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General anesthesia is a procedure that involves putting a patient to sleep, causing them to enter a state of consciousness deeper than sleep, and making them unaware of their surroundings. While it is considered very safe, it is the type of anesthesia most likely to cause side effects, which can vary from muscle aches and soreness to nausea and vomiting. In rare cases, malignant hyperthermia may occur, which is a rare inherited syndrome that causes fever and muscle contractions during surgery. The risk of side effects increases with age and the duration of the procedure.
| Characteristics | Values |
|---|---|
| Purpose | Prevents feeling of pain during medical procedures |
| Administration | Administered by an anesthesiologist, a doctor specializing in anesthesiology, or a certified nurse anesthetist |
| Types | General anesthesia, regional anesthesia, sedation, local anesthesia |
| Common Side Effects | Drowsiness, sore throat, nausea, back pain, muscle pain, chills, difficulty urinating, vomiting, pain, tenderness, redness, bruising at the injection site |
| Serious Side Effects | Malignant hyperthermia, nerve damage, postoperative delirium, anesthetic awareness, collapsed lung, organ failure |
| Precautions | Fasting for about 8 hours before surgery, avoiding certain medications a week before surgery, discussing medical history with the doctor |
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What You'll Learn
General anaesthesia and muscle relaxants
General anaesthesia is used during surgeries in hospitals or surgical centres. It is administered by a specialist called an anaesthesiologist. The medication is given as an inhaled gas and/or through an IV (intravenous) injection before and during surgery. The patient enters a state of deep consciousness, becoming unaware of their surroundings and unable to feel pain. Depending on the type and depth of anaesthesia, the patient may be able to breathe on their own or may require a breathing tube.
To ensure the patient stays still during the procedure, a paralytic medication is administered, paralysing the body's muscles temporarily. As the muscles used for breathing are included in this, a breathing tube is inserted into the throat and connected to a ventilator, which breathes for the patient.
Muscle relaxants are often given during general anaesthesia to facilitate endotracheal intubation. They are neuromuscular blocking agents that prevent muscles from moving when a patient is unconscious. However, the use of muscle relaxants has been associated with an increased risk of postoperative pulmonary complications. The French Society of Anaesthesia and Intensive Care (SFAR) recommends using a device to monitor neuromuscular blockade throughout anaesthesia.
There are various muscle relaxants available, including rocuronium, and reversal agents such as neostigmine and sugammadex.
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Abdominal muscles and anaesthesia
The abdominal muscles play a significant role in anaesthesia and post-surgical recovery. Anaesthesia, a critical discovery in healthcare, enables patients to undergo surgical procedures comfortably and safely. During anaesthesia, the abdominal muscles can increase intra-abdominal pressure, which, if not counteracted, can expand the lower rib cage. This pressure results from the activation of various muscles in the abdominal wall, and its effects on the rib cage are contingent on the specific muscles activated.
Inhalation anaesthetics, such as halothane, can cause rib cage constriction due to the combined action of abdominal and lower rib cage expiratory muscles. Additionally, abdominal muscle activation during anaesthesia is influenced by hypercapnia, and this activation is further intensified by opioid administration. Opioids selectively suppress inspiratory motoneurones, impacting breathing patterns.
Abdominal muscle activity is also observed in anaesthetised dogs, contributing to tidal volume generation. Similarly, in humans, abdominal activity may account for approximately 20% of breathing effort. Furthermore, nitrous oxide and morphine, as well as other opioids, can induce abdominal muscle activation.
After abdominal surgery, patients often experience reduced functional residual capacity (FRC) and impaired gas exchange. While measuring airway closure post-surgery is challenging, abdominal muscles can contribute to ventilation by reducing end-expiratory volume below FRC during inspiration. Overall, understanding the role of abdominal muscles in anaesthesia and postoperative care is crucial for optimising patient outcomes.
