Point of no return. Is it possible not to wake up after anesthesia?

According to statistics, every person experiences anesthesia at least once in their life. Is it dangerous to turn off consciousness and what are the most dangerous consequences?

Boris Teplykh, head of the department of anesthesiology and resuscitation, tells the story

Lidia Yudina, AiF: Boris Anatolyevich, anesthesiologists and resuscitators are responsible for patients in critical condition. What it is?

Boris Teplykh : A critical condition is instability, a “gray zone” between health and severe damage to organs and life support systems. The doctor’s task is to prevent a critical condition from turning into a tragedy, for example, from clinical death turning into physical death.

Team spirit

— What is more important for saving such a patient—the availability of resuscitation equipment or the experience of the doctor?

- Only a doctor can support a patient in critical condition, and the patient must be in the intensive care unit or operating room - under constant hardware monitoring, within walking distance of specialists.

It is impossible to say which is more important. Modern medicine is team medicine. To save a patient, a team of highly qualified doctors, modern equipment and a manager who will connect them in time must converge at one point. Much depends on the patient’s condition. At any level of medicine there will be patients who cannot be saved.

“Some patients may remain in critical condition for decades. How does a doctor understand that the point of no return has arrived?

— A person can remain in a coma for decades; this condition is tragic, but not critical, since it is stable and does not require continuous maintenance of life. Modern equipment and care methods really make it possible to support the patient for months and even years.

Brain death is considered the point of no return. This diagnosis is made based on a clinical protocol that confirms the lack of blood flow to the brain.

Request stop. Who needs to “slow down” their life Read more

— In TV series there is usually a hero who spent several years in a coma and then came back to life. How often does this happen in life?

— It all depends on the level of neurological deficit in which the patient was. If it is insignificant, after some time the person returns to high levels of consciousness. If there is no blood flow, the brain is dead. All cases of miraculous healing are associated with imperfect diagnostics (limitations in technology), when one condition is mistaken for another.

— Most people encounter anesthesiologists only before surgery and know them as specialists who give anesthesia. Many people are afraid of not waking up after anesthesia. How justified is this fear?

— At the dawn of its appearance (from the end of the 19th to the middle of the 20th century), anesthesia was akin to a parachute jump. Nobody knew whether the parachute would open (the patient would wake up after anesthesia) or not, since doctors could not calculate the exact dose of the drug that would ensure stable breathing and blood circulation, and had no idea what doses could lead to what consequences. But the doctors deliberately took risks, because surgery without anesthesia is a guaranteed death from painful shock.

Now we can more accurately calculate the dose of anesthetic and monitor its level in the blood during surgery. Therefore, the risk of being hit by a car is higher than the risk of dying from anesthesia. Fatal complications of anesthesia do not exceed 0.69 cases per 100 thousand anesthesia cases.

Is anesthesia dangerous? Expert - about myths and real medical practice Read more

Why are different patients given different anesthesia for the same type of surgery?

— The doctor’s task is to choose an anesthesia that allows you to control the problems that a person may experience during pain relief. For example, vanishing lung syndrome is well known to all anesthesiologists, in which, with any change in pressure, they rupture. In such cases, we try to avoid general anesthesia, even if it is inconvenient for the surgeons. We try to give nursing mothers anesthetics that will not pass into breast milk.

Everyday moments are also taken into account. Some patients are categorically against turning off consciousness, others do not even want to see transport to the operating room, but want to close and open their eyes in the ward.

Article on the topic

...Why is a colonoscopy done without anesthesia?

Anesthesia: myths, risks, opportunities

Anesthesiologists have long stopped telling patients: “You won’t tolerate anesthesia.” Among modern methods of anesthesia, the optimal option can be selected for each patient, minimizing the risks of complications. Vsevolod Luchansky, anesthesiologist-resuscitator, head, told the Sibmeda portal about how this happens. Department of Anesthesiology and Reanimation of the Federal State Budgetary Institution "Federal Center of Neurosurgery".

Many people are biased towards general anesthesia: some are too afraid of general anesthesia and are confident of its mortal danger to the body, others, on the contrary, are ready to “fall asleep” even during not the most complex medical procedures. The reality is that most people go through general anesthesia at least once in their lives - and therefore, it is important for patients to know what it is like today. Deep sleep of the patient during surgery is very important, but the main task of the anesthesiologist is to maintain normal vital signs of the body - breathing, heartbeat, blood pressure and much more. Many experienced specialists compare the work of an anesthesiologist with the work of a civil aviation pilot, to whom passengers entrusted their lives during the flight.

