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What Is General Anesthesia?

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    Posted: 01 Sep 2009 at 9:28am
What Is General Anesthesia?

General anesthesia, which is usually used for major surgery, produces an absence of pain and sensation in the entire body, loss of consciousness, muscle relaxation, and amnesia. These effects make complicated surgical procedures easier to perform. For instance, muscle relaxation and loss of consciousness prevent movement by the patient, helping doctors perform more accurate surgery. Surgery under general anesthesia is less traumatic for the patient because he or she remembers nothing about the procedure.

Anesthetic drugs must be administered throughout the length of an operation in order to maintain the proper depth of general anesthesia. Most commonly, general anesthesia is produced with a combination of several different drugs, each used for a specific effect, such as producing sleep, pain control, or muscle relaxation. General anesthesia often begins with the injection of a sedative medication, such as midazolam. A patient may also receive medications to reduce the production of saliva, which could cause choking, and of stomach acid, which could damage the lungs if inhaled. Propofol and sodium pentothal are common sleep-inducing drugs that are administered intravenously. These drugs act rapidly but their effect does not last long, so they are often used for the early stages of anesthesia. Anesthesia is then maintained for the length of the surgical procedure with longer acting drugs. Isoforane and desflurane are sleep-inducing drugs that are inhaled. They are mixed with oxygen in an anesthesia machine, then inhaled by the patient through a facemask. Nitrous oxide, a gas that produces light anesthesia when inhaled alone, is often used in combination with other anesthetic drugs to increase their effect. Commonly used muscle relaxants include curare and vecuronium, which work by blocking impulses from nerves to muscles. These drugs paralyze muscles throughout the body, including those involved in breathing. For this reason, doctors place patients who are under general anesthesia on a breathing machine. A pain-blocking drug such as fentanyl is also injected as part of general anesthesia.

Anesthetic drugs can have various side effects, including nausea and vomiting or changes in blood pressure, breathing, and heart rate. In addition, many surgical patients already have other illnesses, such as problems with the heart, blood pressure, lungs, kidney, liver, or nervous system. These problems can make anesthetic drugs more dangerous. To detect and correct any complications that may develop, an anesthetized patient’s blood pressure, heart rate and rhythm, blood oxygen concentration, breathing rate, exhaled carbon dioxide, and temperature are monitored throughout surgery. The patient is also observed for signs such as tearing, sweating, and wrinkling of facial muscles that can indicate anesthesia depth may be lightening.

Using a combination of anesthetic drugs enables doctors to use lower doses of each drug and maintain the proper depth of anesthesia while minimizing the risk of side effects. This strategy, along with better monitoring of anesthetized patients and the development of improved anesthetic drugs, has greatly improved the safety of anesthesia in recent years. In the last decade alone, the number of deaths attributed to anesthetic drugs has dropped 25-fold, to about 1 in every 250,000 general anesthesias.

Anesthesia is reversed simply by halting the administration of anesthetic drugs. Any remaining anesthetic gases in the body are gradually exhaled, and as their concentration in the body falls, consciousness returns. The muscle relaxant circulating through the body is removed by the liver and kidneys, and its effects can also be reversed with other drugs. Medications to control pain continue to be given after the operation.

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Contributed By:
Monica Winefryde Furlong, M.B., Ch.B., M.D.
Attending Anesthesiologist, Beth Israel Medical Center North, New York, NY. Author of Going Under: Preparing Yourself for Anesthesia.

"Anesthesia," Microsoft® Encarta® Online Encyclopedia 2009 © 1997-2009 Microsoft Corporation. All Rights Reserved.
© 1993-2009 Microsoft Corporation. All Rights Reserved.

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