What are different types of anesthesia?

 

There are three types of anaesthesia

1) Local anesthesia:
Local anesthesia numbs a small part of the body for minor procedures. For example, you may get a shot of medicine directly into the surgical area to block pain. You may stay awake during the procedure. Or sedation can help you relax and sleepy during the local procedures.

2) Regional anesthesia:
Regional anesthesia blocks pain to a larger part of your body. You may also get medicine to help you relax or sleep. Types of regional anesthesia include:

Peripheral nerve blocks. This is a shot of anesthetic to block pain around a specific nerve or group of nerves. Blocks are often used for procedures on the hands, arms, feet, legs, or face.

Epidural and spinal anesthesia. This is a shot of anesthetic near the spinal cord and the nerves that connect to it. It blocks pain from an entire region of the body, such as the belly, hips, or legs.

3) General anesthesia: 
General anesthesia affects your brain and the rest of your body. You may get some anesthetics through a vein (intravenously, or IV), and you may breathe in some anesthetics. With general anesthesia, you’re unconscious and you don’t feel pain during the surgery.

 

Some patients may suffer from hallucinations under anesthesia, what are the main reasons? What kind of patients can be more vulnerable?

 

Patients may have mental aberrations through out the surgical process and anaesthesia such as awareness, hallutinations and dreams.

In some literature it is shown that hallucinations can occur less than 2 percent of the patient’s undergoing surgery which is really small. But it hasn’t been clearly defined yet. Hallucinations are usually mixed with dreams and nightmares and patient can think it is real. But this situation usually doesn’t take long time. Patient usually laughs at what they have experienced during surgical procedures

Young and healthy patient usually does not experience hallucinations. Elderly who have underlying health conditions such as diabetes, hypertension etc. are more vulnerable. There is a theory that inflammatory molecules which comes out during the surgical procedure can pass brain barrier and trigger the hallucinations. Young patients have protective brain barriers so that they don’t experience much of that.

In the literature there are some examples; patient believed that a nurse was trying to poison him and all the relatives also involved. Some patients see flying animals, aliens and spaceships.

Patients taking combinations of medications are also vulnerable to hallucinations usually antihistamines steroids and pain relieving opioids are responsible.

 

Is hallucination related to the duration of anesthesia? Does it normally occur during or after the surgery?

 

Hallucinations usually occur after surgery with general anaesthesia during big operations such as heart operations and some sedation procedures patient see hallucination very rarely and usually mix up with dreams and nightmares. There are no clear studies on why hallucinations appear more often in such cases.

Most sinister experiences with hallucinations are experienced usually after big heart surgeries.

The duration of the operation and the anaesthesia can increase these incidences.

If we evaluate the patient well before the surgery and determine the risk factors we can reduce these incidences.
Usually these risk factors are: disorientation, dehydration, constipation, existing mental impairment, infections, immobility, breathing difficulties, pain, multiple drug use and others.

Wards are usually very bright busy and noisy and that helps disorientating people who are vulnerable.

Most importantly patient should be adequately hydrated around the clock and be able to sleep well to avoid such mental aberrations.

The key to safe anaesthesia is to have  dynamic, careful and experienced experts who are monitoring you every second of the operation and can respond quickly to any kind of complications.

by Dr. Cafer Uruk
Chief Anesthesiologist, American Academy of Cosmetic Surgery Hospital