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A PATIENT-SPECIFIC ANESTHESIA PLAN
Turkey Medicals International Patient Co-ordinator, “Our body is a perfect network formed by millions of neural networks connected to the brain and spinal cord. Thanks to this network, painful stimuli are transmitted to the brain, which causes pain to be heard.” was said.
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The concept of pain is also very important for surgeries. A painless, safe operation happens thanks to ’anesthesia’. Anesthesia can be created by loss of sensations and sensations without loss of consciousness or unconsciousness. Anesthesia also controls the stress, fear and anxiety caused by surgery. Today, anesthesia can be performed with a high level of comfort and minimal risk thanks to experienced specialist doctors, modern techniques and new drugs.
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The first condition of safe anesthesia is to create a ‘patient-specific’ anesthesia plan. Each patient for whom an operation decision is made is examined by an anesthesiologist in Turkey hospital before the operation. During the examination, systems with vital functions such as the lungs and heart are evaluated. The patient’s anesthesia plan is revealed by taking into account the patient’s medical history, complaints, medications used, laboratory examinations, and the nature of the operation. A painless, problem-free operation is performed using the appropriate anesthesia technique.
There is no operation without pain. Pain necessarily occurs in all surgical procedures due to the procedures performed. When pain occurs, it creates a stress reaction in the body. Stress causes the sympathetic system to activate, releasing hormones such as adrenaline and noradrenaline. Tue. These substances cause excessive shrinkage of the vessels, the formation of undesirable conditions such as palpitations in the heart. Since it turns into a trauma that affects the whole body, it is important to relieve pain during surgery. What relieves pain is anesthesia.
Anesthesia performed with loss of consciousness in operations is general anesthesia, and the way to relieve pain without loss of consciousness is regional or local anesthesia. Regional anesthesia can be performed in 3 types. These are spinal, epidural and combined methods in which they are performed together. With these methods, a very effective anesthesia is created by blocking the transmission on the nerve pathways that transmit pain at different levels. While there are such effective pain relief methods today, it is an outdated approach not to use them when necessary, and to expect that the pain will be “endured” during and after the operation.
1- Epidural Anesthesia
Epidural anesthesia, which is more decently known among the public as the anesthesia method that provides a ‘painless birth’, is a regional anesthesia method that can be applied in many different surgeries in order to relieve pain. The difference from general anesthesia is that the patient who has undergone surgery is awake during the procedure and does not feel pain, although he completely perceives what is happening around him.
2- How is Epidural Anesthesia Applied?
Epidural anesthesia is the process of giving local anesthetic and analgesic (pain-relieving) drugs to the space above the dura layer, which wraps around the spinal cord like an outer sheath. The epidural is a cavity with adipose tissue, lymph and thin blood vessels inside. It starts from the neck and continues to the coccyx.
Epidural anesthesia can be performed from the back, waist or coccyx. It can be applied in a sitting or lying position on the side. Before the procedure, the area where the anesthesia will be performed is cleaned with an antiseptic substance. Then the skin and subcutaneous tissue are numbed with a fairly thin needle. Then, a thin catheter is inserted by entering the epidural with an epidural needle. One end of the catheter is left stationary in the epidural space, while anesthetic and analgesic drugs are delivered to the epidural space from the remaining end. The first drugs given are the test dose. With the test dose, the accuracy of the location of the epidural catheter and whether there is sensitivity and allergy to the drug are investigated. After these are guaranteed, the injection process is completed by making a full dose. With the help of a catheter inserted into the area, medication is then continued throughout the operation. Additional doses can be given with an injector or with advanced automatic pumps that allow the drug to be delivered through a catheter at regular intervals.
Epidural catheters and pumps can provide a smooth anesthesia during surgery and can also be used to relieve postoperative pain. A ‘ pain pump’ is attached to the tip of the epidural catheter to relieve postoperative pain. Thanks to this pump, the patient can relieve his own pain by pressing a button connected to the pump. In some cases, the anesthesiologist may prefer to administer these medications himself at intervals.
3- How does epidural anesthesia work?
There are pain receptors in all organs of the body that detect pain. Receptors detect situations that cause a feeling of pain, such as hot, cold, infection, trauma, incision. The purpose of pain is to inform the brain of the presence of a number of factors that can harm the body and to ensure that it can be protected from them. When the body perceives pain, it reflexively tries to take measures to get rid of the harmful factor.
Pain, after being detected by receptors, reaches the spinal cord through nerve fibers, and from the spinal cord to the pain centers in the brain. As a result of the brain’s perception of this stimulus, a feeling of pain occurs. In epidural anesthesia, although the pain reaches the spinal cord, the feeling of pain does not occur because its transmission to the brain is blocked. The numbness of pain provided by epidural anesthesia is temporary. Numbness exists only as long as an anesthetic substance is made from an epidural, it is not permanent. When the medication is stopped, the person begins to feel the pain again.
