Article by Dr. Nguyen Thi Hoai Nam – Department of Surgical Anesthesitics – Share99 Central Park International Health Hub
1. Explain the concept of sedativeism, regional anesthesia
Sedative is a condition that reduces the patient's perception of the surrounding environment and reduces their response to external stimulation under the effects of the drug. Depending on the dosage, sedatives can be divided into 4 levels from mild to deep including: mild sedatives, medium sedatives, deep sedatives and body anesthesia.
Regional anesthesia, also known as regional insymural insymural, is a method of losing or reducing sensation in a part or area of the body temporarily but without losing consciousness, the patient remains conscious. Regional anesthesia consists of neuropathic anesthesia (spinal anesthesia, schial anesthesia) and peripheral neuropsychial anesthesia (dysthetic, nervous body numbness, inter-muscle anesthesia…).
Regional anesthesia is currently a trend in multimedia pain relief to treat post-surgery pain. Coordination of regional anesthesia with common analgesic drugs reduces the use of Morphine after surgery, so it reduces the side effects of the drug such as itching, vomiting, nausea, urinary tract, respiratory failure, addiction, increased pain, progress of chronic pain after surgery …
2. Advantages of regional anesthesia
Regional anesthesia brings advantages such as:
- Post-surgery pain relief and better recovery
- Reduce the dose of Morphine
- Reduce hospitalization time
- Reduce re-admission rates
- Decreased rates of vomiting and nausea after surgery
- Patients operate early after surgery and participate in early physical therapy
- Increase satisfaction rate, improve the quality of life of patients
Besides, regional anesthesia still has some undesirable complications including anesthetic poisoning (LAST) and nerve damage. The question is, can sedatives during regional anesthesia help avoid these accidents?
3. Why should regional anesthesia be performed in patients with deep anesthesia or sedatives?
Some notions that when the person is given a total anesthesia or deep sedative will be beneficial when performing regional numbness because:
- Increases the safety of anesthesia due to a decrease in the sudden movement of the person that can cause the numb needle to pierce the important structures of the body.
- Increases the number of patients who agree to anesthesia because the majority have a fear of injections while awake. This will increase the number of patients benefiting from regional anesthesia for surgery or pain relief.
4. Why perform regional anesthesia in a sick person or mild sedative?
On the contrary, there is a notion that it is advisable to let the person awake or only slightly sedative when anesthesia will help to recognize early signs of poisoning caused by:
- Patients who are awake or only mildly sedated can feel and tell their doctor about the early warning signs of anaesthetic poisoning before the poison dose is injected.
- It is possible to recognize and report to the doctor the symptoms of pain and paresthesia that are manifestations of nerve damage when the numb needle pierces the nerve structure.
Many research topics have been carried out to prove pros and cons of regional anesthesia with or without sedative or anesthesia.
5. Does deep sedative or anesthesia affect the patient's ability to recognize and report symptoms?
- For anaesthetic poisoning accidents: A study by the Department of Resuscitation Anesthesithesitics at the Virginia Mason Medical Center and the University of Washington found that Sedation with Midazolam and Fentanyl reduces the reliability of Lidocaine tests during regional numbness. Epinephrine is therefore recommended as a test drug. Patients report symptoms of 100% insensitive central nervous poisoning caused by young children, the elderly, with language barriers, so the symptoms are not sensitive or inadequate. If the anesthetic is mistakenly injected into the blood vessel quickly, the person has a seizure before they recognize and tell the doctor the central neurological symptom. The American Society for Regional Anesthesia and Analgesic Medicine recommends: The ability of deep anesthesia to mask early symptoms of anaesthetic poisoning is not a reasonable reason to give up the practice of regional anesthesia and deep anesthesia or deep sedative anesthesia.
- For neurological damage accidents: Do patients detect signs of heterosexuality and pain when injecting, does it really help detect nerve-touching needles and forecast nerve damage? The results of the study showed a low sensitivity of heterosensities (38.2%). A study in France on 21,278 regional anesthesias showed that paresthesia and pain during injections occasionally occur and are occasionally associated with neurological damage (only related, not proven to have a cause-and-effect link). In a study analyzing the acute accidents of regional anesthesia when the person is awake, sedated or an anesthesiated, the rate of anaesthetic poisoning does not differ significantly between the provincial group and is sedated or anesthetic. Postoscoic malformity has a lower rate and risk in the sedated or anesthetic group.
- For regional anesthesia in children: The majority are performed under deep sedatives or anesthesia due to the child's ina partnership and refused to lie still. One study found that ladder muscle anesthesia in children and adolescents under general anesthesia did not increase the risk of anaesthetic poisoning or nerve damage compared to the provincial anesthesia group. The American Society for Regional Anesthesia and Analgesic Recommends: Despite complete alertness, children may be incapable of communicating symptoms of peripheral nerve damage. However, uns controlled movement of children can increase the risk of nerve damage. Therefore, anesthesia of the lower area of anesthesia or deep sedative in children may be appropriate after considering the risk-benefit ratio.
Sedatives while performing anaesthetic in the area or harm to date still do not have the correct answer. Studies that only make recommendations in practice include:
- There are no guidelines to prove that anesthesia under anesthesia or deep sedation reduces the risk of anaesthetic poisoning and neurological complications
- In adults with regional anesthesia should not be performed under general anesthesia or deep sedatives.
- In children with anesthesia of the lower area anesthesia or deep sedatives may be appropriate.
- Inter-mechanical anesthesia should not be given to children under deep anesthesia or sedatives
- Risk-benefit ratio should be considered before deciding.
At Share99 Health System, patients are always evaluated before surgery according to the pre-anaesthetic examination process to have appropriate anaesthetic and anesthesia options. The modern monitor system fully monitors signs of survival during and after surgery to help detect abnormalities of patients early in order to promptly handle possible accidents. Developing anesthesia under ultrasound guidance is Share99's strength, helping patients relieve pain well and safely during and after surgery.
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