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Transversus Abdominis Plane Block
The Transversus Abdominis Plane (TAP) block is a valuable option for postoperative analgesia. It involves injecting a local anaesthetic (LA) solution into the fascial plane between the transversus abdominis and internal oblique muscles. This interfascial plane contains nerves that provide sensation to the anterior and lateral abdominal wall and the parietal peritoneum.
The TAP block is performed by depositing local anaesthetic between the transversus abdominis muscle and the fascial layer superficial to it. Ultrasound guidance is typically used to ensure the correct placement of the anaesthetic. The ultrasound probe is positioned along the abdominal wall, and the needle is inserted through the skin, with the tip visualised on the ultrasound throughout its trajectory.
The TAP block is commonly used after abdominal surgeries, providing effective pain relief and reducing the need for opioid use. It can be used for both inpatient and outpatient surgical procedures, including open and laparoscopic abdominal surgeries. The block is also useful for postoperative pain control after hernia repair and has been used in renal transplant donors.
The efficacy of the TAP block depends on the spread of LA across the interfacial plane. It is limited to somatic anaesthesia of the abdominal wall, and newer techniques have been proposed to enhance analgesia, such as the quadratus lumborum block, which aims to provide both somatic and visceral analgesia.
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Anaesthesia and bladder muscles
General anaesthesia is medicine administered before surgeries that require patients to be in a deep sleep-like state. During this state, patients cannot feel what the surgeon is doing, and their muscles completely relax.
Anaesthetic agents decrease intrabladder pressure and inhibit the micturition reflex. Halothane, for instance, decreases bladder contractions and increases its capacity. Urinary retention is a side effect of opioids, especially after intrathecal or epidural administration. Epidural morphine relaxes the detrusor muscle, increasing the maximal bladder capacity. Spinal opioids influence the function of the lower urinary tract, acting on the sacral nociceptive neurons and autonomic fibres.
Postoperative micturition difficulties are considered minor complications, but they have a high incidence. Acute urinary retention can follow all types of anaesthetics or operations. Overfilling of the bladder can stretch and damage the detrusor muscle, leading to atony of the bladder wall, so that recovery of micturition may not occur when the bladder is emptied.
In the case of post-operative urinary retention, patients should be stimulated to void and provided with a quiet environment in which to do so. They should be encouraged to sit, stand, or walk as early as possible.
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Local anaesthesia and muscle soreness
Local anaesthesia is a type of anaesthesia that uses medication to numb a specific area of the body where a medical procedure is to be performed. It is different from general anaesthesia, which induces temporary unconsciousness in the patient. Local anaesthesia is generally considered safe and effective, with a low risk of side effects.
However, one possible side effect of local anaesthesia is muscle soreness or pain. This soreness typically occurs at the site where the needle was inserted and can cause minor back pain or muscle pain. In some cases, patients may experience more widespread muscle aches due to the medications used during the procedure. These drugs, known as paralytic medications, are powerful muscle relaxants that temporarily paralyse the muscles to ensure the patient remains still during surgery. While this paralysis is necessary for the procedure, it can lead to muscle soreness and aches as the body recovers from the effects of the medication.
Additionally, local anaesthesia can also cause difficulty urinating, especially if the anaesthesia was administered in the lower body. This is because the bladder muscles may be temporarily paralysed, affecting the patient's ability to recognise the urge to urinate. Nerve damage is another rare but possible complication of local anaesthesia, which can result in temporary or permanent pain, numbness, or weakness.
It is important to note that the side effects of local anaesthesia are typically temporary and usually subside within 24 hours. However, if any side effects persist or become concerning, it is always best to consult a healthcare professional for advice and guidance.
To minimise muscle soreness after local anaesthesia, patients are advised to rest and refrain from strenuous activities for the remainder of the day. Returning to work or other activities too quickly can exacerbate muscle soreness and prolong the recovery process. Additionally, patients should follow their healthcare provider's instructions and take any recommended medications or supplements to aid in their recovery.
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