Competence of the anesthesiologist and existing methods of pain management

Anesthesia is the introduction of the human body into a state where consciousness turns off, all muscle groups relax, reflexes decrease, and sensitivity to pain turns off.

Types of anesthesia

In modern medicine, anesthesia is divided into types. The classification depends on the method by which the narcotic analgesic substance is administered . The following types exist:

1. Combined anesthesia.
2. Non-inhaled general anesthetic.
3. Inhalation general anesthesia.
4. Local anesthesia.

Types of local anesthesia

There are such types of local anesthesia as:

1. Intravenous under a tourniquet.
2. Intraosseous.
3. Caudal.
4. Spinal.
5. Epidural.
6. Plexus.
7. Conductor.
8. Infiltration.
9. Terminal.

Methods of administering anesthesia

Local anesthesia is the reversible temporary elimination of the sensitivity of nerve endings in the desired part of the human body to painful stimuli. This anesthesia has many advantages:

1. Fewer contraindications than other methods of pain relief.
2. Possibility to perform surgery on an outpatient basis.
3. After the drug wears off, there are almost no negative consequences.
4. There is no need to monitor the patient.
5. There is no preparation for pain relief.

Regional anesthesia

This anesthesia may be the safest during operations , in terms of preserving vital functions in older patients or patients with severe somatic concomitant illness.

This group includes:

1. Spinal anesthesia . The substance is injected into the subarachnoid space of the spinal cord, under the dura mater. When the drug is administered, complete muscle relaxation and loss of pain sensitivity in the lower body occurs. A person cannot move his lower limbs. If the procedure is carried out incorrectly, negative consequences can occur.
2. Epidural anesthesia . The drug is injected over the dura mater of the spinal cord under the periosteum. Pain relief occurs due to the blockade of the spinal roots. If the anesthesia technique is performed incorrectly, no negative consequences are observed.

Inhalation anesthesia

When inhalation anesthesia is administered, there are 4 stages:

1. General anesthesia . The patient is still conscious, but there is no pain sensitivity. All reflexes are inhibited, and the patient has difficulty answering questions. The stage lasts from 3 to 5 minutes. It is possible to carry out quick interventions (opening abscesses and cellulitis), and also carry out diagnostic procedures.
2. Excitement . Subcortical processes are excited, and the cerebral cortex is inhibited. Despite the fact that there is no consciousness, the patient may try to get up and be in an excited state. It is prohibited to carry out interventions at this stage; it is worth introducing drugs further to increase the depth of sleep.
3. Surgical stage . Heart contractions and breathing are normal, the patient is unconscious and calm. It is during this phase that all necessary surgical operations are performed. This stage is dangerous because the heartbeat and breathing can stop, and irreversible consequences develop in the cerebral cortex if a person remains in this state for a long time. A person’s vital signs must be constantly monitored.
4. Awakening . When the medication is stopped administered, its concentration in the blood becomes lower. After this, the person wakes up, and all stages proceed in reverse order.

Mask general anesthesia

Endotracheary and fluorothane

With the endotracheal method, the drug enters the body using a special tube that is inserted into the trachea.

This method is used more often than others, since the airway remains free. This opens up access to the head, face and neck.

The use of this method in surgery makes it possible to carry out the operation for a long time without negative consequences.

But despite many positive qualities, this anesthesia is practically not used in modern practice. And all because of the negative effect of fluorotan on hemodynamics. It dilates blood vessels and reduces the contractility of the heart muscle. This can cause a sharp drop in blood pressure. Ftorotan also has a negative effect on the liver.

Rausch anesthesia and intravenous (non-inhalation)

General internal anesthesia has a number of advantages over inhalation methods. With this type of anesthesia, withdrawal occurs quickly , and there is no stage of excitation. But when using this method alone, the anesthesia effect is short-lived. It is for this reason that internal anesthesia is most often done with inhalation. The patient is intubated only after the start of exposure to the non-inhalation method. Drugs for internal anesthesia are drugs from the barbiturate group - sodium thiopental and hexenal.

Are there any complications?

One possible complication is vomiting. Against this background, aspiration is dangerous - the entry of stomach contents into the bronchi and trachea. As a result, breathing may be impaired with subsequent hypoxia - Mendelssohn's syndrome.

Complications from the respiratory tract may be associated with their patency.

Complications during tracheal intubation are grouped as follows:

1. Kink or protrusion of the endotracheal tube from the trachea.
2. Insertion of an endotracheal tube into the right bronchus.
3. Insertion of an endotracheal tube into the esophagus.

