Anesthesia came from the Greek words an- and –aisthesis which literally means “without sensation”. This is anything (usually of medical in nature) that brings temporary absence or diminished pain sensation and muscle relaxation during a surgical procedure. Along with the above mentioned effects, it is also popular for causing a phenomenon called “hypnosis”, which is medically defined as unconsciousness and loss of memory. These expected effects makes surgery inviting to consider for people who wish to prolong their lives when worst comes to worst.
The concept of anesthesia is basic yet a vital component of the health and medical field. Laymen are even aware of its general use, which is keeping the person as comfortable as possible in front of an aggressive medical management like surgeries and insertion of devices inside body cavities.
Anesthesia is widely used and forms a standard on what an ideal surgery looks like, but, its exact mechanism of action is still on a debate by the professionals. This is because anesthesia attacks the nervous system to have the desired effect, and we all know that if we talk of nervous system and brain, we are talking of theories, phenomenon and mysteries. The precise, the absolute, and the definite regarding anesthesia is yet to be discovered by the experts, the reason why every person subjecting themselves on the operating room tables are still subjects. But this is the only way available to prolong life outside the pills, injections and radiations.
The use of anesthesia was proven by experts to have started during the ancient period. Different cultures have their own story to tell regarding their medical practices, particularly, surgeries.
Quack doctors, voodoos, and shamans are known to discover the use of anesthesia. As time passes by, techniques and contents of anesthesia evolve, until its present standard.
Some of the notable persons in the history of anesthesia are the following:
- Theodoric Borgognoni—the first to induce unconsciousness through tropane and alkaloid mixtures.
- Karl Koller—the first to use cocaine as local anesthesia (eye surgery).
- August Bier—the first to use cocaine for intrathecal anesthesia.
- NicolaeRacoviceanu-Pitesti—the first to use opioids for intrathecal anesthesia.
- Raymond Lullus—discovered the first inhalation anesthesia.
- Joseph Priestley—discovered nitrous oxide.
- Crawford Long—the first to use ether as an anesthetic agent.
- Oliver Wendell Holmes Sr.—the first to coin the word anesthesia.
- James Young Simpson—the first to prove the efficacy of chloroform for anesthesia.
With the increasing number of dreaded diseases, the number of cases requiring surgery is also on the rise. Lumps, mass, injuries, fractures, and otheranatomical anomalies are the leading causes why the operating rooms exist.
It has been estimated that there are approximately 234.2 million cases of major surgeries being conducted worldwide per year¹. This means that surgery cases is one of the most conducted procedure in the health field and now become part of the normal activities of the human race. Although this figure is very high, this census is limited only to major cases, excluding the minor ones and undocumented cases which is logically have a higher percentage.
It is true that the field of surgery constantly improving, but, it doesn’t guarantee complete safety.
There are three basic types of anesthesia, these are:
- General anesthesia—this is commonly induced either via inhalation or injection (intravenous or through a vein). Inhalation type uses gas or vapor formulations and it is delivered via face masks. The intravenous type is either incorporated in the intravenous solution or bolus (undiluted). The use of general anesthesia is more advantageous than any other type for this brings hypnosis, one thing that is not provided by the other types. But since it brings unconsciousness, it implies respiratory involvement (may be depression) which imposes greater danger. General anesthesia is commonly used for major surgical procedures like abdominal and thoracic incisions and head surgeries.
- Regional anesthesia—this is commonly administered via intrathecal (in-between the spinal bones) route. This aims to paralyze, numb, and relax muscles and organs proximal to the operative site. The client may (with sedative incorporation)or may not be awake during the whole process of surgery. Two of the most typical examples of this are spinal and epidural anesthesia. Regional anesthesia is commonly used for surgeries of the lower limbs and surgeries on the lower abdominal areas.
- Local anesthesia—this is administered via injection of anesthetic agents to tissues within and around the operative site. This is indicated for minor surgeries. Typical examples of surgeries that require local anesthesia are excisions, suturing of superficial lacerations, and insertion of any material.