– How justified are the patient’s fears of not being able to tolerate anesthesia?

– Question: “Will I tolerate anesthesia?” I'm at least 50 years late. Today there is no such anesthesia that one can “not tolerate.” We have methods for working with everyone, even with severe patients with complex concomitant pathologies. The main question that has to be resolved when discussing severe cases is whether the patient will tolerate surgery.

Today, the tactics of anesthesia have changed greatly - modern painkillers have appeared, there are additional methods of local anesthesia - epidural, spinal anesthesia. There are injectables that turn off consciousness without affecting everything else. There is a set of measures to support and prosthetize those functions that suffer the most in the presence of concomitant pathologies. There are special techniques used in special cases, such as xenon anesthesia for patients with severe concomitant cardiac pathology. Professor A.Yu. reported on such a case of removal of a brain tumor under xenon anesthesia in a young patient with concomitant severe heart disease. Lubnin from the Institute of Neurosurgery named after. N.N. Burdenko - the operation was successful, the patient woke up immediately after its completion.

Today, a very wide range of techniques is used, so for a long time we no longer tell the patient’s relatives: “he will not tolerate anesthesia.”

– There is an opinion that anesthesia shortens life. This is true?

– The idea that anesthesia shortens life is also a myth. Its origin dates back to the very beginning of anesthesiology, to the times when anesthesia was carried out with drugs such as ether and chloroform. The means that are used now do not lead to negative consequences. Modern patient monitoring allows you to quickly and accurately manage the patient’s condition, focusing on changes in vital signs in real time.

– Now in surgery there is a tendency to use “gentle” techniques and minimally invasive interventions. What are the “trends” in anesthesia?

– Minimally invasive surgery is a worldwide practice. Operations are carried out through small incisions, punctures, and anesthetic management responds to these trends. For such operations, “light” surface hypnosis is often used.

However, in neurosurgery one cannot do without invasive, hours-long operations. Neurosurgeons cannot remove a brain tumor using a minimally invasive method, so here we are forced to use deep sleep, strong anesthesia, aggressive methods of hemodynamic control, muscle relaxation and mechanical ventilation. A variety of means and methods allows you to choose the best option for the patient in each individual case.

It can be considered an achievement that carrying out such operations today does not take as much time as before. The devices the surgeon works with have a very precise navigation system that allows them to determine the size and location of the tumor down to the millimeter. This also affects the "gentle" characteristics of anesthesia.

– I believe that coming out of anesthesia has also become easier thanks to modern drugs.

– Of course, they make the procedure more tolerable. Although, to be honest, as an anesthesiologist, I’m not too concerned about whether a person will wake up easily or not easily. It is important for me that the body remains stable during the operation, there are no changes in hemodynamics, there is no pain impulse, there are no negative consequences. The quality of recovery from anesthesia is not the most important task.

– Is it always easy to keep the body in a stable state and what difficult cases do you encounter in your practice?

– In fact, there are many difficult cases. They begin with such a problem as mastering a difficult airway, when the patient cannot undergo tracheal intubation and artificial ventilation. Unforeseen difficulties in ensuring airway patency can arise in any patient.

The problem of mastering difficult airways is one of the most important in anesthesiology: a lot of research and scientific developments are devoted to it. To help anesthesiologists, high-tech equipment has been created that allows them to control all processes. In centers that are equipped with it, the risks of tragic consequences are minimized.

The second problem that can cause severe complications is large surgical blood loss. When surgeons cannot quickly stop bleeding, anesthesiologists help replace blood loss, control clotting factors, etc. These are complex technologies that require modern diagnostic and correction techniques.

The third problem is difficult, long-term operations with great trauma and an unclear neurological prognosis. Major surgery that requires major anesthesiology.

– I suppose the patient’s age can also become a critical factor?

– Rather, it is not the patient’s age, but concomitant diseases that can cause difficulties. In elderly patients, coronary heart disease, hypertension, diabetes mellitus, and widespread vascular atherosclerosis are more common. This requires special approaches to anesthesia and postoperative therapy. For example, in the treatment of heart and vascular diseases, patients now often have stents installed. After this, from three months to a year it is necessary to take antiplatelet agents - drugs that reduce blood clotting. But, naturally, this causes difficulties when the need for neurosurgical operation arises during this period, so the anesthesiologist and surgeon need to choose the right tactics.