Source: https://facelift.guru/plastika/kakie-suschestvuyut-vidy-narkozov-pri-operaciyah.html

Appointment with an anesthesiologist - indications for visiting a specialist

Anesthesiology is a field of clinical medicine. Literally from Greek, the word stands for “the science of lack of sensitivity.” Anesthesiology studies and collects techniques for reducing the sensitivity of the human body. The goal is to protect against the effects of painful shock and maintain the ability to control body systems. A specialist in the field of anesthesiology is an anesthesiologist. You should contact him not only on the eve of the operation.

Who is an anesthesiologist

An anesthesiologist is a medical specialist who is solely responsible for anesthesia. During the operation, the anesthesiologist works in a team with surgeons. This profession involves a high level of responsibility, because the life of the patient largely depends on the anesthesiologist.

The future doctor receives an education in the field of anesthesiology, studies the latest practices and the experience of past centuries. In addition to his main specialty, an anesthesiologist undergoes training to become a resuscitator. These professions are related.

In addition to the main responsibilities - providing anesthesia, pain relief - the doctor must be able to take emergency measures.

A specialist in the field of anesthesiology must have qualities such as the ability to quickly assess the situation and provide the necessary assistance.

What is the responsibility of an anesthesiologist?

In general terms, we can say that the competence of an anesthesiologist includes providing anesthesia. But this concept has its own nuances and is much broader. List of responsibilities of an anesthesiologist:

1. Determining the appropriate type of anesthesia on an individual basis. The doctor must accurately calculate the dosage and reduce the likelihood of complications to a minimum. There are no general recommendations for anesthesia that are ideal for absolutely everyone. When choosing anesthesia, many nuances must be taken into account. The body of each individual person is unique. An error or omission when administering an anesthetic drug can result in tragedy.
2. Preliminary collection of information about the patient's health status. To choose the right anesthetic drug, the doctor must have information. Taking an anamnesis includes studying the results of tests and other studies. It is important to know whether the patient has allergies. The doctor studies the patient’s medical history and carefully reads his medical record. Reviews the opinions of other specialists. Communicates with the patient, conducts examination and consultation.
3. Introduction of anesthesia. The most direct responsibility. First of all, this is general and spinal anesthesia. The local surgeon and dentist have the right to administer it. An anesthesiologist is able to carry out a full range of anesthesiological procedures.
4. Monitoring the patient's condition. During the operation, the doctor carefully monitors the patient's condition. Monitors heart rate and breathing. Monitors the functioning of the cardiovascular, digestive systems, and brain. Corrects the functioning of important organs, if necessary.
5. Preventing the patient from recovering from anesthesia early. This is also an important point. Early awakening is fraught with consequences for both the patient and the operating medical team.
6. Providing emergency medical care. If the patient's life is threatened, the anesthesiologist is obliged to take rehabilitation measures.
7. Consulting the patient and his relatives. Before the operation, the doctor informs the patient about the upcoming event. Explains all the details. Warns of possible consequences. Answers all your questions.

In addition to working as a team with the surgeon and participating in the operation, the anesthesiologist also works as a solo specialist. Anesthesia may be necessary for certain diseases, such as cancer. Then he works with the patient separately.

In what cases is it necessary to contact an anesthesiologist?

You must make an appointment with an anesthesiologist in the following cases:

• upcoming surgery;
• upcoming birth;
• pain that does not go away after surgery;
• chronic diseases in severe form, which occur with pain and these sensations are constant;
• phobias and panic reactions when undergoing certain studies (for example, MRI);
• any life-threatening conditions (for example, pain shock due to injury).

If a planned surgical operation is scheduled, the examination is scheduled 7-10 days before the event. If emergency assistance is required, then within a few hours or minutes (depending on the severity of the condition). If the patient experiences pain constantly, anesthetic procedures are prescribed by the attending physician. If there are fears, the patient contacts the anesthesiologist independently.

Attention! If you have or suspect an allergy, you must inform the anesthesiologist about this before surgery!

What studies are necessary for an anesthesiologist before surgery?

Before surgery, the anesthesiologist needs to familiarize himself with the results of the following studies:

1. auscultation of the heart muscle and lungs;
2. ECG;
3. spirometry;
4. FGDS;
5. chest x-ray;
6. heart rate measurement;
7. blood pressure measurement;
8. Doppler ultrasound;
9. allergy testing;
10. inspection.

The anesthesiologist must be aware of how the heart, lungs, and stomach function. If there are chronic diseases or if clarification is required on any issue, more studies are prescribed.

What laboratory tests does the anesthesiologist order?

