Anesthesia, questions and answers with dr Sanja Filipović

19-02-2020
Anestezija - Atlas bolnica

What is anesthesia?

Anesthesia originated from a Greek word meaning deprivation of consciousness. Modern anesthesia does not only mean taking away consciousness, but also taking away reflexes, pain and voluntary centers of activity.

The unconscious part of the brain remains active, so some patients dream during anesthesia.

The frightened ones mostly ask if the anesthesia is safe.

Dr Sanja Filipović: ” Today’s modern anesthesia, above all, is extremely safe compared to 2-3 or more decades ago. Today, you have a modern routine monitoring that is for the shortest, simplest interventions to the most demanding and most complicated. And indeed, there are very few theoretical possibilities for an accident or an unwanted event related to anesthesia to occur. In the end, our specialization enables us, teaches us and trains us how to recognize those unwanted situations that can happen and react in a timely manner “.

You have an appointment or examination performed under anesthesia. The preoperative preparation of the patient follows. The part of it includes filling in the questionnaire as well as talking to the anesthesiologist. Dr. Sanja Filipović explains which questions you need to answer and why it is very important to be honest.

Dr Sanja Filipović: “ Our patients will perform all the necessary laboratory analyzes we ask them, medical findings, maybe even some ultrasound, X-ray, etc. They will certainly fill out an anesthesia questionnaire that we require to be filled in, but despite all that, it is very important that you speak with the patient.

Through that conversation with the patient, the anesthesiologist will once again confirm all the information. (I always tell my patients that I know that they have already written it down. Surely, I have to ask them one more time).

It will be an introduction for the anesthesiologist. The first contact with the patient and in that way you will get valid data from the patient, but also valuable ones. You will have the opportunity to create a small psychological profile of your patient. That is somehow part of the anesthesia conversation and preparation. This way you will check if they are too scared. Also, you will check if they are completely relaxed, if something happened just before the operation, some serious stress, etc. So that’s very important to me. ”

dr Sanja Filipovic - anesthesia

Common questions to the anesthesiologist

Dr. Sanja Filipović: “Most often patients ask if they will wake up, if it is safe enough, those are the most common questions. The preoperative preparation is very important, as part of the preoperative preparation, there is also a conversation with the patient. Conversation is extremely important because the patient also gets to know and evaluate you. I always try to think from the other side, that I am a patient, what it would look like. “Somehow I think that’s the best angle, because then you’ll understand the patient in the best way.”

The first anesthesia that was recorded was with the gastroscopy procedure

Dr. Sanja Filipović: ” Gastroscopy is most often performed using analgesia. Analgesia is a type of mild, shallow anesthesia. Thus, it is not general endotracheal anesthesia. The patient is practically in a mild sleep, he can even hear something. He can move, but that is nothing unusual. It is important for the patient not to be in pain, to be minimally uncomfortable during that procedure. Also, during the anagosedation, the patient can get a good night’s sleep. The patient can open his eyes after half an hour and say how wonderful he slept and that he rested very well. ”

General anesthesia Atlas hospital

 

After gastroscopy, ankle arthroscopy was on the program

Dr. Sanja Filipović: “ Since it is an ankle procedure, the patient can be awake. So ankle arthroscopy can be done under regional anesthesia or the patient can sleep. If there are no medical contraindications for one or another type of anesthesia, we usually ask patients to choose. Sometimes the choice of anesthesia is their wish. It cannot always be like that, but when there is space for that, the patient chooses whether he wants to sleep or not.”

But what about the fear of anesthesia that both patients confirmed to us

Patient: ” Yes, I’m afraid of anesthesia and that’s the only thing I’m afraid of.” Because I’ve never been in a state of unconsciousness. And there is a general fear of not waking up from anesthesia. That is the biggest fear of most people. ”

Dr. Sanja Filipović: “ Monitoring during anesthesia means monitoring the patient from the beginning to waking up and later. That is why I say that the duration of the operation is not the same for the anesthesiologist and for the surgeon. The anesthesiologist will be present before the intervention, throughout the intervention and during the patient’s awakening, as well as in the immediate postoperative course. ”

What are the body functions that the anesthesiologist follow?

