Medical Director / Professor Huang Wenqi, Deputy Director of the Center for Anesthesia and Surgery, First Affiliated Hospital of Sun Yat-sen University Professor Feng Xia and Professor Yang Yi
In the “Chinese Anesthesia Week†just past, anesthesiologists shouted out the slogan “Began to start a painless life with good lifeâ€. Everyone who knows medicine knows that if you want patients to safely walk down the operating table, not only depends on the surgeon's skills, but also on the level of anesthesiologists. Apart from surgery, what can the anesthesiologist do for the patient?
“To cure insomnia, save lives, relieve cancer pain and pain in childbirth, anesthesiologists can do more!†Professor Huang Wenqi, deputy director Professor Feng Xia and deputy director of the Anesthesia Surgery Center of the First Affiliated Hospital of Sun Yat-sen University The media reporter stated that the "comfortable medical care" that the medical community is concerned about in recent years is closely related to the development of anesthesia technology. The role of anesthesiologists is not only to allow the operation to proceed smoothly, but also to allow patients to enjoy comfortable and painless treatment.
Want painless baby?
How painful is childbirth? "External studies have shown that the highest level of pain is to use a knife to cut off the pain of the fingers, followed by childbirth pain." Huang Wenqi said that most of the mothers have to go through more than 10 hours of continuous pain.
Especially the primipara who are obedient to childbirth tend to have an unforgettable memory of pain. Some people will suffer from rolling in bed, increase oxygen consumption, and even cause maternal and child metabolic acidosis. Some people are unable to shout with self-control and increase the risk of postpartum hemorrhage. The increase of uteroplacental blood flow is also not conducive to the oxygenation of the fetus.
"If you want to worry about having a child with no pain, then you should make an appointment as soon as possible anesthesia doctor." Feng Xia pointed out that painless childbirth is mainly used in two major categories of drugs and non-drugs. Among them, epidural anesthesia is the most common. When a regular contraction occurs, the obstetrician and anesthetist assess the actual condition of the woman. Epidural anesthesia can be performed when the mother or the family sign the informed analgesia for childbirth. The anesthesiologist inserts the spine puncture needle into the epidural space of the pregnant woman, and the catheter put on the needle enters into the epidural space, injecting the anesthetic into the body, so as to relieve the maternal pain and wait for the full opening of the cervix to deliver the disease.
The benefits of analgesia are obvious. Feng Xia pointed out that painless childbirth can reduce maternal stress response caused by pain, so that mothers will no longer suffer from childbirth pain, reduce the fear of childbirth and postpartum fatigue. Especially in the first stage of labor when the longest time and the greatest physical exertion are consumed, the maternal woman can be fully rested. When the cervix is ​​fully opened and the second stage of labor is entered, the mothers can have enough energy to complete the delivery. If childbirth suffers from heart and lung diseases and hypertensive disorders during pregnancy, childbirth analgesia is more helpful for safe delivery.
Feng Xia pointed out that in the event of an emergency in the delivery process, it is necessary to use an epidural catheter to perform anesthesia for cesarean section. This is convenient and quick, and it is changed to caesarean section for women who are not painlessly delivered. The time needed is short, and time is needed for maternity and child safety.
Painless childbirth can cause baby choking? Adjust the drug concentration
Huang Wenqi pointed out that the proportion of painless childbirth in developed countries in Europe and the United States is generally above 85%, while China does not exceed 5%. As an economically developed region, Guangdong has an analgesic rate of delivery that is higher than the national level, but only 10%.
On the one hand, painless childbirth, many mothers and their families feel concerned that "the use of narcotic drugs will affect fetal health." In fact, Feng Xia pointed out that the drug formulations used in painless delivery generally consist of small doses of local anesthetics and small amounts of opioids, which are highly diluted and configured. Compared to the anesthetics used for cesarean section, the dose of analgesic drugs for delivery is only 1/20 to 1/10 of that. Analgesic drugs enter the epidural space through labor pumps for analgesia. Only a small amount of drugs are absorbed into the bloodstream, and the placenta enters the fetus even more insignificantly, so it can be said that it is not affected by the drug.
