Rajesh was a fit 25-year-old, but when he suffered from blinding pain in his stomach, he realised that he needed immediate medical attention. On visiting his doctor, and several tests later, he was diagnosed with gall stones, and had to undergo a surgery. The initial shock of having to go under the knife wore off, but the worry about the entire procedure still gnawed at him. He followed all that his doctor had told him; even so his surgery had to be cancelled at the last moment. Rajesh had given into temptation and had a cup of tea a few hours before the surgery. Why Rajesh’s surgery was cancelled was a mystery to him but his anaesthesiologist knew the cup of tea could even lead to death.
Surgery is a serious step, no matter how routine the procedure might be. As a step to making you more aware about what you should ask your doctor before a surgery, we had Dr Hemant Shinde, consultant anesthesiologist at Hinduja Healthcare Surgical Hospital, Mumbai tell us about what a patient should know before undergoing a surgery and what the complications of general anaesthesia are.
How does anaesthesia work?
The exact mechanism is unknown but various theories are put forward by scientists. There are four components that go into the working of general anaesthesia, namely – hypnosis, analgesia (pain killing effect), reflex inhibition and muscle relaxation. Hypnotics act on the sleep center in the brain near caudate nucleus (a small part of the brain), analgesics act on the pain receptors in the brain as well as the spinal column, inhalational agents prevent the reflexes action in the brain as well as the spinal cord and the muscle relaxants act at the neuromuscular junctions (areas where the neurons and muscles meet).
When these four factors are properly managed, the type of anesthesia is called balanced general anaethesia. To achieve this, an anaesthesiologist has to use multiple medicines which act on various parts of the central nervous system.
What precautions should one take before a surgery?
In the run up to a surgery, a patient usually, only visits the surgeon who recommends the surgery. But it is essential that he/she visit the anaesthesiologist as well. This serves a two pronged propose – it helps the anaesthsiologsist understand the patient’s case better, creates a rapport between the patient and the doctor and helps quell any fears the patient might have. It is important that the patient be put at ease as far as possible before the surgery, since this helps in making the process of administering anaesthesia much smoother. A worried patient is a bad candidate for surgery.
During their visit to the anaesthsiologist, the patient should feel free to ask any questions they might have, tell him/her about any previous surgeries they might have had, allergies they suffer from, medication they are on, the medical condition they are suffering from and other diseases they might also have. (Read: 10 reasons you could consider robotic surgeries)
Before the surgery, the patient should be fasting for at least six hours prior to surgery. If he/she is diabetic then they should have been fasting for eight hours, as the gastric emptying (digestion) time is prolonged in diabetic patients. He/she should refrain from smoking for four weeks before the surgery and should not consume alcohol at least 72 hours before the procedure. The patient should also continue or discontinue any medication as advised by their treating physician.
On the day of the surgery, the patient must be accompanied by a responsible adult and must carry all his/her investigations and reports. Most importantly, when asked if he/she has eaten or drunk anything in the six to eight hour window prior to the surgery, he/she must tell the truth. Not accepting that they have eaten something can be life threatening. Regurgitation of food/drink (which is common during surgery due to administration of general anaethesia) can cause the patient to die of aspiration (where the food or drink enters the wind pipe causing the patient to choke).
After the surgery, if the patient is discharged the same day, he/she must make sure not to drive or work near an open flame. It is also essential that the patient not look down or bend especially while standing at a height, as the drugs used in general anaesthesia can cause a person to fall over, leading to an accident.
What can one expect after a surgery?
After undergoing a surgery performed under general anaesthesia, a patient may be drowsy for a few hours, suffer from nausea and vomiting, be confused and may not be oriented with respect to time and place, suffer from transient immediate memory loss (may not remember immediate events but memory usually returns in a few hours after the effect of the drugs have worn off), may have throat irritation due to insertion of the endotracheal tube ( a tube inserted into the trachea during the procedure), may suffer from generalised body ache and might shiver for some time after the procedure.
Can general anaesthesia kill a person?
Anything under the sun including the sun can kill so anesthesia is no exception!
If conducted improperly, it can increase one’s chances of dying on the operation table; therefore it is not something that should be taken casually. That being said, it is a very safe and commonly done practice before a surgery. Moreover the monitoring devices used and with the invention of better medicines over the years have made death caused due to general anaesthesia a rarity. (Read: How local anaesthesia could have killed the 3-year-old in Bangalore)
When should one avoid general anaesthesia?
Owing to the fact that general anaesthesia is a fine balance of factors, there are some instances when a person cannot be administered general anaesthesia. For instance, if a person has an allergy to any of the drug used to induce general anaesthesia, has not fasted for six hours before the procedure or when the patient suffers from certain serious medical conditions like acute status asthmaticus, cardiac failure, severe shock, hypotension, COPD (chronic obstructive pulmonary distress) and liver failure, he or she is not a candidate to undergo general anaesthesia.
How much is too much?
Administering general anaesthsia is a fine balance, it requires considerable amount of attention to the patient and his/her medical history, and the doses are specially designed to work on a specific patient. The amount of anaesthetic to be used is designed keeping in mind the patient’s ideal weight, age – elderly patients cannot be administered a large dose; and his/her reaction to the amount of medication already administered.
The most significant factor in altering a patient’s dose is the medical condition of the patient. Certain drugs need to be given and others need to be avoided depending on severity of the patient’s medical state. Similarly, if the patient’s pre-existing disease does not allow the use of a certain drug, its concentration is adjusted to suit the parameters of the patient.
What are the side effects of general anaesthesia?
The side effects of general anaethesia may lead to nausea, vomiting, skin rashes, itching, low blood pressure, throat pain and irritation, cough, drowsiness, short term memory loss, confusion, weakness, lack of concentration, inability to take self care and lack of orientation in time and place. These usually wear off with time as the person recuperates. If the symptoms persist it is essential that the patient visit his/her doctor as soon as possible.
Can a person be immune or resistant to general anaesthesia?
Fortunately such occurrences are rare and one should not believe everything they hear, as they may not be based on medical facts. That being said, there are extremely rare genetic medical conditions where a patient may show resistance to anesthetic medicines. Apart from genetic factors there are patients who develop a resistance to the medicines used to induce anaesthesia. These are commonly patients who are repeatedly exposed to drugs; for instance drug addicts or patients who require multiple anaesthetics for a medical condition like severe burns. In these patients due to their repeated exposure to the same medicines, it may lead to a condition called enzyme induction where drugs are metabolised very quickly. Such patients are at increased risk of the anaesthesia wearing off too early.
What else can render anaesthesia ineffective or make it wear off too early?
Apart from the physiological reasons, other factors like improper storage of the vials of medicine may lead to less or no action of the medicine. In India lack of quality control in bulk drug manufacturing can also lead to spurious drugs being manufactured which may not have the desired effect.
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