Anesthesia - Regional Anesthesia And Sedoanalgesia

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Anesthesia - Regional Anesthesia And Sedoanalgesia
Anesthesia - Regional Anesthesia And Sedoanalgesia
Video: Anesthesia - Regional Anesthesia And Sedoanalgesia
Video: Epidural Anesthesia & Spinal Anesthesia | Regional Anesthesia 2023, February
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Regional anesthesia & sedoanalgesia

With regional anesthesia, a temporary anesthetic is applied to a specific area of ​​the body. This leads to the elimination of pain and inhibition of mobility. The medication blocks the transmission of pain through the nerves to the brain. In order to prolong the effect, a thin plastic tube (catheter) is attached to the nerves to be anesthetized. This can be used to administer drugs continuously or as a single dose. If the pain is only eliminated (without anesthesia and without muscle blockade), this is referred to as analgesia, e.g. epidural analgesia.

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  • What is spinal anesthesia?
  • Epidural anesthesia or epidural anesthesia
  • Combined spinal and epidural anesthesia
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  • Local anesthesia
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Clarification and education, general rules of conduct, procedures before the operation and monitoring of vital organ functions are the same for regional as for general anesthesia. Breathing aids and artificial ventilation are not provided. Since regional anesthesia is generally less of a burden for the entire organism than general anesthesia, they are often preferred. This is especially true for older patients, with an increased risk and for outpatient interventions with discharge on the day of the operation.

A distinction is made between several types of regional anesthesia, as it is possible to interrupt the conduction of pain at different points:

  • Near the spinal cord: The nerve block is performed in the area of ​​the back with the medication being administered into the spinal cord fluid or the space surrounding the spinal cord.
  • Peripheral: The medication is administered directly to the plexus or individual nerves with subsequent anesthesia and pain relief from, for example, the shoulder, arm or leg.
  • Local: The medication gets into the tissue, e.g. under the skin, which numbs nerve endings ("icing", local anesthesia).

With regional anesthesia, the patient can be conscious during the operation. In some operations, such as a knee joint mirroring, the patient can follow the process on a monitor. Most patients, however, do not want to experience anything from the operation and are therefore also given a sleeping pill.

What is spinal anesthesia?

Spinal anesthesia ("cross stitch") belongs to the group of regional anesthesia procedures close to the spinal cord. When doing this, the patient must sit bent forward and with a rounded back ("cat hump") - it is also possible to lie on the side on the operating table with knees bent. As a result, the individual vertebral bodies move apart and the intervertebral space becomes larger. This enables the anesthetist to insert a very thin needle into the spinal canal in the lower back. After administering a dose of anesthetic with or without additional medication, the needle is removed again. A spinal catheter can be inserted to prolong the effect.

Since the puncture site is locally anesthetized beforehand, the procedure is as painless as a blood sample. At first, a pleasant feeling of warmth is usually perceived in the legs; the nerve block then sets in within a few minutes. By positioning the body in a certain position immediately after the injection, the location, extent and effect of the spinal anesthesia can be controlled. The agent can be distributed in the spinal fluid in such a way that, for example, only the right leg is anesthetized. The anesthesia team usually uses a cold spray to check the level of spread.

Spinal anesthesia is possible for interventions below the navel. These include operations on the legs, pelvis, perineal area and lower abdomen.

Epidural anesthesia or epidural anesthesia

With epidural anesthesia (PDA), the anesthetic is not administered directly into the spinal fluid, but into the surrounding space (epidural or epidural space). The spread of the anesthetic effect depends on the level of the puncture site, the amount and concentration of the local anesthetic.

The performance of epidural or epidural anesthesia is similar to that of spinal anesthesia. However, it takes longer to take effect. The desired spread is controlled by carefully administering small single doses of medication. A catheter can also be placed during this anesthetic procedure.

This procedure is particularly well suited for operations in the upper abdomen, pelvis, genital area and on the legs. The method is also helpful if, for example, the operated leg is to be moved on a motorized rail after an operation or the blood circulation in the leg is to be increased. Another classic area of ​​application is obstetrics. In the so-called “fast track” abdominal surgery, patients should quickly get back on their feet and start eating. Medicines are administered via the epidural catheter placed on the upper back, which not only relieve pain, but also improve blood circulation in the bowel.