Some older mothers worry that analgesic delivery, although comfortable for the first stage of labor, can make them unable to cope with the exertion in the second stage of labor, leading to an extension of the second stage of labor and even leaving the child in the birth canal for too long. Oxygen asphyxiation. Feng Xia said that painless labor leads to a certain incidence of slow labor, but the proportion is low, and the concentration of anesthetic can be adjusted, as long as the drug is controlled in a suitable concentration, will not affect the maternal in the second stage of labor Force.
Maternal wombs worry that after painless childbirth, low back pain is likely to occur after delivery. Feng Xia pointed out that postpartum low back pain has little to do with epidural anesthesia, and it is mainly related to stress on the spine during pregnancy and childbirth.
Of course, the use of epidural anaesthesia is also a certain risk, such as the puncture may fail, or the dural puncture will lead to leakage of cerebrospinal fluid. Some mothers will have some adverse reactions, such as lower blood pressure, fever, temporary weakness in the legs and so on. Experts reminded that the incidence of these adverse reactions is very low. After the occurrence of such adverse reactions, the health care workers are informed in a timely manner and will recover after taking symptomatic treatment.
Can become stupid after general anesthesia? Can fade in a day or two
“Does the general anesthesia make people stupid?†On the Internet, people who have undergone major surgery show up and say that they have a feeling of “drunk†after surgery, and even feel that memory is not as good as before. "General anesthesia makes people silly."
In fact, general anesthetic drugs mainly affect the whole body through the blood, and have the effect of sedative and hypnotic analgesia. After the anesthetic is subsided after the operation, the patient will soon wake up and have no influence on intelligence. Some people will experience one or two days of “drunken feelings†after surgery. The length of time and degree will vary from person to person. This is a sequela of anesthetic drugs, but it will not have serious effects on brain function. With the advancement of anesthesia concepts and techniques and the emergence of new anesthetic drugs, the incidence and severity of anesthesia sequelae have been greatly reduced.
The reporter was informed that commonly used general anesthetic drugs include intravenous anesthetics and inhaled anesthetics. Anesthesiologists will consider which anaesthesia and “anaesthesia combination†to choose based on the patient’s specific state and the complexity, duration, and surgical site of the surgery to reduce side effects and ensure the safety of the operation. For example, when the patient is in a state of stress, awake can not be combined with surgery, epidural anaesthesia is difficult to puncture or post-anesthesia pain, poor results, etc., and other anesthetic methods fail, general anesthesia is also required. Some major surgeries such as open heart surgery or painless gastroenteroscopy for increased comfort also require general anesthesia. If the blood pressure and blood sugar are not well controlled, there are serious heart diseases, etc., then general anesthesia cannot be used, and it is necessary to wait until the patient's condition is adjusted before proceeding with surgery.
Do children have general anesthesia affect brain development? Risk and benefit need to be weighed
"Do children perform general anesthesia and will not affect the development of the brain?" Yang Hao pointed out that the issue of "narcotic drugs will affect children's intellectual development" has so far failed to find clear evidence both at home and abroad. Although studies have suggested that children who have undergone surgery during infants and young children will have a later learning ability than children who have not undergone surgery, the results of this study are not convincing. The current medical community generally believes that an anesthetic does not have a significant effect on the development of the brain.
Yang Lan pointed out that when infants and young children are undergoing surgery or certain tests, because of their young age, they often cannot cope with surgery because of fear and crying, and can only use general anesthesia. In general, when surgery is performed, it is first calmed down with inhaled anesthetics or other anesthetic drugs such as dexmedetomidine, midazolam, ketamine, etc., and local anesthesia, inhalation anesthesia, and surgery are performed depending on the surgical site and surgical method. Intravenous anesthesia or a combination of multiple anesthetic methods. Some hospitals use ketamine as an analgesic drug in pediatric surgery. Today, more new anesthetics such as midazolam or propofol and other opioids are used to maintain general anesthesia. Clinical practice shows that inhaled anesthetics such as sevoflurane are also very suitable for general anesthesia in children.