The anesthesiologist prescribes the following tests:

• standard (general) blood test;
• analysis to determine blood thickness and the possibility of its clotting;
• blood test for hepatitis B and C;
• blood test for HIV;
• blood test for sexually transmitted diseases;
• analysis to assess the gas state of arterial blood (if the volume of the operation is very large or if the patient has lung diseases);
• blood chemistry;
• analysis to determine blood type and Rh factor;
• hormonal blood test;

In addition to blood tests, a urine test is also prescribed. All these analyzes allow us to give a correct assessment of the functioning of important organs and systems of the body. These are the cardiovascular, digestive, endocrine, and respiratory systems. The state of blood flow and the risk of blood clots or bleeding are determined.

How does an appointment with a doctor work?

Immediately before the operation, the anesthesiologist's appointment is as follows:

1. the doctor talks with the patient, explaining the importance of preparation for the upcoming operation;
2. if necessary, psychologically prepares a person for the event;
3. conducts a survey to collect anamnesis;
4. conducts an inspection;
5. determines the presence of allergies and chronic diseases.

At the initial appointment, the patient receives instructions from the anesthesiologist about taking medications. This is important if the patient has a chronic disease and is prescribed a course of treatment. The anesthesiologist makes recommendations regarding the preoperative diet.

Explains why it is important to give up some foods and give preference to others. In case of a cold, he will tell you whether you can take antipyretics. Provides advice on alcohol consumption. Familiarize the patient with the list of activities to prepare for surgery.

He will tell you about the rules that he must follow. The patient receives full consultation with a specialist.

For which operations is an anesthesiologist required?

An anesthesiologist is a universal specialist. He collaborates with doctors working in various fields of medicine. These include specialists and emergency doctors. The following operations are subject to anesthetic intervention:

• in the field of general and vascular surgery;
• in the field of orthopedics and traumatology;
• in the field of neurosurgery;
• in the field of urology;
• in the field of plastic surgery;
• in the field of otorhinolaryngology;
• in the field of oncology;
• in the field of ophthalmology;
• in the field of obstetrics and gynecology;
• in the field of dentistry.

The list of diseases in each area is quite large. In addition, the intervention of an anesthesiologist is mandatory in emergency cases. These are operations after injury or urgently performed. Emergency operations are performed during exacerbation of chronic diseases.

General anesthesia

General anesthesia or anesthesia is a state of deep sleep induced artificially. The central nervous system is depressed (reversible).

The skeletal muscles relax, the patient loses consciousness and does not remember the period of time when he was under anesthesia. He becomes insensitive to pain. This condition is achieved with the help of various medications.

The effectiveness of anesthesia depends on the dosage and properties of the drugs. There are several types of general anesthesia:

1. Inhalation. Its varieties are endotracheal, mask, endobronchial. They are united by the method of administering anesthetics - they are inhaled.
2. Non-inhalation method. Active medications are introduced into the body by injection.
3. Combination. In this case, various anesthetics are introduced gradually, alternating with each other. This method is used if there are concerns about complications. The combination greatly facilitates anesthesia.

When performing general anesthesia, artificial ventilation is required. Sometimes there are concerns that while the patient is under anesthesia, gastric contents may enter the lung cavity. Then doctors resort to using a laryngeal mask or endotracheal tube.

Some medical centers use the electronic anesthesia method. In this case, instead of anesthetics, electric current is used.

As the operation nears completion, the anesthesiologist reduces the dose of anesthetics. If necessary, administers additional medications.

Regional anesthesia

With regional anesthesia, a specific part of the human body (leg, arm, pelvis) is anaesthetized. In this case, the transmission of signals from nerve impulses to the brain and to the muscular system is stopped.

The patient remains conscious during the process. Special monitoring of breathing and heartbeat processes is not required from the anesthesiologist. This method puts less strain on the heart muscle and blood vessels and is safer.

The following types of regional anesthesia are distinguished:

• spinal;
• conductor;
• epidural;
• plexus.

Their difference is in which part of the human body the anesthetic is injected. Sensitivity is restored after 120 minutes.

Local anesthesia

With local anesthesia, a separate area of ​​the human body is subject to pain relief. The effect of anesthetics is as follows:

1. blockade of nociceptors (free endings of nerve fibers sensitive to pain);
2. The transmission of pain signals to the brain and muscles through the nervous system is disrupted.

The operated area becomes numb and sensitivity is blocked. The body's protective physiological systems are switched off. The patient is conscious during the process. Special monitoring of breathing and heartbeat processes is not required from the anesthesiologist. Types of local anesthesia:

• application;
• conductor;
• infiltration;
• spinal.