When they talk about an individual approach to each patient, this is exactly what is meant – taking into account all the characteristics of the patient’s condition, age, anatomical, characterological, concomitant and background diseases. In complex cases, a council with the participation of many specialists gathers to decide how to manage the patient, taking into account the initial status, surgical risk and possible outcomes.

– Everyone knows about the fatal danger of anaphylactic shock, which can be provoked by anesthesia. Is it possible to predict its development?

– No matter how hard we try to reduce the amount of drugs used during anesthesia, it remains quite large. It is impossible to predict anaphylactic shock, because it can develop in response to the first administration of any drug. The rapid response of staff and modern hardware and medication support play a decisive role in this situation. In my practice, there have been cardiac arrests a couple of times as a result of individual intolerance to drugs, and in both cases we were able to cope with the formidable complication without harm to the patient.

– How do modern technologies help anesthesiologists and do they meet international standards in Russian surgical centers?

– Our center is fully equipped with everything necessary. I think that we fully correspond to the international level of equipment, I saw myself that foreign operating rooms have exactly the same monitor systems and anesthesia machines. However, developed Western countries continue to be the leaders in the development and implementation of healthcare solutions. As soon as innovations enter the market, we introduce them ourselves with a slight delay. Therefore, the lag is actually minimal. Another thing is that the availability of modern high-tech care is still far from ideal; society’s needs for high-tech hospitals like ours are very great.

– Are there precise “protocols” for administering anesthesia or is the tactics determined by the anesthesiologist in each specific case?

– There are recommendations from leading clinics on methods of anesthesia for different categories of patients with various pathologies. Their nuances are discussed at conferences, described in articles and dissertations, so the main features of various types of pain relief are well known. In our work, we focus on protocols for the management of anesthesia in neurosurgical patients, developed at the Institute. Burdenko. However, despite this, anesthesia is always an individual work of an anesthesiologist with a specific patient; it is not calculated simply “by body weight.” The result depends on the experience, literacy and skills of the anesthesiologist and his understanding of what is happening with the patient at each moment. In our specialty, the level of equipment in the operating room is very important, the availability of high-quality monitors, anesthesia machines, consumables and many other things that make anesthesia safe for the patient.

Anesthesiologists are responsible for sleep, pain relief, muscle relaxation, and prosthetic breathing for the patient. Throughout the entire surgical intervention, they monitor the patient’s condition - assess respiratory function, depth of anesthesia, depth of pain relief, level of relaxation, etc. If you maintain all indicators at normal levels, monitor blood pressure, breathing, and the absence of hypoxia, the patient will emerge from anesthesia in a normal state.

Anesthesia, like any administration of drugs, is, of course, a load on the body, although it cannot be compared with surgical stress. Modern approaches to anesthesia call for optimizing this effect and refraining from administering any drugs without strict indications. For example, anesthesiologists often administer diphenhydramine before surgery because it is thought to be calming and prevent allergic reactions. In reality, its main effect is a heavy head upon waking. We do not administer this drug and do not feel any difference.

My position is to minimize pharmacological aggression. I am happy every time I can remove one or another drug from the anesthesia regimen, reducing the effect on the body. The fewer drugs, the better, in fact, because each of them has its own range of side effects, and their interaction with each other can have unpredictable consequences.

– Now many procedures are offered to be performed under anesthesia. This is common today in dental treatment, for example. In your opinion, is this justified?

- Absolutely unjustified. The fact is that general anesthesia always has and will have complications.

When we talk with a patient when making decisions about anesthesia, we evaluate the situation in terms of risk. There is a risk of surgery, there is a risk of anesthesia and the risk, for example, that coronary heart disease will lead the patient to a heart attack during surgery - and we must balance all these risks.

If the balance is not in favor of the risk, and it is possible to get by with local anesthesia, you should do so. Of course, there are not many tragic situations - but they still happen from time to time and are discussed in a professional environment. When a person came for a minor operation and suffered brain death, for example.

At our clinic, anesthesiologists have the latest equipment and instruments at their disposal. In addition, we have seven operating rooms and a whole team of anesthesiologists and resuscitators. If we are faced with a critical situation, we have the maximum opportunity to get out of it without consequences. Is it possible to organize such a powerful service in a small dental clinic? I doubt.

