Anaesthesia Choices
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Why would you give general anaesthesia if local can be used?

This question sounds normal, no doubt is being used commonly among doctors. If we make a simple analysis of the sentence we will come to one important conclusion: The way the question is composed is logical and can not be reversed. Why? Could somebody ask: Why would you give local anaesthesia if general can be used? No; it sounds irrational. This meaning is certainly in the knowledge of all doctors in the world.

Local anaesthesia is the first choice and any other type follows

Every treatment and every medical act may have some possibility for complications. Nevertheless complication is a word almost exclusively medical. If we compare the frequency and the severity of the possible complications between local and general anaesthesia maybe we will lead to no conclusion, because there many factors involved. No doubt, local anaesthesia has advantages and benefits.

If we make a simple analysis of the doctor’s thoughts while he is choosing the type of anaesthesia for certain procedures, we will come to the following conclusion: Generally we think first which type of anaesthesia suits to the procedure and then for which type is our patient convenient. If both factors incline towards local anaesthesia, we suggest it. If not, then we suggest the general, because under general anaesthesia any procedure can be done.

Which type of anaesthesia suits the procedure?

The choice of anaesthesia is a very serious act, and inclination to one or other type is taking place after careful consideration of different factors. Small defects, small birthmarks, and small lesions can be operated under local anaesthesia. With knowledge and experience, with the use of the proper equipment, local anaesthesia can be used to numb bigger areas and make even extensive and time-consuming operations.

One false impression concerning the use of local anaesthesia for large areas is that a lot of anaesthetic solution will be needed and would be dangerous! This is wrong as the local anaesthetics are diluted therefore avoiding overdose. Furthermore, they are being used with other medicines which limit absorption and any side effects.

The use of local anaesthesia is sometimes restricted by specific factors like the locality of the lesion in order to avoid possible injury to other tissue, an infection of the site where the procedure will be performed in order to avoid spreading it by the injected anaesthetic solution. The expansion the injection makes to the infiltrated tissue may also be unwanted in order to avoid deforming changes before operating. Let it be noted that sometimes in the theatre the patient’s help to the surgeon with some movements is the key for the best result.

Operations which cannot be performed under local anaesthesia have to be carried out under General Anaesthesia. This is carried out in an accredited Hospital and under the care of a qualified anaesthetist.

Experienced surgeons frequently use local anaesthetic in addition to the general in order to avoid bleeding, to enable easier tissue separation, and to facilitate painless recovery.

Which type of anaesthesia best suits the patient?

If we consider the use of local anaesthesia and its relation to the procedure as positive, the next consideration should be in relation to the patient’s health factors. These might be problems which have to be under the control of General Anaesthesia, like high blood pressure, asthmatic attack before emergency situations and some psychological and psychiatric problems.

If there are no restrictions to local anaesthesia then we proceed to examine the patient’s calmness. This estimation begins from the time the patient first contacts the doctor, and might continue till final decisions are made. We see the patient’s reactions during examination; we ask additional questions which explain his calmness and fears. The final estimation however, is made by both doctor and patient.

For calm patients we perform minor operations under local anaesthesia; for moderate and major operations further sedation is always administered. The sedating drugs are given in order to achieve further calmness and drowsiness in order for a painless operation to be experienced. If the patient’s calmness is estimated as inconvenient for local, then General Anaesthesia is advised.

It is important that the doctor is familiar with both ways. Most of the Plastic surgery procedures can be done by using both types of anaesthesia. The doctor has to have more than one choice for the majority of the operations he can perform.

© 2011 Dr. CHRISTOS MEREZAS PLASTIC SURGERY

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