Dr Satya Dev Gupta
16 October 1846, is considered to be a great day in the field of medicine particularly that of surgery. This was the day, when pain less surgery technique (Anaesthesia) was introduced by an American dentist, Sir William Morton, proved to the world that ether causes complete insensibility to pain during an operation performed in front of a crowd of doctors and students at the Massachusetts General Hospital. Morton instructed the patient to inhale the ether vapor and, once the patient was suitably sedated, a tumor was removed from his neck. The patient felt no pain. Thus more than 150 years ago William Morton successfully used diethyl ether as general anesthesia. Advances in anesthesia have made many new surgical techniques possible, and mortality directly attributable to anesthesia is now rare. Most recent advances have contributed to an important decrease in morbidity from anesthesia and to an increase in quality of preoperative, perioperative and postoperative management
In the practice of medicine (especially surgery and dentistry), anesthesia or anesthesia (from Greek “without sensation”) is a state of temporary induced loss of sensation or awareness. It may include analgesia (relief from or prevention of pain), paralysis (muscle relaxation), amnesia (loss of memory), or unconsciousness. A patient under the effects of anesthetic drugs is referred to as being anesthetized.
Anesthesia enables the painless performance of medical procedures that would otherwise cause severe or intolerable pain to an un-anesthetized patient. Three broad categories of anesthesia exist:
General anesthesia suppresses central nervous system activity and results in unconsciousness and total lack of sensation. Sedation suppresses the central nervous system to a lesser degree, inhibiting both anxiety and creation of long-term memories without resulting in unconsciousness. Regional anesthesia and local anesthesia, which block transmission of nerve impulses between a targeted part of the body and the central nervous system, causes loss of sensation in the targeted body part. A patient under regional or local anesthesia remains conscious, unless general anesthesia or sedation is administered at the same time. Two broad classes exist:
Peripheral blockade inhibits sensory perception in an isolated part of the body, such as numbing a tooth for dental work or administering a nerve block to inhibit sensation in an entire limb.
Central, or neuraxial, blockade administers the anesthetic in the region of the central nervous system itself, suppressing incoming sensation from outside the area of the block. Examples include epidural anesthesia and spinal anesthesia.
In preparing for a medical procedure, the health care provider giving anesthesia chooses and determines the doses of one or more drugs to achieve the types and degree of anesthesia characteristics appropriate for the type of procedure and the particular patient. The types of drugs used include general anesthetics, hypnotics, sedatives, neuromuscular-blocking drugs, narcotic, and analgesics.
There are both major and minor risks of anesthesia. Examples of major risks include death, heart attack and pulmonary embolism whereas minor risks can include postoperative nausea and vomiting and hospital readmission. The likelihood of a complication occurring is proportional to the relative risk of a variety of factors related to the patient’s health, the complexity of the surgery being performed and the type of anesthetic used. Of these factors, the person’s health prior to surgery stratified by the ASA (American Society of Anesthesia) laid down the guidelines for the (physical status classification system) has the greatest bearing on the probability of a complication occurring. Patients typically wake within minutes of an anesthetic being terminated and regain their senses within hours.
Epidural anesthesia for painless labour — what is it?
Delivering a baby can be scary for a new mother-to-be. Let alone the fear of what might happen during the process, but the amount of pain one is likely to feel. Let alone the fear of what might happen during the process, but the amount of pain one is likely to feel is considered immeasurable. But it is possible to have a normal birthing process without the pain – by the use of an epidural. With the advent of modern techniques the outcome is becoming better.
Pain Management – The role of the anesthetist
World-wide more than 4 million people are at present suffering from cancer pain, and many more from other kinds of pain. Pain remains an under-treated and neglected public health problem. Lately technological advances and greater understanding of the physiology and anatomy of pain have helped further progress in pain management but much is still empirical without a scientific basis. Since the fundamental component of the practice of anesthesiology in the treatment of pain, the anesthetist is the best person to understand pain and organize pain clinics.
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain’s widely used definition defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”; however, due to it being a complex, subjective phenomenon, defining pain has been a challenge.
In medical diagnosis, pain is regarded as a symptom of an underlying condition. While primarily dealing with the pain management of patients in pre and post operatively, the anesthesia specialists have developed a special aptitude towards the pain management.
The pain can be acute, with short duration produced by a stimulus is called as (1)Nociseptive, meaning usual pain perception as occurs in normal individuals in normal circumstances. This type of pain can be treated with the commonly used analgesic drugs.If pain is spontaneous and associated with tissue damage then is known as (2) Inflammatory(3) Neuropathic pain is also spontaneous and caused by neural tissue damage or a lesion of the nervous system.(4)Functional pain: hypersensitivity to pain resulting from abnormal central processing of normal input. 3rd and 4th type of pain are chronic cannot be treated with simple and traditional analgesics but needs other drugs and techniques as the pain fibers and receptors in central nervous system undergo modulation. (Pain in diabetes, cancer, neurological, neuromuscular pain etc. fall in this category)
The advent of anesthesia gave an impetus to surgical specialties in a big way; may it be simple or advance operations. In disaster management emergencies the role of anesthesiologist is pivotal in medical team in reviving the victims back to the life. ICU and critical care units are going to have further advancements and role of this specialist shall be more demanding and challenging.
(The author is Professor and Ex. Head of the Department Anesthesia and Intensive care unit, Government Medical College Jammu. )
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