Management of Anesthesia Failure

Introduction:

Anesthesia is used very frequently in medical treatments. The primary function of anesthesia is to overcome the surgical pain and sensations over the targeted surgical site. In addition, the use of anesthesia numbs the area by blocking the nerve supply. This topic explains anesthesia, its effects, different types and modes of delivery and anesthesia failure, why it occurs, and how it can be managed.

What Is Anesthesia?

Anesthesia is a medicine or drug used to inhibit the pain sensation in the surgical area. They block the nerve signals going to the brain. They work as temporary loss of signals which can be regained soon after they wear off. There are different types of anesthesia present. These anesthetic medicines are delivered in different modes to the patient required. Some drugs cause unconsciousness, while some keep the patient conscious during surgery, while some serve as cream or lotion to control pain in the localized area.

What Is the Use of Anesthesia?

Anesthesia is used to control the pain in the targeted area. It is delivered to the patient by any means, of injection or sprays, or inhaling gasses by masks so that surgery can be performed without any pain sensation by the patient.

What Are the Types of Anesthesia?

There are four types of anesthesia. They are:

• General Anesthesia - General anesthesia is the anesthesia in which a complete loss of consciousness causes the patient to go to sleep. At the same time, a surgical procedure is performed. It is used for head, chest, and abdomen surgeries.

• Regional Anesthesia - Regional anesthesia is the anesthesia that leads the patient to be conscious with loss of sensation in the more significant body part requiring surgery, like lower limbs. They are used in cesarean surgeries, to numb the legs, or for knee or hip surgeries.

• Local Anesthesia - Local anesthesia is anesthesia used to numb a small area of the body. It is mainly used in dental procedures, biopsies, or eye surgeries. It is the most used anesthesia technique. And it keeps the patient awake.

• Sedation - Sedation causes anesthetic effects as it causes incomplete loss of consciousness during the surgical procedure. It is similar to general anesthesia but provides the patient with natural sleep. It can vary from mild to moderate sedation.

What Are the Different Modes of Anesthesia?

Different anesthesia uses different modes. They are:

• Inhaled Gasses by Masks - The method uses masks to inhale the gasses for the anesthetic effects. It is used for general anesthesia.

• Injection - Injection delivered into the veins is a common method used by all anesthesias. General, regional, and local anesthesia can all be given by injection.

• Sprays, Gels, or Lotions - Local anesthesia can be applied by sprays or lotions over the targeted small area.

Who Can Perform Anesthesia?

Anesthesia is performed by doctors, mainly, anesthesiologists, doctors specializing in anesthesia. An anesthesiologist is required primarily in major surgeries like cesarean section or brain or heart. Ideally, general anesthesia, sedation, and regional anesthesia need an anesthesiologist to examine the patient's activity. But other doctors can perform local anesthesia for minor procedures like dental or nerve block procedures. In addition, some topical or local anesthetic present in gels or lotions can be administered directly by the patient.

What Are the Different Anesthetic Agents Used in Anesthesia?

There are different types of anesthetic agents used in surgical procedures. Some of them are :

• Volatile agents - Isoflurane, Desflurane, and Sevoflurane.

• Propofol.

• Ketamine.

• Etomidate.

• Diazepam.

• Bupivacaine.

• Lidocaine.

• Midazolam.

• Nitrous oxide.

• Prilocaine.

• Fentanyl.

What Are the Side Effects of Using Anesthesia?

Side effects of using anesthesia are:

• Nausea and vomiting.

• Sore throat.

• Delirium (disturbed mind).

• Muscle aches.

• Itchiness.

• Shivering.

• Headaches.

• Difficulty in urination.

• Hematoma (bleeding under the skin).

What Is Anesthesia Failure?

Anesthesia failure is when the patient shows no effect on the anesthetic drug delivered by the doctor. Hence, ineffective anesthesia is called anesthesia failure. The patient feels pain in the surgical targeted area as the anesthesia is inadequate enough to numb and block the nerve sensations.

Why Does Anesthesia Failure Occur?

Anesthesia failure is not a common thing. It is rarely seen. Many factors can lead to the failure of anesthesia. Possible factors are:

• Any previous infection present in the patient.

• Wrong selection of anesthetic drugs in the patient.

• Lesser or too much use of anesthesia in the patient.

• Patient's anatomical variations with the accessory nerve supply.

• Patient's anxiety.

• Any form of technical mistakes.

• Any other drug interaction with an anesthetic agent.

• Using older stored anesthetic agents.

• A patient who has already encountered repeated doses of anesthetic.

• Wrong positioning of the patient.

• Improper technique to deliver anesthesia.

What Happens if Anesthesia Failure Occurs?

When anesthesia fails, the drugs do not work or wear off early, and the patient has continued nerve sensations instead of blocking nerve signals. But some medications given along with anesthesia can prevent the patient from completely becoming aware of the situation.

Which Is the Most Common Reason for Anesthetic Failure?

The patient's anxiety is the most common reason for anesthetic failure. So, it is essential to calm and relax the patient before starting any procedure on the patient. Anxiety causes tension and nervousness in the patient, which can cause anesthesia not to work on operating the patient further.

How Can One Manage Anesthesia Failure?

The anesthesia failure can be managed by pre-evaluating the parameters before anesthesia. Some of the managing points are:

• The doctor should check the patient's medical history in case the patient has any infection or has previously undergone an anesthetic procedure.

• The doctor can use nerve stimulators or ultrasound X-rays for nerve detection.

• Proper patient positioning has to be done.

• Anesthesia and the technique used for anesthesia delivery should be evaluated before planning further procedures.

• It is very important to relax the patient before going for anesthesia.

Conclusion:

Anesthesia blocks the nerve signals and sensations going to the brain and is used very frequently in surgical procedures. There are four types of anesthesia: general, regional, and local anesthesia and sedation. The anesthesia is delivered to the patient in different modes. Furthermore, anesthesia has side effects that are very concerning to the patient and the doctor. Anesthesia failure is also faced by the doctor and the patient sometimes. However, with proper pre-evaluation techniques, anesthetic failures can be prevented.