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Writer's pictureBrenna Reistad

Understanding Anesthesia

Reminder, this is for roleplay, please do not use this as actual medical guidelines.


Breaking down the different kinds of anesthesia and how it works. 


Types: 


Local

Anesthetic is injected into the tissue of an area to numb the specific location for minor surgery such as wound cleaning or stitches. 


Local anaesthetics       

  • Bupivacaine

  • Lidocaine

  • Lidocaine + epinephrine (adrenaline)

  • Ephedrine


Regional

Can be used while awake or with a sedative. Anesthesia is injected near a cluster of nerves to numb specific areas of the body only. You do not see or feel the surgery taking place. 

The most common types are nerve blocks, spinal, and epidural anesthesia. 


General

In general anesthesia, you are unconscious and have no awareness or other sensations.



Analgesics / Narcotics 

  • Fentanyl

  • Remifentanil

  • Sufentanil

  • Morphine


Anesthetics / Sedatives / Hypnotic

  • Inhaled

  • Halothane

  • Isoflurane

  • Nitrous oxide

  • Oxygen

  • Injectable          

  • Ketamine

  • Propofol

  • Thiopental


Muscle Relaxants

  • Succinylcholine


Reversal Agents

  • Naloxone

  • Flumazenil 

  • Neostigmine 


Anti-Memory

  • Propofol 

  • MidazolamHow anesthesia works:  Anesthesia works by shutting down specific receptors in the brain that process and react to pain. Because the receptors are shut down, they ignore the process entirely, allowing the patient to feel nothing. There are three stages of a general anaesthetic: The primary goals of general anesthesia are to achieve: The main levels of sedation are:

  • Induction

  • Maintenance

  • Emergence

Asleep vs. General Anesthesia


  • The brain is put under a series of deficits while ‘going under’ or being given general anesthesia. There are multiple, critical steps to protect the body and memory during surgery. Dr. Howard Nash, a scientist at NIH’s National Institute of Mental Health explains: Although doctors often say that you’ll be asleep during surgery, research has shown that going under anesthesia is nothing like sleep. 

  • “The first is an inability to remember things. A patient may be able to repeat words you say, but can’t recall them after waking up.”

  • Next, patients lose the ability to respond. “They won’t squeeze your fingers or give their name when asked,” Nash says. “Finally they go into deep sedation.”

Anesthesia Awareness


  • 1 patient in about every 1,000 - 2,000 surgeries may gain what is called anesthesia awareness. 

  • Where medications like the paralytic work, for some reason, the brain is not adequately sedated and becomes aware during the surgery. In some cases the patient is unable to feel the painkiller, leading to severe PTSD. 

  • Part of the process of anesthesia is made to keep this from happening or having a traumatic memory form. Not all anesthesia awareness results in trauma, I have a real story of my own experience with this. 

  • Thankfully, because the cocktail of drugs was mostly still working, my body didn’t register this memory as ‘traumatic’ which it easily could have. It’s more of an ‘odd’ memory. I don’t get any emotion when thinking about it other than how strange it felt. 



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