Anesthesiologists have a saying: intubate once, intubate twice, intubate three. Did not work out? Call a colleague. The Center for Neurosurgery, in seven operating rooms equipped with the latest technology, employs an experienced team of anesthesiologists and resuscitators. At any time, several specialists can join in solving problems that have arisen and jointly solve these problems.

– They say that almost half of the success of an operation depends on the anesthesiologist. How do you think?

- Hard to tell. For example, a surgeon has a goal - to remove a brain tumor. If the surgeon cannot do this, the anesthesiologist will not help him. The goal, in any case, is achieved by the surgeon and depends only on him. The normal well-being of the patient and the functioning of the body during the operation depend on the anesthesiologist. In the end, of course, these different things add up to one common achievement.

What comparison should I make? The surgeon, like a captain, guides the ship to its goal. And the anesthesiologist makes sure that it doesn’t sink.

Safety and comfort

— Usually the patient does not have the opportunity to dictate terms. More often than not, a person does not even know what kind of anesthesia he will undergo.

— The doctor always tries to take into account the patient’s comfort, if it does not contradict medical indications, because the result of the operation largely depends on his mood. If the anesthesiologist understands that his wishes will not allow him to perform high-quality pain relief, he tries to explain this and convince the person.

— What type of anesthesia is the safest?

— As our teachers said, the one that the anesthesiologist speaks better. And it suits a specific patient for a specific operation.

— Lately there has been a lot of talk about the unreasonable use of anesthesia. For example, why treat teeth under general anesthesia or give birth under epidural anesthesia? Isn't it easier to endure?

— Everyone’s pain limit is different. When deciding whether to use anesthesia, we base it on how close the expected pain is to the threshold of intolerance. If we take a scale from 0 (no pain) to 10 (maximum), then for pain of 3 points it is recommended to use anesthesia.

Prolonged acute pain cannot be tolerated. Subsequently, this can lead to the development of chronic pain syndrome, which will never go away on its own. Often, being patient means getting severe post-traumatic disorder and subsequently ruining the lives of yourself, your loved ones and other innocent people. And this is much more dangerous than the hypothetical risk of anesthesia.

Click to enlarge

The effect of general anesthesia on humans

Contents
hide

The effect of general anesthesia on humans

Is it possible to wake up during surgery?

Is it true that general anesthesia shortens life and by how much?

Anesthesia is a rather crude intervention in the normal functioning of the body. But in the modern world it no longer poses such a danger as it did before. According to doctors, the diseases that people suffer from are much more dangerous than pain relief.

The first successful operation using general anesthesia was performed in 1846. At that time, the US doctor Morton successfully used ether anesthesia to remove a tumor. Russian doctor Nikolai Ivanovich Pirogov used it in 12847. By the way, anesthesia and anesthesia are not the same thing. Anesthesia is a tool for causing the human body to lose sensitivity to external factors. This state is called anesthesia.

Medicinal sleep does not protect the patient from pain. Any of modern anesthesia has many components and includes a number of painkillers. Nowadays, anesthesia makes it possible to remain in a vegetative state for quite a long time. For this reason, doctors can perform complex, hours-long operations.

Now there are many types of anesthesia and anesthesia, and doctors, when preparing for a planned operation, choose the most suitable option for the patient.

Ways to increase the safety of anesthesia

Hardman and Moppett, in their article “To err is human,” wrote: “Errors are an inevitable part of anesthesia. An anesthesiologist is a person, and humans make mistakes” (17). This is why, despite the continued decline in anesthetic mortality, there is still a need to improve patient safety during anesthesia. The adoption of the Helsinki Declaration of Patient Safety in Anesthesiology by the European Board of Anaesthesiology (EBA) and the European Society of Anaesthesiology (ESA) is only one step in the right direction (23). This declaration obliges all medical centers that provide anesthesia care to take prescribed measures to improve patient safety during anesthesia.

One of the main points of development is the optimization of the education and training of anesthesiologists (18). Moreover, they should include not only the development of individual specialized skills, but also the simulation of full-fledged clinical situations (19,20). In addition, we consider it necessary to remind our readers of the minimum requirements established by the German Federal Court, for example, they established that anesthesia must be performed by an anesthesiologist, i.e. a specialist who has undergone special training. It is acceptable for anesthesia to be performed by a doctor of another specialty if there is no other option, and the anesthesiologist is available, albeit at the level of verbal contact (24).