“They should not have surgery, should not be accepted general anesthesia, to weigh the risks and benefits.†Yang Hao pointed out that, for example, appendicitis surgery, intestinal obstruction surgery, severe congenital heart disease such as emergency, emergency surgery, the purpose is to save lives In order to save important functions of the child, the longer the surgery is delayed, the more likely it is that more complications will occur and even life-threatening. The benefits of surgery far outweigh the risks.
Latest progress: With "visual anesthesia", doctors can "point to where"
In the past, anesthesiologists mostly adopted the technique of “blind beatingâ€. With the popularization and application of “visual anesthesia†techniques, anesthesiologists used ultrasound guidance to implement nerve block techniques to achieve precise anesthesia.
Take the foot fracture surgery as an example. In the past, the legs were required to be anesthetized. However, anesthesiologists can now block the nerve conduction signals at the surgical site of the foot, so that the patient does not feel pain and no extensive anesthesia is required. To achieve better surgical results.
The new technology of “visual anesthesia†reduces the amount of anesthetics used, which in turn reduces the risk of narcotic accidents due to differences in drug and individual physique, and also reduces postoperative pain, and “accelerates†for postoperative recovery. With the decrease in the amount of medication and the reduction in the length of hospital stay for patients, there is a reduction in medical costs. Again, some critically ill patients who are unable to withstand general anesthesia can now undergo surgery with the help of precision anesthesia.
The Anesthesiology Department of Zhongshan First Hospital used the "visual anesthesia" new technology earlier in the country and has applied the technique to the surgery in the hospital. This technique not only effectively reduces the patient's pain, but also reduces hospitalization costs. The reporter was informed that cesarean section and other operations are also exploring the use of "visual anesthesia" for accurate analgesia.
Expert doubts: The new technology is difficult to come to the patient? Anesthesia doctors are not enough
In addition to analgesia and lifesaving, anesthesiologists have "unique skills" to improve insomnia and relieve skin itching. However, in China, anesthesiologists basically have no time to use new technologies to deal with these chronic diseases.
"Since painless diagnosis is so good, why is it difficult for new technologies to come to us?" Huang Wenqi explained that this is mainly due to the shortage of manpower for anesthesiologists in China. At present, the number of anaesthetists in China is about 80,000 people, but it is responsible for about 56 million operations. In recent years, with the advancement of medical care in China, the amount of surgery has skyrocketed year by year, but the number of anesthesiologists has not been correspondingly increased.
Taking Zhongshan No. 1 Hospital as an example, in order to meet the patient's diagnosis and treatment needs, the operating room of the hospital has been implemented “24-hour operation†earlier in the country. There are 70 anesthesiologists in the hospital, and the proportion of anesthesiologists and surgeons is only 1 : 6~1:7. This situation is quite common in large domestic hospitals. In foreign hospitals of the same level, the ratio of anesthesiologists and surgeons is often 1:2.9.
To ensure the safety of daily operations, Chinese anesthesiologists have been busy and unable to provide more comfortable medical care for patients, leading to painless childbirth as a luxury even in some of the top three hospitals in Guangzhou.
As a member of the Guangdong Provincial Committee of the Chinese People's Political Consultative Conference, Huang Wenqi stated that in recent years the country is strengthening the training of anesthesiologists, but it has not been able to meet clinical needs in a short period of time. He called for the hospital to clearly specify the proportion and treatment of anesthesiologists and surgeons in the regular training of anesthesiologists. "Each year, the growth of anesthesiologists must match the increase in the number of surgeries." (Reporter Pengshan Ren, Ren Shanshan's correspondent)
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