Combined spinal and epidural anesthesia

This method combines the advantages of both methods. First the epidural catheter is advanced and then the spinal anesthesia is applied. The anesthesia sets in quickly and can be extended as required.

Common complications can be:

  • Insufficient expansion of the nerve block and elimination of pain during the operation. In these cases, general anesthesia is used;
  • Bleeding or temporary pain at the puncture site;
  • Cardiovascular complications.

Rare to extremely rare complications are:

  • A headache,
  • Drug allergy,
  • Urinary retention,
  • Risk of falling,
  • Infections especially of the spinal cord,
  • excessive spread with pulmonary complications.

Note All of these rare complications are mostly temporary. Permanent nerve damage with paralysis or numbness are only known in isolated cases worldwide.

Peripheral regional anesthesia

The anesthetist first looks for the right spot or the nerves to be blocked. Either a nerve stimulator or an ultrasound device is used for this. Then the anesthetic is administered and the needle is removed or a catheter is placed. With the nerve stimulator, the patient feels rhythmic muscle twitching through small electrical currents. In contrast, with the ultrasound-targeted method, only the cool electrode gel can be felt on the skin. The ultrasound-targeted technique is being used more and more frequently because it allows the target structures to be injected with the anesthetic directly under visual control and neighboring sensitive body parts can be spared.

The regionally limited nerve block is only fully developed after 15 to 30 minutes. From this moment on, the operating area is numb. Due to the time it takes to take effect, peripheral nerve blocks are sometimes applied outside of the operating room in the preparation area. The effect lasts for up to several hours, depending on the local anesthetic and any additives. Arms or legs cannot be moved during this. Peripheral regional anesthesia is well suited for interventions in the shoulder, arms and legs. It is also used less often in the breast area. Possible rare complications include nerve damage, bruising, and infection in the area of ​​the puncture.

The risk potential is lower than with general anesthesia and regional anesthesia near the spinal cord. However, even this anesthetic procedure is not without possible side effects.

Common complications can be:

  • Insufficient expansion of the nerve block and elimination of pain during the operation. In these cases, a general anesthetic is used.
  • Bleeding or temporary pain at the puncture site.

Rare to extremely rare complications are:

  • Drug allergy
  • Seizure
  • Infections, especially of the spinal cord

Note All of these rare complications are mostly temporary. Permanent nerve damage with paralysis or numbness are only known in isolated cases worldwide.

Local anesthesia

Local anesthesia (local anesthesia) is a small area anesthetic. The sensation of pain is switched off in a certain area for a certain time. Local anesthetics act directly on the branches of the nerve endings in the subcutaneous tissue and inhibit the transmission of pain impulses there.

This means that minor operations or examinations can be carried out painlessly. Consciousness and motor skills (ability to move) are retained.

The two most important forms of local anesthesia are surface and infiltration anesthesia. In most cases, they are carried out by the doctor performing the operation or examining them.

  • Surface anesthesia : Local anesthetics are applied to the mucous membranes, cornea or conjunctiva as a spray or in the form of drops using cotton swabs. Typical areas of application are gastroscopy and eye examinations.
  • Infiltration anesthesia: Active ingredients are injected into the skin of the operating area in a fan shape, for example during dental treatment or before removing a birthmark.

Note The most common complications of local anesthesia are allergic reactions.

Sedoanalgesia

Sedo analgesia is often given in addition to regional anesthesia procedures. A sleeping pill is injected, which also has an anxiolytic and calming effect. Sometimes this is done in combination with a pain reliever. This gives rise to the term “sedoanalgesia” (sedative = calming; analgesia = pain elimination). Since these drugs affect breathing and circulation, monitoring is necessary as with general anesthesia. This means that the anesthetist can react to critical situations at any time.

Monitoring ("stand by")

During interventions under local anesthesia by the surgeon, an anesthetist can be called in to monitor vital organ functions. In “stand by” so to speak, this specialist can intervene in dangerous situations, for example in the case of very seriously ill patients.

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