WHY PEOPLE AFRAID OF GENERAL ANESTHESIA

The modern history of plastic surgery begins at the end of the 19th century, when new surgical instruments were developed, antiseptics appeared, and anesthesia began to be actively used. Agree, it’s somehow strange to go through pain and suffering to improve your appearance, in fact, to improve your quality of life. It was only when anesthesiology reached its peak that women went in droves for rejuvenation.

The first plastic surgeries were performed under local anesthesia, and their radicality was minimal and their effectiveness was moderate. For example, anti-aging facial plastic surgery consisted of excision of a small strip of skin in front and behind the ear and suturing the wound: no detachment, no SMAS lifting, just skin. This rejuvenation could be performed annually.

As the operation became more complex, so did the anesthesia. Today we have the opportunity to safely carry out serious complex operations aimed at correcting all parts of the face. The duration of anesthesia can be from one to eight hours. All types of pain relief can be divided into local, regional and general.

Is it possible to wake up during surgery?

There are rumors among the people that the patient can wake up during the operation and hear the doctors talking. But anesthesiologists say that this is fiction, since the state of the human body during surgery is monitored by sensors that show the smallest changes in the functioning of the body.

But the greatest fear among people who are about to undergo surgery is the information that general anesthesia reduces life expectancy. Is it so?

Complications of general anesthesia

The risk of aspiration during general anesthesia has remained unchanged for decades, ranging from 1 in 2000 to 1 in 3000 procedures; Pregnant women after the second trimester have a slightly greater risk, approximately 1 in 1000 (9,10). Although recent studies have shown a decrease in the incidence of aspiration in pregnant women (8). Fortunately, the mortality rate from bronchopulmonary aspiration is low and the dreaded acid-associated pneumonitis (Mendelssohn syndrome - chemical pneumonitis, massive bronchospasm, significant impairment of gas exchange, approximately 8% of all aspirations, mortality approximately 3%) is quite rare.

It appears that pressing on the cricoid cartilage, as we have been taught so far, does not prevent aspiration. not likely to prevent aspiration. Although the administration of antacids, H2 antagonists and proton pump blockers reduces the risk of aspiration of gastric contents with a pH <2.5. However, this does not improve outcome after aspiration (9).

Current evidence suggests that a small exception to the “nothing by mouth” rule (avoiding everything, even clean water, 2 hours before the start of anesthesia) does not increase the risk of aspiration (11).

Many patients fear intraoperative awakening: if the patient remembers events that occurred during surgery, this can lead to chronic psychological problems (10). The risk of awakening is 0.1-0.15%, it increases in young girls, as well as cardiac and obstetric patients, amounting to 0.26% (12,13). The risk of developing long-term neuropsychological disorders as a result of intraoperative awakening ranges from 10 to 33% (11). It is believed that the phenomenon of awakening is not so dangerous if it is not accompanied by pain (11). Sufficient depth of anesthesia and use of muscle relaxants may help avoid awakening.

Muscle relaxants are an independent element of anesthesiological practice. They facilitate tracheal intubation and improve the surgeon's working conditions during abdominal and endoprosthetic operations, especially in emergency surgery. Arbous et al (7) statistically estimated that the use of muscle relaxant antagonists at the end of surgery may help reduce mortality. This allows us to draw an indirect conclusion that Residual Curarization in the postoperative period negatively affects the outcome of the intervention.

The risk of postoperative pulmonary complications is associated with:

• Increasing age
• Increasing the duration of the operation
• Operations on the abdominal organs
• Using the long-release muscle relaxant pancuronium
• Deep muscle relaxation (12).

FEAR ONE: “I’M AFRAID OF NOT WAKING UP AFTER GENERAL ANESTHESIA”

This is why some patients ask to have the operation performed under local anesthesia or a “lighter” intravenous anesthesia.

Let it be known to you that endotracheal anesthesia, when the machine breathes for the patient, is the most controlled, manageable and safe. Thanks to the endotracheal tube, the patient's tongue never sinks - which is precisely what intravenous anesthesia is dangerous for.

