Modern anesthesiology: types and purposes of anesthesia

• Operating principles
• Anesthesia methods
• Indications and contraindications
• Types of anesthesia
• pain relief in pregnant women
• Anesthesia for children
• Recommendations
• Complications
• Drugs used
• Price

Nowadays, it is possible to receive medical care not only fast and high-quality, but also painless. Almost any action of the doctor that can bring discomfort or unpleasant sensations to the patient is accompanied by dental anesthesia, or in other words, “freezing”. He stops experiencing pain and fear and relaxes, allowing the dentist to calmly do his job.

Operating principles

Anesthesia is carried out immediately before the start of treatment. The anesthetic comes in both liquid and gel form. The doctor injects into the soft tissues that are located near the diseased tooth. After some time, the tongue, gums and cheeks become numb and “freeze”. At this moment, the anesthetic acts as a blocker of nerve impulses that send a pain signal to the brain. The patient calmly endures dental procedures without experiencing stress.

The duration and effectiveness of dental anesthesia depends on the quality of the materials used and the location of the injection. The closer to the problem area the injection was administered, the more intense its effect. Each organism is individual, therefore the drug will be excreted at different rates.

Different types of drugs function in their own ways. For example, gel-like ones applied to the gums or surface of the cheek last only a couple of minutes. If they are installed in the upper part of the jaw, the effect will last for 2-3 hours. To treat the lower group of teeth, a deeper injection is required, so the result lasts up to 4 hours. After the solution is absorbed, the numbness disappears and sensitivity returns to the patient.

Intravenous anesthesia

This type of anesthesia refers to non-inhalation types of anesthesia, which are characterized by a long-lasting effect and a greater depth of effect compared to inhalation anesthesia. Intravenous anesthesia can be performed using the following drugs:

• Thiopental, Recofol, Oxybutyrate and Propofol - classic pain relief
• Fentathyl with diphenhydramine - neuroleptanalgesia, which can be carried out on spontaneous breathing or combined with artificial ventilation
• Sibazon with Fentathyl is ataralgesia, which provides superficial, gentle anesthesia and can be carried out with other types of anesthesia.

This type of anesthesia is used to remove abscesses and phlegmons that occur with complications; it is also possible to treat small benign tumors if their removal under general anesthesia is not possible.

Anesthesia methods

Depending on the goals and nature of the problem, the doctor chooses the method of pain relief. In medicine there are two main methods:

Anesthesia

It is most often used in surgery, and in dentistry much less often, in case of urgent need. It affects the entire body of the patient, inducing a state of sleep. At this time, all muscles relax and consciousness turns off. You can administer painkillers intravenously or inhale vapors through a mask. Deep anesthesia is used during complex operations when a person does not have enough strength to cope with pain or it is necessary to completely eliminate body movement. During sleep, the doctor monitors the patient's condition to avoid emergency situations.

Recovery from anesthesia is the body’s return to normal functioning after a long “freeze.” For all people, this process proceeds differently, some experience signs of nausea or a feeling of lethargy, while others wake up well-slept and rested.

General anesthesia in dentistry during pregnancy is applicable only in emergency cases when there is no other alternative.

Local anesthesia

Unlike anesthesia, it occurs locally, affecting only certain areas of the body. Can be used for children and pregnant women, without fear of unwanted consequences. In dental practice, this method is most often used, so we will talk about it in more detail.

Local anesthesia

Treatment under anesthesia is the only option for providing surgical care to a patient or performing complex manipulations. Often, a doctor will numb a specific area, which is achieved by injecting it with an anesthetic solution and is called local anesthesia. This type of anesthesia is used for opening ulcers, treating teeth, and excising a hernia. Local anesthesia is the injection of an anesthetic into the skin and other anatomical structures of the place where surgery is expected to be performed.

The anesthetic injections are superficial; only in exceptional cases can the doctor administer the drug more deeply. Local anesthesia is performed by injecting the drug through a very thin needle, so the actual anesthesia procedure is minimally painful. Often, the administration of an anesthetic is combined with sedation - sedatives are introduced into the patient’s body, which normalize the person’s psychological state, reducing feelings of anxiety and restlessness.

Despite the fact that local anesthesia is used very widely in medicine, the consequences of anesthesia can be quite serious. For example, local anesthetics can have a negative effect on the heart and brain, leading to heart rhythm disturbances, seizures and loss of consciousness. At the same time, doctors claim that local anesthesia, compared to general anesthesia, is safer for the patient’s health.

