The Master Of Your Breathing At Surgery

Dr David NekyonIt is a common perception in the general public that anaesthesia is akin to being ‘half dead’, at best and ‘almost dead’ at the worst.The truth is that what is being referred to is actually a state of general anaesthesia. There are two other types of anaesthesia : Regional and local anaesthesia. This latter group is a separate entity as it involves the anaesthetising of only a small local area or a large region of the body like one leg or an arm.General anaesthesia is referred to as such because it involves the depression of many of the body’s systems including the brain.During anaesthesia, the patients many body systems must be kept running at an optimum to prevent any complications and this takes a lot of detail and preparations that start long before the patient arrives in the operating room.The patient is seen the day before the operation in what is called a pre-operative anaesthetic assessment. During this period the anaesthesiologist/ anaesthetist will take a full medical history to see if one has any co-existing medical conditions that could be a problem to the anaesthetic process.He/she will then carry out a full physical examination of the patient and this is to verify the findings of the patients ward doctors and also to detect any changes in the condition.It is important to note that the anaesthetist is required to make his own independent decision as to whether the patient is fit to undergo anaesthesia, no matter how eager the surgeon is to get at the disease. If the patient is deemed not fit, then his case has to be postponed until he is treated and stabilised further and then reviewed again.A frequent situation found pre-operatively is high blood pressure. However, should a patient be deemed fit for anaesthesia the planned procedure is explained to him and he is required to sign a consent form that states he is willing to undergo surgery/anaesthesia. It is true to say that most patients in Uganda do not ask any questions at all, perhaps because they feel this is disrespectful, but nothing can be done to you if you do not agree to it.The next day when the patient arrives in the operating theatre he will be re-assessed by the anaesthesiologist to make sure there have been no changes in the patients condition overnight.The patient is then placed on the operating bed and several monitoring devices are then attached to his body. Theses include those for blood pressure, ECG (for pulse rate and rhythm of the heartbeat) and one that measures the percentage of oxygen in the blood.An intravenous drip is set up in one of the patient’s veins and these will be used to administer fluids, blood and drugs. The patient is then asked to breathe pure oxygen for three minutes and then one of two things may happen: An injection of an anaesthetic drug may be given via the drip or the patient is made to breathe anaesthetic gas until he drifts off into a sleep.This is a very critical moment because the patient loses control of his faculties and the anaesthesiologist must take over these responsibilities and this begins with the ability to breathe. Oxygen is blown into the patients lungs using a face mask. A muscle relaxant is given to paralyse the patient and to be able to ventilate a patients lungs for long periods and to avoid vomitous damaging of the lungs, a long plastic tube is inserted directly into the lungs. The patient is then given strong pain killers and then watched carefully.Frequent interventions by the anaesthetist are required if the blood pressure drops too low, or the heart starts skipping beats or there is an allergic reaction or if the oxygen levels drop. Two uneventful hours could easily be followed by 10 minutes of complication. The anaesthesiologist cannot afford to allow his mind to wonder.At the end of the surgical procedure the anaesthetic gas is turned off gradually. One wants the patient to wake soon after the last skin stitch is applied and not before nor hours later.Newer anaesthetic gases have been developed that allow patients to wake up faster and in some cases go home the same day. The patient again enters another critical period as the return to consciousness of a patient may be fraught with complications if not well handled. Especially when the breathing tube is removed from the lungs. This has to be skillfully timed as the patient should be prepared to take over his/her own breathing and not swallow his/her tongue, which would then block his/her windpipe.The writer is an anaesthetist at Mulago HospitalEnds