Anesthesia

Anesthesia
 
Pain medications come in different forms and have been used for thousands of years.  The most common methods of relieving pain today are by taking a pill, patch, injection, or through intravenous access.  All of these methods significantly reduce or remove pain from the body. 
 
Dr.. Crawford Long, a Georgia physician, discovered ether over 150 years ago.  He found that when ether is inhaled, pain perception is blocked by removing conscious awareness and allows a myriad of surgical procedures to be done without feeling pain.  When the anesthesia is removed, the patient awakens with no conscious memory of the surgery being performed and did not perceive pain during the surgery.
 
Lidocaine is directly injected through the skin in a general or specific area, and locally blocks the conduction of the pain signal.  The nerves are unable to relate pain signals to the brain without affecting the awareness or level of consciousness of the patient.  The local sedation or anesthesia of the nerves from that area allows procedures to be preformed.  For example, when  i.e. when your dentist injects your jaw, they are then able to operate on a tooth, or when your doctor places an injection called a digital block at the base of your finger, he/she is then able to operate on the tip of the nail and finger. In addition to pain blocking medications, anti-anxiety medications may be used to relax a patient during minimal or lengthy minor surgical procedures such as the repetitive multiple injections during sclerotherapy.
 
Conscious sedation is usually used for outpatient procedures that do not involve major surgery, however, it cannot be comfortably performed with a local anesthetic block.  A patient is typically gowned and monitored in a surgical procedure room and an IV is placed through which one or several medications are given to a patient.  These medications severely reduce pain and anxiety, placing the patient in a sedated state, allowing the surgical intervention, which then allows the patient to breathe without mechanical ventilation.   This type of sedation is typically used for larger vein procedures such as endoluminal therapy or even venous phlebectomy. 
 
Tumescent therapy has become very popular with cosmetic surgeons in the last few years.  This technique involves infusing a very low dose anesthesia in a much diluted form that is then injected in a general area of the body, causing almost complete anesthesia in a generally wide area.  This allows a patient to be conscious and enables surgeons to complete procedures such as endoluminal therapy or phlebectomy to be performed in a patient.  This works quite well.
 
Most of us know that general anesthesia results in "total unconsciousness."  It uses a muscular paralytic that disables all muscles, including the ones required for breathing.  General anesthesia thus usually requires a plastic tube inserted down into your trachea so that mechanical pressure breathing can be obtained because your body no longer spontaneously breathes on its own.  Brain function is suppressed and patients typically have no recollection of the surgery. 
 
John Drew Laurusonis, MD
Doctors Medical Center