Local anesthesia is indicated for minor operations and when the patient refuses general anesthesia. Often prescribed for elderly patients in order to minimize possible risks during general anesthesia.

For what reasons can an anesthesiologist cancel a planned operation?

Diseases for which the anesthesiologist may insist on canceling the operation:

1. heart diseases (failure, tachycardia, arrhythmia, angina pectoris, diseases of the heart valves and coronary arteries);
2. heart attacks, strokes;
3. liver and kidney diseases (failure, hepatitis, cirrhosis);
4. respiratory diseases (failure, pneumonia, bronchitis);
5. epilepsy;
6. inflammation and infection of the area to be operated on;
7. allergic reactions;
8. low blood pressure;
9. obesity.

Failure may also be caused by unreliable equipment or too long an operation. An anesthesiologist may refuse to perform an operation if the patient drank alcohol or smoked (if prohibited). The reason for refusal may be a violation of the diet and meal before surgery.

Anesthesiology is a relatively young science. But this is a very precise and important area of ​​medicine. An anesthesiologist is an indispensable participant in the surgical process. An appointment with an anesthesiologist is necessary to prepare for surgery. The anesthesiologist also helps the patient prepare psychologically and explains many unclear points.

Source: https://zapis-online.ru/registratura/priem-anesteziologa/

Types of anesthesia - methods of administering anesthesia during operations

Anesthesia is a decrease in the sensitivity of part or the entire body, as well as a complete cessation of perception of information about one’s own condition and the environment. Anesthetic management of the operation is necessary to protect the patient from surgical stress and the safety of his life.

There are a large number of classifications of anesthesia, one of them, the simpler one, distinguishes local, general, combined and combined anesthesia.

Local anesthesia and its types

Local anesthesia is a reduction or complete cessation of sensitivity in a certain part of the body.

The following types of local anesthesia are distinguished:

1. Applique.
2. Infiltration.
3. Conductor.
4. Spinal.
5. Epidural.

• Application (superficial) anesthesia is performed by applying an anesthetic drug to an area of ​​the mucous membrane or skin.
• In this case, the anesthetic penetrates into deeper layers of tissue, causing dysfunction of nerve receptors and loss of sensitivity.
• Application anesthesia is used for painful procedures in dentistry, cosmetology, otorhinolaryngology, gynecology, urology, etc.

Drugs that are used for local anesthesia (lidocaine, tetracaine, kamistad, inocaine, EMLA, proximetacaine, xylocaine, etc.) can be in various forms: aerosols, ointments, gels, sprays, solutions.

A contraindication for the use of topical anesthesia is individual intolerance to any drug. A complication of superficial anesthesia is an allergic reaction, most often redness, slight swelling.

With infiltration anesthesia, the anesthetic is administered by injection. At the site of drug administration, a blockade of nerve impulses occurs.

Technique of infiltration anesthesia:

1. First, the anesthetic is injected intradermally.
2. Each new portion of the drug is injected into the edge of the nodule, which was formed by the previous injection. This creates an infiltrate of anesthetic drug over the area of ​​the future incision.
3. Subcutaneous tissue is then infiltrated.
4. Only after this is an incision made with a scalpel into the skin and subcutaneous tissue.
5. Then layer-by-layer infiltration of muscle tissue with an anesthetic is performed.

Drugs used for infiltration anesthesia : novocaine, lidocaine, ultracaine.

Contraindications and complications. A contraindication for this type of anesthesia is hypersensitivity to anesthetic drugs. Complications with infiltration anesthesia are rare; most often these are allergic reactions.

1. Conduction anesthesia
2. An anesthetic drug is injected into the paraneural space, which causes a blockade of impulse transmission along a large nerve trunk.
3. The method is used for operations on the upper and lower extremities, thyroid gland, genitals, and dental operations.

Complications of conduction anesthesia. The most severe complication is neuropathy, and allergic reactions may also occur.

• Spinal anesthesia
• With this type of local anesthesia, the drug is injected into the cerebrospinal fluid, and the blockade of impulse transmission occurs at the level of the spinal nerve roots.
• Spinal anesthesia is used when performing operations on the lower extremities, in the lumbar spine, some operations on the genital organs, etc.

are used for anesthesia . lidocaine, bupivacaine.

1. Complications of spinal anesthesia: transverse myelitis, meningitis, anterior horn syndrome of the spinal cord, etc.
2. Epidural anesthesia
3. With this method of anesthesia, anesthetic agents are injected into the epidural space of the spine through a catheter, thereby blocking the transmission of impulses along the nerve endings of the spinal cord.
4. The method can be used as an addition to general anesthesia during some operations, during caesarean section, for postoperative pain relief, and is often used during childbirth, caesarean section.
5. Most often, lidocaine, ropivacaine, and bupivacaine are used for epidural blockade.
6. Complications: epidural hematoma, high block, spasms, paralysis.