There was a sad situation in my life when my friend died after a gynecological operation due to retraction of the root of the tongue. They didn’t keep track of the position of the lower jaw, and oxygen stopped flowing into the respiratory tract.

It is to control the state of breathing even during intravenous anesthesia, for example during minor operations lasting up to two hours, that our anesthesiologists always use air ducts or laryngeal masks, which help control the position of the lower jaw and the root of the tongue.

Modern anesthesia machines are sensitive to the slightest change in pulse, pressure and oxygen level in the patient’s blood. In case of danger, they sound such a siren that it is simply impossible to miss this state. In addition, almost all drugs used by anesthesiologists for anesthesia have antidotes: substances that neutralize them. So, I hope I managed to dispel this fear.

Recommendations for preparing for anesthesia:

• Stop smoking at least a few days before surgery - this way you will significantly reduce the risk of respiratory complications during surgery

• do not drink alcohol for several weeks before surgery

• exclude the use of new or “controversial” products, so as not to disrupt the gastrointestinal tract

• inform the anesthesiologist about the slightest deviations in health: dizziness, pain, weakness, anxiety, etc.

How does a patient recover from anesthesia?

• After the anesthesia ends, the patient regains consciousness - reaction, sensitivity, and muscle function are restored.

• In the first hours after surgery, the person is under the strict supervision of an anesthesiologist and other specialists.

• At first, the patient is given an anesthetic to smoothly exit the state of drug-induced sleep and dull the pain.

• To restore blood volume, infusion therapy with electrolyte solutions is performed.

• As a rule, already on the second day after surgery, the patient is transferred to a specialized department, where doctors continue to monitor him.

• Side effects of recovery from anesthesia may include dizziness, headache, and mild nausea. But in general, the condition is tolerable, especially against the backdrop of positive emotions from the transformation.

Epidural anesthesia: pros and cons

Thanks to epidural anesthesia, when an anesthetic is injected into the space along the spinal canal, contractions become less painful and labor is noticeably calmer - while the woman is conscious.
With a good dose calculation, sensitivity disappears almost only in the pelvic area, but sensations in the legs and the ability to move them remain. This anesthesia is also called walking epidural, although in fact you won’t be able to walk - your legs will be weak, and sensors or catheters on different parts of the body will not allow you to go far. The psychological aspect is also important: when you know in advance that it won’t hurt, it’s much easier to relax and not worry. According to Oleg Karmanov, with epidural anesthesia already performed, it is faster and easier to proceed to an emergency caesarean section, if necessary: ​​you will not have to waste time on pain relief. But you can’t always rely on epidural anesthesia; at a certain stage of labor it is already too late to perform it. The method has a number of contraindications, including intervertebral hernia and serious circulatory and coagulation disorders. Dangerous complications of epidural anesthesia are extremely rare.

To operate or not?

This is the strangest thought that comes to the mind of a suspicious person who finds out that anesthesia can shorten his life by several years. After all, most often he simply has no choice. He is forced to undergo surgery, exposing himself to all sorts of risks and unwittingly “giving up years of his life to anesthesia,” because otherwise he could simply die from a disease that cannot be treated conservatively.

A conversation with an anesthesiologist usually takes place after the operation has been scheduled and its need has been clearly defined. And the task of the anesthesia specialist is to calm the patient, eliminate his unnecessary fears and set him up for a successful outcome. Therefore, when a patient asks an anesthesiologist how many years of life anesthesia will take away from him, the doctor may laugh it off by answering: “How long do you plan to live?” or something like that. But it is hardly possible to get a direct answer with a specific figure from the anesthesiologist, because it is not in his interests to frighten the patient.

Another thing is people who consciously decide to undergo surgery. Usually this is plastic surgery aimed at solving aesthetic rather than medical problems. For those who go for it, doctors are sure to explain the harm of general anesthesia. And if the patient has health pathologies, but still wants new breasts, nose or ears, the anesthesiologist may well threaten by shortening his life.

It is very difficult to associate any diseases that develop after surgery with anesthesia. In any case, this is a complex effect, which necessarily includes a person’s own attitude towards his health and love for life. In addition, anesthesia is improving every year. Or rather, the composition of drug mixtures is improving. These are purer substances that have minimal impact on the body. Of course, there is harm, but expressing it in years and subtracting them from life is wrong.