Risks and Complications
Like other medications and procedures, anesthesia use doesn’t hold the record of not having any unwanted effects. The significant number of cases of anesthesia-related problems may be due to patient-related factors, anesthesia/procedure-related factors, or both.
1. Patient-related factors
Some of the documented patient-related factors that are significantly affecting the census of mortality (death) and morbidity (illnesses) are the following:
- Nutritional status of the client;
- Respiratory, cardio, hepatic, and renal status of the client;
- Extreme age (too young-under 8 years old and too old-more than 65 years old);
- Circulatory status;
- Chronic use of alcohol, cigarette, and other substances;
- On a medication maintenance.
2. Procedure-related factors
- Type of anesthesia to be used (general anesthesia have higher risk than regional and local anesthesia);
- Urgency of the procedure (an immediate/emergency procedure have a higher risk than elective procedures);
- Length of the procedure (the longer the procedure, the more anesthesia is used, the higher the risk);
- Involvement of more body parts (the more tissues/organs involved, the higher the risk).
Some of the most common complications of anesthesia use are:
- Cardiac problems like myocardial infarction (MI);
- Respiratory problems like pneumonia, apnea (temporary loss of respiration), and pulmonary embolism;
- Renal problems like renal insufficiency and failure;
- Neurological problems like temporary-permanent cognitive dysfunction;
- Development of some allergies;
One of the latest trends in preventing and/or minimizing the unwanted effects of anesthesia was developed by the American Society of Anesthesiologists (ASA) known as the ASA Physical Status Classification System. This aims to categorize patients according to their health status then classify it under the 6-tier scale that they have. According to them, this gives idea on the surgeon on the overall status of the patient based on its physical status, which guides them in the possible modification of their actions within the procedure.
- ASA 1—this stands for “healthy person”. This is considered the best status in administering anesthesia or for surgery. It has the lowest tendency for the occurrence of possible complications.
- ASA 2—this stands for “mild systemic disease” or simply the person to be operated has a simple disease. Still, this type of client is subjected to anesthesia use and surgery with minimal caution.
- ASA 3—this stands for “severe systemic disease” of the person has a more severe disease but not yet considered to be fatal. The surgeon and anesthesiologist need to be more cautious on their actions for the client may develop a more severe complication if not attended properly.
- ASA 4—this stands for “severe disease that is constant to threat life” or the client has a fatal diseases that may either chronic or acute that continuously imposing danger. There is a thin demarcation on the possibility of survival for the patient, precision among the surgeon and anesthesiologist is a must.
- ASA 5—this stands for “a person who will not survive if no operation is done” or the person needs to have the surgery as soon as possible before it inflicts irreversible damage or death. This is a case requiring immediate surgical intervention and survival tendency is low even with minimal error.
- ASA 6—this stands for “a pronounced brain-dead person that will undergo surgery for organ donation purposes”. The client has no chance to survive even with the latest technology we have. The operation will be conducted to remove viable organs or specific organ which he had signed to donate before when he is still competent to decide.
Anesthesia use requires special attention from health care providers who handles the client. This is due to the possibilities of problems that might arise anytime. Nurses, since they are the front-liners of health care delivery, they must be knowledgeable and skilled enough to handle such case. among the basic things to consider are the following:
- Establishment of rapport and good relationship;
- Proper identification;
- Establishment of pre-anesthetic vital signs;
- Provision of learning needs of the client;
- Provision of or ensure presence of support system;
- Pre-operative or pre-anesthetic preparation of the client;
- Health education on what is expected before, during , and after the induction of anesthesia;
- Secure consent legally and ethically;
- Ensure safety upon administration of pre-anesthetic agents;
- Continuous monitoring of vital signs, mobility, response, and cognition of the client;
- Review of laboratory results, immunologic and hydration status, and the overall health status of the client;
- Preparation of emergency materials like resuscitation equipment and antidotes;
- Ensure continuous communication among health care team members;
- Maintaining safe environment for the client (even when awake/conscious);