Indications and contraindications for the use of local anesthesia

Any dental intervention that causes pain must be accompanied by “freezing” of the required area of ​​the oral cavity. There is a list of diseases for the treatment of which it is necessary to administer anesthetic drugs:

• Complex caries;
• Removal of a tooth or its roots;
• Periodontitis;
• Inflammatory processes in the dental system;
• During prosthetics.

Before drawing up a treatment plan and choosing medications, the doctor must interview the patient and find out from him the presence of contraindications in order to exclude the possibility of complications.

• Allergy to drugs used;
• Heart diseases;
• Diabetes;
• Problems with the endocrine system.

General anesthesia in dentistry: objective indications

It would hardly be correct to consider general anesthesia a solution for those who are simply afraid of dentists. This is a serious procedure for which there must be objective reasons. However, in some cases, general anesthesia - the administration of narcotic analgesics by inhalation or intravenously to completely turn off consciousness - has its advantages.

• Pathological panic and fear of dental procedures, inability to administer anesthesia by injection, patient's immunity to sedatives. If such a patient needs to undergo dental surgery - to remove an abscess or large cystic formation, to clean necrotic tissue formed as a result of purulent inflammation on the jaw bone - general anesthesia cannot be avoided.
• Serious psychological or neurological disorders in which the patient cannot behave adequately during the treatment process and correctly comply with the requests of the dentist.
• Pathologically increased gag reflex.

It is important to understand that treatment under general anesthesia must be carried out in a hospital setting. In addition to the dentist and nurse, the presence of an anesthesiologist is mandatory.

Types of anesthesia

There are several methods in medicine; they differ in duration, effectiveness and location.

Conductor.

The most common type of local anesthesia in dentistry. Using a special needle, the drug is injected near the nerve trunk, blocking pain impulses that go to the brain. The injection is given in doses not exceeding a volume of 5 ml. To ensure a guaranteed result, the injection is placed at an angle of 90 degrees.

“Freezing” applies only to a certain group of teeth, in the place where the treatment will take place. After about 15 minutes, the medicine begins to work and the doctor can begin work.

The injection site can be additionally lubricated with lidocaine. If during the procedure the patient continues to feel discomfort, another dose may be administered.

Infiltration

It differs from the conductor only in the angle of the needle and the place of application. The drug is injected directly into the root apex area. This type is most effective for teeth and upper jaw. With infiltration anesthesia, you can “freeze” both a small area and a large surface of the oral cavity along with soft tissues.

Applique

This method is performed without a syringe. The dentist applies the necessary product directly to the diseased tooth and the soft tissues surrounding it using a cotton swab or fingers. Some doctors spray anesthetics using a special spray.

It is mainly used during simple and quick operations, since its effect is short-term and does not protect against severe pain. The result is stored for a maximum of 20 minutes. It is often used as the first stage before the injection “freezing” method.

Intraosseous

The dentist resorts to this technique much less often when other types of anesthesia have proven ineffective. An analgesic that is injected directly into the hard tissues between the teeth. The difficulty lies in the technique; to get to the bone, the doctor cuts the gum and drills a hole in it with a bur. This is the most effective method for quickly and permanently freezing the required area.

Intraligamentary

Its peculiarity is the high speed of injection, so numbness occurs almost immediately, but lasts only 20-30 minutes. The advantage of intraligamentary anesthesia in dentistry is that it acts directly on the tooth without touching the cheeks, lips and tongue. That is why the recovery process is much easier.

Dental anesthesia during pregnancy and breastfeeding

Dental treatment during pregnancy and breastfeeding seems problematic or impossible for many due to the negative impact of anesthesia on the fetus or nursing baby. This is a common misconception that often deprives young women of their chances of healthy teeth and a beautiful smile. By “sharing” calcium and other substances useful for teeth with the baby, a woman’s body may experience a lack of them, which will result, in particular, in bad teeth.

For a pregnant woman, dental procedures can be divided into two groups: those that can be postponed until the post-lactation period, and those that cannot be postponed. Timely treatment of caries, pulpitis and other “acute” diseases is mandatory. Also, you should not delay performing operations for which there are objective indications, for example, removing cysts that are increasing in size or teeth that cannot be treated.

Dental prosthetics, wearing braces, implantation, installation of veneers and lumineers can be postponed until “later”.

Anesthesia for pregnant women has its own characteristics. The requirements for it are the following - the minimum probability of penetration of the active substance through the blood and placenta to the fetus (for a nursing mother - through the milk to the baby). For this purpose, dentists use drugs in which vasoconstrictor components (adrenaline/epinephrine) are contained in a concentration of 1: 200,000. There are at least two reasons for this:

• This concentration will not affect the development of the fetus and will not harm a breastfed baby.
• The vasoconstrictor component does not retain the injected medicine on the local area of ​​the gum, providing insensitivity to pain, and at the same time, not allowing the composition to spread further throughout the body through the bloodstream.