Complications of regional anesthesia

In recent years, regional anesthesia has become a very important part of anesthesia. The use of regional anesthesia for intraoperative analgesia and postoperative pain relief has played a huge role since prolonged regional blockade has been proven to provide the most effective analgesia after surgery (13, 14).

But, despite this, when determining indications for regional anesthesia procedures, it is necessary to remember possible complications: nerve damage and paraplegia after central blocks, as well as infectious complications. In addition, many surgical interventions cannot be performed using only the regional component, and general anesthesia is necessary.

The most severe complication associated with central (neuraxial) blockade is permanent paraplegia. The incidence estimated from retrospective studies is 1 in 150,000 to 220,000 procedures, which is slightly lower than recent studies (15,16). A study of more than 1.7 million patients found that the risk of developing an epidural hematoma is 1 in 200,000 procedures in obstetric practice, and 1 in 3600 in orthopedic surgeries in women. The average risk is 1 in 10,300 procedures (14). Another single-site study of 14,228 epidurals found a risk of hematoma of 1 in 4,741 procedures, with epidural hematomas occurring only after lumbar puncture. Although none of the patients showed permanent neurological damage (13). A 2009 publication estimated the risk of long-term paraplegia or death from neuraxial blockade to be 0.7 to 1.8 per 100,000 procedures. Two thirds of paraplegia are transient (15). Prolonged epidural anesthesia requires constant neurological monitoring, as early diagnosis and immediate intervention (laminectomy) can prevent long-term neurological damage. A large review of 32 studies performed from 1995 to 2005 analyzed neurological complications after regional anesthesia (16). The review cited the risk of neuropathy after spinal anesthesia as 3.8 per 10,000 procedures, and for epidural anesthesia 2.19 per 10,000. Moreover, for spinal anesthesia, the risk of permanent neurological problems according to various studies ranges from 0 to 4.2 per 10,000 procedures, and for epidural anesthesia from 0 to 7.7 per 10,000.

The following risk factors for the formation of epidural hematoma were also identified:

• Taking anticoagulants
• Coagulopathies
• Female
• Age > 50 years
• Orthopedic surgeries
• Ankylosing spondylitis
• Kidney failure
• Large number of punctures and catheter movements (17).

To reduce the risk of epidural hematoma formation, it is recommended to adhere to strict anticoagulant guidelines in regional anesthesia practice (18).

Transient neurological deficit after peripheral nerve blocks occurs in 2.84 cases per 100 procedures (interscalene block), 1.48 per 100 (axillary block) and 0.34 per 100 (femoral nerve block) (16). In 16 studies examining neurological complications after peripheral blocks, only one case of permanent neuropathy was reported.

Infectious complications are another risk inherent in prolonged catheter-based regional anesthesia techniques. Severity ranges from mild local infection to epidural abscess. The German Society for Safe Regional Anesthesia, formed by the German Society of Anesthesiologists and Resuscitators, as well as the German Professional Association of Anesthesiologists, based on uniform standardized documentation, calculated the risk of infectious complications of catheter techniques. A total of 8,781 catheter procedures (22,112 catheter days) were studied (19). Of these, 5057 are neuraxial techniques and 3724 are peripheral catheter techniques. A total of 4 severe, 15 moderate and 128 mild infectious complications were registered. Neuraxial techniques were found to be associated with a higher risk of infection compared to peripheral techniques (2.7% vs 1.3%).

In addition, risk factors are:

• Multiple skin punctures instead of one (4.1% vs 1.6%)
• Length of time the catheter is in place
• Poor general condition of the patient.

Perioperative antibiotic use or diabetes mellitus were not associated with an increased incidence of infectious complications.

Direct influence

Indeed, to put a person under general anesthesia, substances are used that dull the activity of the central nervous system. Muscle relaxants and painkillers are also necessary for successful operations. Such a chemical “cocktail” cannot but affect a person’s health, therefore, before surgery, the patient is carefully examined, and afterward they are given strong recommendations regarding lifestyle corrections.

The consequences of general anesthesia that most often affect human health are:

• cardiovascular problems;
• pressure surges;
• failure of liver and kidney function;
• worsening sleep;
• cerebrovascular accident;
• mental instability (panic attacks, memory impairment, increased anxiety).

If a person does not pay attention to the symptoms and neglects the disease, they can develop and manifest themselves in old age (and maybe earlier), which may well cause a deterioration in the quality of life and early departure from it.