General anesthesia

General anesthesia or general anesthesia is a reversible depression of the central nervous system, accompanied by loss of pain sensitivity, consciousness, memory, and relaxation of skeletal muscles.

This state is achieved by administering one or more anesthetic drugs, the dose of which is selected individually by the anesthesiologist depending on the type and duration of the surgical intervention and the individual characteristics of the patient.

Based on the number of drugs used, the following are distinguished:

1. Mononarcosis (one agent is administered for anesthesia).
2. Mixed anesthesia (two or more drugs are administered simultaneously).
3. Combined anesthesia (use of anesthetics with analgesics, muscle relaxants, gangioblockers, etc.).

There are inhalation and non-inhalation anesthesia.

In inhalation anesthesia, anesthetic drugs are administered through the respiratory tract.

Inhalation anesthesia can be (depending on the method of administering anesthetics):

1. Mask.
2. Endotracheal
3. Endobronchial.

Non-inhalation anesthesia is achieved by administering anesthetics intravenously, intramuscularly, rectally, etc.

The following drugs are used for anesthesia: nitrous oxide, chloroform, fluorotane, xenon, ketamine, fluorotane, propofol and many others.

As a rule, intracavitary surgical interventions are performed using combined endotracheal anesthesia with artificial ventilation.

Extracavitary operations can be performed with the patient breathing independently using monoanaesthesia.

Complications of general anesthesia. Severe complications of anesthesia are currently rarely recorded, these are inadequate restoration of spontaneous breathing, respiratory arrest, arrhythmia, bradycardia, convulsions, cardiac arrest.

Combined and combined anesthesia

• Combined and combined anesthesia methods are now increasingly used.
• Combined anesthesia is the simultaneous or sequential use of different methods of one type of anesthesia (for example, inhalation and non-inhalation).
• The simultaneous use of local and general anesthesia during surgery is called combined anesthesia.

Rate — (4

Source: https://www.operabelno.ru/vidy-anestezii-sposoby-vvedeniya-narkoza-pri-operaciyax/

Legal analysis of the legal features of the use of local anesthesia in the practice of a phlebologist

This legal opinion was developed specifically for members of the Association “National College of Phlebologists”

Provide answers to questions posed by the Customer:

1. What are the legal aspects of working with local anesthetics? What legal acts regulate it?
2. What are the hazards (risks) when working with local anesthetics?
3. Does the legislation provide for the need to conduct allergy tests before administering local anesthetics?
4. Are acceptable volumes of local anesthetic administration established somewhere?
5. Are there any special requirements for working with local anesthesia in an outpatient setting? Do such requirements affect the equipment of the room in which medical interventions are performed using local anesthesia?
6. Is the use of Klein's solution and tumescent anesthesia regulated by law?
7. Are other features of the use of local anesthetics in the field of phlebology recorded in the legislation?

Contents of the response

No. Section name

1	General characteristics of working with local anesthetics. Legal regulation. Medical professionals authorized to administer local anesthesia
1.1	Infiltration anesthesia as a medical service
1.2	The use of infiltration anesthesia by a surgeon and a cardiovascular surgeon
1.3	The use of infiltration anesthesia by doctors of other specialties
1.4	Conducting infiltration anesthesia by nursing staff
2	Dangers (risks) of using local anesthesia
2.1	Risks of criminal liability
2.2	Anesthetic overdose/poisoning
2.3	Intravascular administration of anesthetics intended for infiltration anesthesia
2.4	Occurrence of allergies/anaphylactic shock
2.5	Risks of civil liability
2.6	General recommendations for reducing the risks of legal liability
3	The need to conduct allergy tests before administering local anesthetics
4	Permissible volumes of anesthetic administration
5	Requirements for working conditions with local anesthesia in an outpatient setting. Equipping a room in which medical interventions are performed using local anesthesia
6	The use of tumescent anesthesia and Klein's solution in an outpatient setting
7	Other features of the use of local anesthetics in the field of phlebology
8	Conclusion

1. General characteristics of working with local anesthetics. Legal regulation. Medical professionals authorized to administer local anesthesia.

The basic regulatory legal act that regulates the use of local anesthesia is Federal Law No. 323-FZ of November 21, 2011 “On the fundamentals of protecting the health of citizens in the Russian Federation” (hereinafter referred to as Federal Law No. 323).

