A pediatric anesthesiologist deals with issues of pain relief and maintaining the child’s health during surgical operations, invasive diagnostic and therapeutic procedures. His task is to ensure maximum physical and psychological comfort for the little patient throughout the entire procedure. Many parents are more frightened by the need for general anesthesia for children than by the intervention itself. Anesthesiologists have many modern methods of pain relief that are well tolerated, which makes it possible to find the optimal anesthesia option for each small patient.
Indications for the use of anesthesia
Pediatric specialists try to choose the most gentle procedures for children that do not require the administration of potent drugs. Unfortunately, this is not always possible. Under general anesthesia, children undergo:
- surgical operations;
- interventions with a high risk of bleeding;
- extensive therapeutic procedures in dentistry;
- operations on the abdominal organs;
- invasive diagnostic procedures.
The use of general anesthesia is indicated in cases where, for some reason, it is impossible to administer local anesthesia or place children under sedation.
The effect of anesthesia on the body
04.10.2021
For many, the term “anesthesia” has a frightening effect. This is understandable, since under anesthesia a person is deprived of the ability to control his actions. For this reason, a large number of myths and rumors are associated with anesthesia. Whether anesthesia is really so harmful to the body and what this harm consists of is to be clarified within the framework of this article.
What is anesthesia?
During anesthesia, the central nervous system is in a state of inhibition. The main task is to eliminate pain sensitivity. This is achieved by using drugs called anesthetics. In order to understand how anesthesia works, you need to have at least some understanding of the mechanism of pain.
The human body is literally permeated through and through with pain receptors. They are designed to absorb any irritation. A pain signal is transmitted to the receptor. It is then transmitted along a nerve fiber to the spinal cord . Already from it, information enters the brain , which is the main computer of the human body. by the brain and transmitted to organs and tissues in the form of pain. Under the influence of anesthesia, such a chain is broken. This blocks the transmission of pain impulses. Next we should consider the types of anesthesia.
Anesthesia and its types
“Narcosis” and “anesthesia” are not identical concepts. During anesthesia, consciousness is switched off (general anesthesia). During anesthesia, pain is eliminated with the help of anesthetics. You can interrupt impulses absolutely anywhere. Various types of anesthesia are based on this principle:
- Superficial anesthesia. This is achieved by using local anesthetics. In other words, impulse suppression occurs at the initial stage.
- Local anesthesia . The nerve through which pain impulses are transmitted is blocked. An anesthetic is injected into the place where the operation . Already in the initial part of the nerve, the pain impulse is interrupted.
- Conduction anesthesia. It is similar to local anesthesia. However, the nerve blockage does not occur at the site of the operation , but at any part of it. Let's say an operation is performed on the upper limb. In this case, the anesthetic can be injected into the collarbone area. When performing anesthesia of this type, the doctor must have high skill and precision. The needle should not hit the nerve. Otherwise it can be seriously damaged. But if the drug is administered at a considerable distance from the conductor, then the desired anesthesia may not be achieved.
- Epidural anesthesia. The nerve is blocked where it ends and enters the spinal cord . The area between the lining of the brain and the spinal canal is called the epidural space. This is where the anesthetic is injected.
- General anesthesia. All brain functions are depressed. Impulses enter it, but after processing there is no command about pain.
Of course, the safest type is considered to be superficial and local anesthesia. Conduction anesthesia poses a great danger. But this type is used only for surgical interventions on the extremities. In terms of danger, it is followed by epidural anesthesia. It is used for operations on the lower half of the body. The greatest risk is associated with general anesthesia.
Some common myths
anesthesiologist can say reliably how harmful anesthesia is . But most of them are still inclined to think that anesthesia is really harmful. However, this harm should not be correlated with common myths. Some people believe that after anesthesia you may not wake up. Of course, this is a misconception.
Before the operation , the anesthesiologist will carefully calculate the dose that is necessary for a particular patient. In case of an error, it will be detected by devices that monitor the patient during surgery . There is an opinion that anesthesia reduces life expectancy by at least 5 years. It is not known who came up with this, but no research has been carried out on this subject at all. With a smooth course of general anesthesia, the harm to the body will be minimal. But do not forget that any surgical intervention is a serious stress for the body.
Of course, there is a risk of not waking up after anesthesia. But statistics show that this is possible only in one case in a quarter of a million operations. At the same time, the mortality rate from car accidents is 1 in 10,000 accidents.
Some argue that after anesthesia, memory deteriorates and the intensity of thought processes decreases. This is partly true. But this can be observed mainly in elderly patients. They usually have vascular pathology of the brain . Anesthesiologists must take all these features into account.
Published in Surgery Premium Clinic
Main types of anesthesia for children during operations and invasive diagnostics
General anesthesia, depending on the type of drug administration into the body, can be divided into three large groups.
- Inhalation or mask anesthesia. It is carried out using inhalational anesthetics. Medicines in the form of an air mixture are supplied through a special mask. This type of anesthesia is used mainly for diagnostic procedures, dental procedures, and short surgical interventions.
- Intravenous anesthesia. It is performed by introducing the required dosage of the drug into the baby’s circulatory system.
- Endotracheal anesthesia.
What group of drugs does Propofol belong to?