In epidural anesthesia, the type, amount, density, distribution of the anesthetic substance given to the area, as well as the level at which the needle is inserted and the patient’s position determine the width of the area to be matched. When appropriate doses are used, only the pain fibers become numb. The patient does not feel as if he is “paralyzed” because the nerve fibers that enable the muscles to work, movement, that is, the motor fibers muscle do not match. The patient can move his legs comfortably. In other words, epidural anesthesia is an ideal method that can provide pain relief without paralyzing and painless surgery.
Operations of all tissues and organs under the breast and under the epidural anesthesia method can be performed. Epidural anesthesia can be easily used in all branches of obstetrics, general surgery, urology, orthopedics and aesthetic surgery. Painless surgery, caesarean section, female genital organ operations, hernia, appendicitis, bladder tumors, urinary tract problems, orthopedic surgeries on legs and hips, tummy tuck, liposcrupture and many examples such as breast surgeries can be operated with epidural anesthesia. Especially in aesthetic surgery, epidural anesthesia is very popular as an aesthetic method. In addition, epidural anesthesia can also be used to treat pain in cases with serious pain, such as cancer pain, by placing it permanently.
4- Advantages of the epidural method
The most important advantage is that the patient does not take gas because general anesthesia is not applied. Therefore, problems such as inability to wake up do not occur. Another advantage is painlessness after surgery. The risks in professional hands are extremely low. Epidural anesthesia is a very effective method for eliminating the feeling of pain and the risk of side effects is also quite low. However, epidural applications should be applied by well-trained and experienced anesthesiologists in this regard.
5- What are the risks of epidural anesthesia?
The most common side effects of epidural anesthesia are hypotension and headache. Giving serum to the patient before epidural anesthesia, lifting the legs up, giving vascular astringent medication if necessary, and the recommendation of 24-hour hospitalization after the procedure eliminates these problems.
Insufficient anesthesia is another risk. This problem is usually solved by increasing the concentration and amount of the given drug. Administration of the drug to places other than the epidura causes the anesthesia to not work, the appearance of undesirable effects. Intravenous administration of the drug, on the other hand, may cause contractions, irregular heartbeat. Test dose applications are applied to eliminate these problems.
The risk of epidural anesthesia affecting the respiratory muscles or paralysis is almost never experienced with techniques and experience.
As with any medical procedure, epidural anesthesia also has some risks. Thanks to experienced and knowledgeable anesthesiologists and modern techniques, epidural anesthesia has become an extremely safe and useful anesthesia method, reducing all risks to a minimum.
6- Who does epidural anesthesia not apply to?
Epidural anesthesia is not applied to patients with low blood pressure, allergies to anesthetic drugs to be used, infection in the area where the needle will be inserted, neurological disease, active bleeding, platelet count below 100,000. The fact that the patient does not want this procedure is another reason for not applying.
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Turkey's world-renowned organ transplant specialist. Dr. Demirbaş has 104 international publications and 102 national publications.
Physician's Resume:
Born on August 7, 1963 in Çorum, Prof. Dr. Alper Demirbaş has been continuing his work as the President of MedicalPark Antalya Hospital Organ Transplantation Center since 2008.
Prof. who performed the first tissue incompatible kidney transplant in Turkey, the first blood type incompatible kidney transplant, the first kidney-pancreas transplant program and the first cadaveric donor and live donor liver transplant in Antalya. Dr. As of August 2016, Alper Demirbaş has performed 4900 kidney transplants, 500 liver transplants and 95 pancreas transplants.
In addition to being the chairman of 6 national congresses, he has also been an invited speaker at 12 international and 65 national scientific congresses. Dr. Alper Demirbaş was married and the father of 1 girl and 1 boy.
Awards:
Eczacibasi Medical Award of 2002, Akdeniz University Service Award of 2005, Izder Medical Man of the Year Award of 2006, BÖHAK Medical Man of the Year Award of 2007, Sabah Mediterranean Newspaper Scientist of the Year Award of 2007, ANTIKAD Scientist of the Year Award of 2009, Social Ethics Association Award of 2010, Işık University Medical Man of the Year Award of 2015, VTV Antalya's Brand Value Award of 2015.
Certificates:
Doctor of Medicine Degree Hacettepe University Faculty of Medicine Ankara, General Surgeon Ministry of Health Turkey EKFMG (0-477-343-8), University of Miami School of Medicine Member of Multiple Organ Transplant, ASTS Multiorgan Transplant Scholarship. Lecturer at Kyoto University. Lecturer at University of Essen, Research assistant at the University of Cambridge .
Professional Members:
American Society of Transplant Surgeons, American Transplantation Society Nominated, Middle East and Southern Africa Council Transplantation Society 2007, International Liver Transplantation Association, Turkish Transplantation Association, Turkish Society of Surgery, Turkish Hepatobiliary Surgery Association.
Disclaimer:
Our website contents consist of articles approved by our Web and Medical Editorial Board with the contributions of our physicians. Our contents are prepared only for informational purposes for public benefit. Be sure to consult your doctor for diagnosis and treatment.