In particular, paragraph 4 of part 5 of Article 19 of this guarantees the patient the right to relief from pain associated with a disease and (or) medical intervention, using available methods and medications.

The use of drugs to provide local anesthesia (including infiltration) before an invasive medical procedure fully meets the definition of “relief of pain associated with a medical procedure.”

In addition, on December 25, 2018, amendments were made to Federal Law No. 323, according to which, from January 2022, medical care will be provided on the basis of clinical recommendations (clause 3, part 1, article 37 of Federal Law No. 323).

Accordingly, procedures and standards play a vital role in resolving issues of quality and safety of medical care, and from January 1, 2022, clinical recommendations will play an equally important role.

However, the current procedures for the provision of medical care do not contain any special requirements for the use of drugs for local anesthesia (including those from the amide group).

For example, the procedure for providing medical care in the field of “surgery” (Order of the Ministry of Health of Russia dated November 15.

2012 No. 922n) only general requirements for the premises of a medical organization and recommended staffing standards were approved*.

*Note: the specifics of working with local anesthetics in an outpatient setting and the general requirements for the premises in which local anesthesia is performed will be discussed by us in section 5 of this consultation.

In turn, with regard to the treatment of diseases of the veins of the extremities, today there are only standards of medical care that apply to medical services provided in an inpatient setting. However, some of them explicitly provide for the use of local anesthesia and some local anesthetics:

Source: https://kormed.ru/baza-znaniy/nashi-analiticheskie-zaklyucheniya/yuridicheskiy-analiz-pravovyh-osobennostey-primeneniya-mestnoy-anestezii-v-chastnosti-s-ispolzovaniem-lidokaina-i-inyh-lekarstvennyh- preparatov-groupy-amidov/

Choosing a method of pain relief

The choice
of anesthesia method is an extremely
important point in anesthesiology.

Each
method of pain relief has both
positive and negative
properties.
Therefore, in a specific situation, for each patient for a specific
operation, the choice of pain relief method
is carried out individually.

In modern
anesthesiology, there is a principle
“each patient has his own anesthetic
aid.”

anesthesia
method is based on to ensure reliable functioning
of the patient’s organs and systems both during
surgery and in the postoperative
period, the adequacy of pain relief, and
convenience for the surgeon when performing
the intervention.

It is worth
noting the trends in modern
anesthesiology.
For complex traumatic abdominal operations,
combined intubation anesthesia remains
.

For operations on the extremities,
preference is given to conduction
anesthesia.
For operations on the lower abdominal cavity and lower
extremities, epidural
and spinal anesthesia are often used.

Intravenous
anesthesia is used for non-cavitary
operations with a short duration.

• 
  Combined methods of pain relief play
  an important
  role in modern anesthesiology .
  The most common combinations are:
• • local
  infiltration anesthesia +
  neuroleptanalgesia;
• • regional
  conduction anesthesia + intravenous
  anesthesia;
• • epidural
  anesthesia + endotracheal anesthesia.
• Relationship between
  surgeon and anesthesiologist
• Like
  any other specialist, the anesthesiologist
  bears full legal responsibility
  for the actions that are part of his duties.

ness
and competence.
At the same time, sometimes arise in the relationship between the anesthesiologist and the surgeon
.

Preoperative
examination of the patient

In
the preoperative period,
disagreements often arise between the surgeon
(attending physician) and the anesthesiologist.
The surgeon believes that the patient has been sufficiently examined
and can be operated on.
The anesthesiologist suggests completing the examination and
only then taking the patient for surgery.

It should
be noted that legally responsibility
for determining the indications and timing
of the operation lies with the attending
surgeon.

However, if
the anesthesiologist’s objections are of a fundamental
nature and significantly affect the actions
of the anesthesiologist and the safety of the patient,
they should be discussed collectively
and, if necessary, resolved by the heads of
the surgical and anesthesiological
departments.

It is important
that in any case, the anesthesiologist must
do everything possible to ensure the safety
of anesthesia and adequate provision
of anesthetic care and in no
case can refuse to
provide anesthesia.

Choosing
a method of pain relief

The choice
of anesthesia is the responsibility of
the anesthesiologist.
But if the surgeon insists on general anesthesia, and the anesthesiologist

anesthesia
more justified resolved collectively.

It is possible to make
a compromise solution (local
anesthesia, neuroleptanalgesia).
In this case,
there cannot be a solution

Who
is responsible for the patient on
the operating table?