Propofol is a drug whose purpose is to induce and maintain general anesthesia, as well as sedation during mechanical ventilation. Chemically, Propofol (more precisely, its main active ingredient diisopropylphenol) is a phenol molecule with two isopropyl groups attached to it. It is not included in the groups of barbiturates or opioids, it is not a narcotic drug, therefore it is not characterized by the severe side effects of drugs from these groups.
Contraindications to general anesthesia in childhood
Planned operations and diagnostic procedures are not performed if the child:
- there are symptoms of an acute infectious disease;
- individual intolerance to anesthetics was previously identified;
- severe cardiovascular failure was diagnosed;
- eating within 5 hours.
Contraindications to the use of inhalation anesthesia are:
- severe respiratory distress;
- severe renal failure;
- increased intracranial pressure due to tumors in the brain, hydrocephalus.
In each specific case, the anesthesiologist individually assesses the ratio of possible risk and the need to use general anesthesia.
Recommended dose of Propofol
The dosage of Propofol depends on age, body weight, and various individual characteristics. The starting dosage for sleep induction for the average adult is approximately 40 mg every 10 seconds, or 2-2.5 mg/kg body weight. For children over 8 years of age, approximately the same dosages are used; for younger children, higher doses are possible.
The maintenance dosage to maintain anesthesia is 4-12 mg/kg/h for adults and 9-15 mg/kg/h for children.
How to select anesthesia for children
The most important stage of a child’s preoperative preparation is the search for the optimal type of pain relief. The anesthesiologist carefully studies the baby's medical history, collects anamnesis, identifies possible contraindications and risks in order to minimize the negative impact of general anesthesia on the child's body. When planning anesthesia, he takes into account:
- baby's age and weight;
- anatomical features of the respiratory tract;
- condition of the cardiac and respiratory systems;
- previous diseases and surgical interventions;
- congenital malformations;
- features of the birth of a baby (natural birth, cesarean section, complications during childbirth, etc.);
- genetic history of the baby (health status of immediate family).
Information collected during preoperative preparation helps the anesthesiologist choose the most gentle, yet effective option for general anesthesia, even for the youngest patients.
What types of heart surgeries are there?
During a palliative operation, another “defect” is surgically created, which the child does not initially have, but thanks to which the circulatory pathways in the large and small circles disturbed by the defect are changed. This includes surgical expansion of the atrial septal defect, all options for intervascular anastomoses - i.e. additional shunts, communications between circles. The Fontan operation is the most “radical” of all such methods; after it, a person lives without a right ventricle at all. For some of the most complex heart defects, it is impossible to correct anatomically, and surgical treatment aimed at correcting blood flow can be called a “definitive” palliative correction, but not a radical operation.
In other words, in case of heart defects, when the intracardiac anatomy - the structure of the ventricles, the state of the atrioventricular valves, the location of the aorta and pulmonary trunk - is changed so much that it does not allow for a real radical correction, today's surgery follows the path of eliminating poorly compatible conditions as early as possible. life of circulatory disorders, and then long-term palliation. The first stage of this path is saving a life and preparing for further treatment, and protecting against future complications, the second is the final stage of treatment. All together, this is a long path to the final operation, and on it it is necessary to overcome one, two, and sometimes three steps, but, ultimately, to make the child healthy enough for him to develop, learn, and lead an ordinary life, which this long-term palliation will provide for him. Check it out, not so long ago - 20–25 years ago this was simply impossible, and children born with defects of this group were doomed to death.
Such “final palliation” is the only way out in many cases; although it does not correct the defect itself, it provides the child with an almost normal life by improving the mixing of arterial and venous blood flows, completely separating the circles, and eliminating obstacles to blood flow.
Possible consequences for the child after general anesthesia
Exit from the sleep state largely depends on the level of health of the children, the type of anesthesia used and the specific drugs. The average time for full restoration of consciousness is from 1 to 2 hours, the return of cognitive functions is 1–2 days. During this period, the child is under constant medical supervision.
Modern anesthetics are quite safe, and serious negative consequences after anesthesia in children are rare. The most common problems are:
- nausea and vomiting;
- dizziness;
- mild disorientation;
- headache and muscle pain.
With the correct selection of techniques and drugs for anesthesia, high-quality preoperative examination and highly qualified anesthesiologist, the risk of problems is minimal.
Consequences and side effects
The drug is safer than many of its previously used analogues. However, it also has accompanying actions. Side effects of Propofol include:
- arterial hypotension (low blood pressure),
- bradycardia (slow heart rate),
- depression of respiratory function (up to short-term apnea).
In rare cases, convulsions, allergic reactions may occur, and after waking up - nausea, vomiting, and headache. The vast majority of patients have a completely normal reaction to Propofol.
To minimize side effects, a doctor should prescribe Propofol based on preliminary tests, which should determine how safe the use of this drug is for a particular patient.
In addition, constant monitoring of the patient’s condition under anesthesia and the availability of resuscitation equipment in the clinic, incl. apparatus for artificial ventilation of the lungs.
Propofol can only cause harm if the permissible dosage is exceeded. But provided that the drug is prescribed correctly and the anesthesiologist is equipped with all the means necessary for control, the occurrence of such a situation is excluded.
