this same anesthetist who would be present on the day of my operation: it was important for me”, explains Carole. The anesthetist is there to reassure patients and answer their questions as precisely as possible.
Before anesthesia…
The future operated must be fasted for at least six hours : food can cause regurgitation of gastric fluid into the lungs and lead to the risk of asphyxiation. Smokers should go without cigarettes for the same amount of time because tobacco can interfere with breathing and cause coughing and spasms. It can also cause acid hypersecretion and slow stomach emptying.
Premedication
One hour before anesthesia, the nurses administer a tranquilizer orally to relax the patient, soothe his anxieties and make it easier to fall asleep. However, depending on the person, the following effect varies: “The drugs put me in a real cotton ball,” recalls Carole. For others, the stress is more intense and the sedatives have little effect. “Until I fell asleep, I was aware of everything and the fear was very present”, testifies Gérald, 49, heart surgery.
During the procedure…
“The anesthetist administers to the patient a combination ofanesthetics (morphine-like),painkillers ( once morest pain) and sometimes a curare (helps muscle relaxation) intravenously”, informs Doctor Lardeyret. The subject is put, in all cases, on a drip to guarantee his safety and maintain the anesthesia. The anesthesiologist is present throughout the entire procedure and monitors the vital functions of the patient.
Breath control
During general anesthesia, the patient most often loses all or part of his breathing capacity. Doctors then resort tointubation (installation of a tube in the trachea) to help him breathe artificially. “In the event of short general anesthesia or benign operation, intubation is not always necessary, a laryngeal mask can be used (this device which seals the periglottic area consists of a mask and ‘a balloon, positioned in the pharynx) or a face mask,’ says Dr Gomez.
After anesthesia…
After the anesthetic effect wears off, the patient wakes up slowly. “Waking up is always a bit difficult, but the same every time: I fall asleep and the next second I hear voices in the distance saying to me, ‘Madame B., wake up!’ It went well, you’re in the recovery room,” recalls Carole. Mandatory, this step allows you to control the return to normal the patient’s respiratory functions and theno occurrence of complications. The welcome in recovery room has a variable duration depending on the nature of the intervention.
For most patients, recovery goes without a hitch. Sometimes side effects (nausea, vomiting or restlessness) occur. Even with medication, pain can also cause the operated person to suffer as soon as they wake up. “Doctors move or remove organs, so it hurts,” says Carole.
Disorders can sometimes appear during the days following general anesthesia: drop in blood sugar due to fasting, hypotension caused by sedatives, headaches, back pain, urinary disorders, temporary discomfort, etc.
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