During
the operation, the anesthesiologist is
fully responsible for the anesthesia itself,
monitoring the patient’s condition and
treatment measures if
various disorders occur.
During this period, the surgeon is responsible for the tactics and technical
performance of the surgical intervention.

Who
is responsible for the patient

in
the early postoperative period?

The
responsibilities of the anesthesiologist include
monitoring the patient and ensuring
his stable condition until recovery from
anesthesia, restoration of adequate
spontaneous breathing, swallowing,
muscle tone and normal hemodynamic parameters
.

When a patient is admitted

, the anesthesiologist-resuscitator working in the department bears
full
responsibility for him during the entire .

The attending
surgeon here acts as
a consultant, bearing responsibility for
actions within his competence.

The success
of surgery and anesthesia is in the close cooperation
of anesthesiologists, resuscitators and
surgeons!

Source: https://studfile.net/preview/6446207/page:12/

Modern anesthesiology: types and purposes of anesthesia

Anesthesia, or narcosis, is an artificially created reduction or absence of sensitivity during medical procedures. What methods of anesthesia exist and what is its purpose?

Prescription of anesthesia

A modern anesthesiology service solves the following tasks:

• providing the surgeon with optimal working conditions during surgery, which determines the quality of surgical treatment,
• providing effective and safe pain relief to the patient during surgery,
• maintaining the vital functions of the patient’s body before, during and after surgery,
• protecting the patient’s body from aggressive influences – surgical, biological, physical, infectious, chemical, etc.

Anesthesia is used during medical procedures and operations on any part of the body to protect the patient from surgical trauma.

Anesthetic care in general includes a wide range of tasks:

• preliminary assessment of the patient’s condition in order to identify anesthetic risk,
• if necessary, providing intensive therapy to the patient in order to prepare him for surgery,
• premedication or drug preparation for anesthesia,
• choice of anesthesia method and drugs,
• the use of anesthesia for emergency and planned surgical operations, dressings and diagnostic studies,
• monitoring the patient’s condition during anesthesia, prescribing medication correction in order to prevent life-threatening metabolic and functional disorders,
• awakening the patient after general anesthesia,
• elimination of pain in certain diseases (oncology and other incurable diseases) and other conditions.

• What types and methods of modern anesthesia exist?
• Types of anesthesia
• Main types of anesthesia:

• general anesthesia,
• local anesthesia,
• combined anesthesia.

General anesthesia or anesthesia is a controlled medical coma, multicomponent anesthesia with temporary shutdown of consciousness, reflexes, pain sensitivity and relaxation of skeletal muscles. During anesthesia, anesthesia-respiratory devices are used.

General anesthesia is carried out using several methods:

• inhalation anesthesia,
• non-inhalation anesthesia,
• combined anesthesia.

Inhalation anesthesia or “mask anesthesia” is carried out using inhalation anesthetics entering the body through the respiratory tract. Volatile liquids or gaseous drugs are used.

In its pure form, the method is practically not used, but is a component of combined anesthesia. Modern substances for inhalation anesthesia are safe for the patient’s body; the main part is quickly eliminated from the body through the lungs, and the remainder is utilized by liver cells. Inhalation anesthesia is a well-controlled method of anesthesia.

Non-inhalational anesthesia is a type of general anesthesia in which anesthetic solutions are administered intravenously. The advantage of this method is the rapid onset of anesthesia in the form of a pleasant fall asleep for the patient, and the absence of an excitation stage. The relative disadvantage of intravenous anesthesia is the short duration of its action, so it is not used in its pure form for long-term operations.

Combined anesthesia is the use of local and general anesthesia methods.

Local anesthesia is the suppression of pain sensitivity in a limited area of ​​the body, which is achieved by blocking peripheral nerves at different levels. Local anesthesia is most often used in outpatient practice for operations, dressings, and diagnostic procedures. There are several methods of local anesthesia:

• superficial (treatment of skin and mucous membranes),
• injection of anesthetics into body tissue (infiltration anesthesia),
• injection of an anesthetic near the nerve trunk (regional anesthesia).

The infiltration method is the impregnation of tissues with an anesthetic solution and its layer-by-layer introduction.

Regional anesthesia is divided into spinal, conduction, epidural, intraosseous and intravascular anesthesia. The analgesic effect with this method is achieved by turning off conduction in a specific nerve or nerve plexus while maintaining the patient’s consciousness.

Current trends in the development of anesthesiology

Newly introduced anesthesia drugs are characterized by a short duration of action, which is an important condition for the controllability of the effect. Modern ultra-short-acting anesthetics reflect this trend. The advantages of modern drugs are their rapid elimination from the body, non-toxicity and absence of side effects, and reduced patient sleep time after their use.