Features of pain relief in pregnant women

One of the most common misconceptions is that pregnant women are contraindicated for dental treatment. You should not trust unreliable sources; dentistry and pregnancy are completely compatible concepts. Expectant mothers should undergo a professional examination during planning and at 8, 18 and 28 weeks of pregnancy. Untreated infections in the oral cavity contribute to the development of other dangerous diseases.

The question immediately arises: can the use of dental anesthesia harm the health of the unborn child? Modern technologies allow the use of drugs with lower concentrations of adrenaline. Accepted painkillers are ultracaine, primacaine or mepivacaine*. They do not penetrate the placenta, therefore, do not harm the body of a pregnant woman.

*A verified and accurate list of acceptable medications can be obtained from your doctor.

Which anesthetic to choose?

While a healthy person can afford almost any method of anesthesia, patients with serious diseases of the body must be extremely careful in choosing the drug. Thus, it is necessary to warn the dentist, who will anesthetize the oral cavity, about such health problems as disruptions in the endocrine system, high blood pressure, and a tendency to allergic reactions.

• Allergy sufferers and asthmatics can be given anesthetics that do not contain preservatives.
• For diabetics and patients with an enlarged thyroid gland, anesthesia that does not contain vasoconstrictor components - adrenaline and epinephrine - is recommended.
• For patients with compensated heart disease and a tendency to moderate increases in blood pressure, anesthesia is indicated, in which the concentration of vasoconstrictor components (epinephrine, adrenaline) is 1:200,000.
• Patients with progressive diseases of the cardiovascular system can be treated with drugs that do not contain adrenaline and epinephrine.

Anesthesia for children

Painless pediatric dentistry is a hot topic today. All parents know what a trip to the dentist means for a child. If this brings few pleasant emotions to an adult, then what can we say about children. The first scheduled visit is always scheduled for the age of 6-7 years - this is the time when baby teeth are replaced with permanent ones.

The psyche of children is not yet fully formed; one wrong word or action can provoke the development of unpleasant memories. Therefore, it is important to instill confidence in the child, to mentally prepare him for the procedure: explain why he is going there and what the doctor will do. The use of anesthetic agents in pediatric dentistry is an integral part of comfortable treatment.

The most suitable injection methods for babies are infiltration, conduction and application. The place where the drug is administered is “frozen” in advance and only then does the doctor give an injection. The child’s body is not yet fully formed, so in pediatric anesthesia, special medications are used that make it possible to carry out the procedure safely.

Inhalation anesthesia

This is the most commonly used type of anesthesia, which is characterized by ease of implementation, relatively easy control and short duration of action, which is important for minor surgical interventions. Inhalation anesthesia is the administration of drugs through a mask, which ensures their entry into the organs of the respiratory system. Most often, Narcotan, nitrous oxide, Trilene, Ftorotan and Etran are used for this type of anesthesia. There is a certain problem - to achieve the desired result, it is necessary that the effect of anesthesia be deep, and this is fraught with serious complications. Therefore, this type of anesthesia is most often used in pediatric surgery. Children under anesthesia administered by inhalation feel excellent, they do not experience respiratory dysfunction, and complications are extremely rare.

Recommendations

For the successful use of anesthetics, there are two conditions: 1) the patient must abstain from drinking alcohol at least 24 hours before treatment; 2) feel good.

Often, after the effect of painkillers wears off, the patient experiences pain, swelling, tingling at the injection site, and difficulty opening the mouth (trismus). Within 2-4 days, all residual effects should disappear.

After treatment, sensitivity returns gradually, so take the food carefully so as not to accidentally bite yourself. It is also recommended to quit smoking during this time.

Endotracheal anesthesia

One of the most commonly used methods of anesthesia when performing complex surgical interventions is endotracheal anesthesia, which involves immersing the body in a state of deep narcotic (medicinal) sleep. At the same time, the muscles completely relax, and the patient does not breathe independently. To achieve the desired state, doctors carry out a set of measures for the patient:

1. Tracheal intubation is the insertion of an endotracheal tube into the lumen of the trachea, which is needed to provide artificial ventilation of the lungs.
2. Intravenous administration of narcotic anesthetics, sedatives and tranquilizers.
3. Administration of muscle relaxants – they block neuromuscular transmission.
4. Artificial ventilation.

The quality of endotracheal anesthesia depends not only on the experience of the anesthesiologist, but also on how correctly the patient’s condition is monitored. It is imperative to monitor blood pressure, pulse, and oxygen saturation.