Dr. Sanja Filipović: “ Cardiovascular and respiratory system monitoring. There is also a more perfect monitoring of the depth of the degree of pain, it is not a routine monitoring. In some more developed countries, that is also part of routine monitoring, monitoring the depth of the degree of pain during the operation. If patient, despite having an absence of consciousness, have any awareness of pain. There is even monitoring of the reflex degree, whether there is any reflex response.

We try to take away the reflexes during the operation and those protective reflexes, which are even protective for life, but are not desirable to exist during the intervention and monitoring of the degree of consciousness. There is one scale, the so-called BIS monitoring (Bispectral index). We use it, it does not have to be in routine use, but you can follow a degree of reflex from deprivation, that is, the degree of pain, the degree of consciousness.

anesthesia apparatus

Standard monitoring is cardiorespiratory function.

This includes monitoring of the following:

  • heart rate
  • tensions
  • pressure
  • monitoring heart pressure
  • saturation – values ​​of oxygen levels in the blood

What is capnometry?

We monitor everything with the help of equipment. This is the most common routine monitoring, which is for all short-term or large interventions. There is another part of the obligatory monitoring, which is the monitoring of respiratory function, the so-called capnometry or capnography. This means that based on exhaled carbon dioxide, you are actually monitoring the patient’s respiratory function during the intervention. Until recently, until about 20 years ago, it was not routine, but now it is. In a quality and good operating room, you must have a good capnograph which is a sure sign that you have intubated the patient so the positions of the tubes are in the right place. Further general monitoring of the chart during the intervention may indicate some possible respiratory problems or complications during the intervention. ”

Dr. Vladan Stevanović confirmed to us the importance of an anesthesiologist is his team before entering the operating room where he performed the ankle arthroscopy. How important an anesthesiologist is for your work?

 

Dr. Vladan Stevanović: “ Without anesthesiologists, none of these interventions would have been performed. We can apply some forms of local anesthesia on our own, but it is really uncomfortable for both of us, the surgeons and the patient. The role of the anesthesiologist is not only in the operative and preoperative condition of the patient, but also in the postoperative course, for pain control and therapy of some chronic pain. I think that the role of the anesthesiologist is extremely important and they are always welcome, we are extremely good collaborators “.

Anesthesia is a hard and demanding profession, a difficult and beautiful specialization. They do not “fight for it”, it’s not popular. The fame is mostly taken by cardiac surgeons, orthopedists, neurosurgeons, but in those difficult moments before the operation, patients will forever remember the people to whom they entrusted their consciousness, because in the end anesthesiologist break their fear and patients have confidence in them.

Dr. Sanja Filipović: ” To be honest, anesthesia is not popular, if anythinng can be popular in medicine or the world of science. It is not popular, because it is a very hard and very demanding profession. Anesthesia is a job that requires exceptional physical fitness and a lot of knowledge. You have to respond to a number of 24-hour shifts. You need to be prepared to be available 24 hours a day, to help someone. To give them anesthesia and to be maximally concentrated to apply the best possible solution at that moment, for particular patient.

I say that from the experience of someone who worked at the Emergency Center for many years, so then I know what it means to do night work and make big decisions at four in the morning. Anesthesia is very nice, as long as you hear that normal beep sound on the monitor, but if something disturbs that sound, then it can already be dangerous and very stressful. Unfortunately, this job is very stressful.”

Postoperative recovery

Photo by Zinc Moon – anesthesia

Profession of an anesthesiologist is stressful, but also beautiful, as our interlocutor told us. The reward follows when the patient is brought back to life.

Dr. Sanja Filipović: “Cardiopulmonary resuscitation procedures are the ones by which you practically return the vital functions of the patient to their previous state. Resuscitation is a set of measures and procedures that we apply primarily to life-threatening patients. These are different causes that lead to this condition. They can occur immediately after the operation. They can occur during the intervention. They can occur in someone straight from the street, some polytraumatized patients, who are life-threatening and such were brought to the operating room or hospital.

Resuscitation procedures

It is a set of procedures and measures that you apply from the very beginning to such a life-threatening patient. You start and run until you return it to its optimal state. That is the most beautiful thing, when you resuscitate the patient. That is the most beautiful thing that can be in this profession. That feeling and the reward that you feel when you see that you have brought someone back to life. It is something absolutely priceless and irreplaceable in any other way. That feeling that you carry inside you makes an anesthesiology job beautiful. ”

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