In modern anesthesia, mainly combined and combined methods of pain relief are used, which are characterized by the rational use and combination of the positive properties of modern anesthetics, eliminating side effects, complications and guaranteeing reliable and safe pain relief.

Source: http://www.rumex.ru/information/sovremennaja-anesteziologija-vidy-naznachenie-anestezii-145

What interventional pain treatment methods can a physician anesthesiologist-resuscitator legitimately use?

Of course, it should be recognized that the provision of a number of medical services contained in the Nomenclature of Medical Services in subsection 03 “anesthesiology and resuscitation” of class B (and this is local, application, conduction, epidural, spinal, spinal-epidural anesthesia ) are legally assigned to the exclusive competence anesthesiologist . An anesthesiologist-resuscitator also has the right to administer medications into the spinal canal, into the epidural (epidural space), and implantation of an intravenous port system .

According to Order No. 541n (Unified Qualification Directory), an anesthesiologist-resuscitator:

“Provides anesthesiological support for operations, diagnostic and therapeutic procedures that require pain relief or monitoring of the respiratory and circulatory system during their implementation, using modern anesthesia methods approved in the Russian Federation. Conducts general intravenous, inhalation, regional, multicomponent and combined anesthesia during abdominal and extracavitary operations in surgery, urology, obstetrics and gynecology, traumatology and orthopedics, etc. in adults and children.”

• Thus, as a rule, an anesthesiologist-resuscitator applies anesthesia before performing a particular operation (other medical procedure), which requires anesthesia of any part of the human body.
• However, Order No. 541n also establishes the authority of an anesthesiologist-resuscitator to carry out various methods of local and regional anesthesia .
• Based on the analysis of Order No. 541n, it follows that the specified authority of the doctor does not depend on the further performance of the operation (other medical manipulation) on the person.

In addition, it is worth paying attention to the Order of the USSR Ministry of Health dated July 21, 1988 No. 579 “On approval of the qualification characteristics of medical specialists,” according to which an anesthesiologist-resuscitator must be able to:

• conduct anesthesia in obstetric and gynecological practice during normal and operative delivery, during obstetric procedures, during extragenital pathology, during emergency operations and procedures ;
• carry out local anesthesia: application, infiltration, case and epidural anesthesia (at the lumbar level);
• carry out premedication, anesthesia , post-anesthesia period in children, while providing calculated dosages (by age and body weight) of medications, maintaining airway patency and intubation (choosing an endotracheal tube, its diameter depending on age, features of intubation technique), using equipment for children;
• carry out according to indications:
• inhalation, intravenous, combined anesthesia by mask and endotracheal method, with separate and endobronchial intubation, with artificial ventilation and spontaneous breathing, combined electroanalgesia and transcutaneous electrical neurostimulation, intravenous anesthesia by infusion (drip) method using devices for long-term dosed infusions;
• conduction anesthesia: blockade of nerves and nerve plexuses of the upper and lower limbs, epidural (at various levels, regular and extended with a catheter), spinal; epidural analgesia with the administration of morphine for pain relief in the postoperative period and for pain syndromes ;
• anesthesia for planned and emergency operations in all areas of specialized surgery (thoracic, neurosurgery, otorhinolaryngology, ophthalmology, maxillofacial surgery, orthopedics and traumatology, obstetrics and gynecology, urology, dentistry);
• diagnose and treat complications in the postoperative period, disorders of vital functions, and provide pain relief .

Also, according to this order, the anesthesiologist-resuscitator also performs catheterization of the epidural space.

Thus, the analysis of the above legislative norms gives the right to conclude that in the context of this legal advice and the questions posed, the anesthesiologist-resuscitator has the right to perform local and regional anesthesia for pain relief, and also has the right to conduct other types of anesthesia for preparing the patient for surgery (planned or emergency). In addition, if we rely on the Order of the USSR Ministry of Health dated July 21, 1988 No. 579, the anesthesiologist-resuscitator is also authorized to catheterize the epidural space .

This gives the right to assume that the anesthesiologist-resuscitator has the right to administer drugs into the spinal canal and into the epidural (epidural space) - since catheterization of the epidural space can also be accompanied (and is usually accompanied) by the introduction of drugs into the epidural space. In addition, according to the Nomenclature of Medical Services, these drug administrations belong to section 11 of class “A” (special methods for obtaining test samples, access and administration) and are not surgical operations.

Source: https://interpain.ru/legal-support/kakie-intervencionnye-metody-lecheniya-boli-mozhet-zakonno-primenyat-vrach-anesteziolog-reanimatolog/