How Anesthesia Works - Yale Medicine Explains

Transcript

• 00:05We have nerve endings
• 00:07everywhere,
• 00:08literally everywhere.
• 00:10And ordinarily,
• 00:12from these nerve endings,
• 00:13pain gets transmitted.
• 00:16You can kind of think
• 00:17of them as
• 00:18your early warning system. They
• 00:20are the first line of
• 00:21defense that you have against
• 00:22threats in your environment.
• 00:25So it could be a
• 00:25cut. It could be an
• 00:27incision. It could be, something
• 00:29blunt. That initiates
• 00:31a chemical response
• 00:33that is transmitted to the
• 00:34spinal cord then travel to
• 00:36the brain and that's how
• 00:37pain is essentially perceived.
• 00:40Now this is in comparison
• 00:41to chronic pain. Chronic pain
• 00:43is essentially a
• 00:44response. Right? So this is
• 00:45an ongoing false alarm that
• 00:48really does not provide you
• 00:49or the body any benefit.
• 00:51Pain medications and anesthetics
• 00:54utilize
• 00:55a very large number of
• 00:56different mechanisms.
• 00:57But in general, it's interrupting
• 01:00those pathways.
• 01:01From wherever
• 01:02the insult or the incision
• 01:04is or the puncture is
• 01:05and disrupt that communication to
• 01:07the spinal cord.
• 01:08So that pain is ultimately
• 01:10not experienced.
• 01:15There are a few different
• 01:16types of anesthesia that we
• 01:18use now. One is a
• 01:19local anesthetic, right, which many
• 01:21of you have probably experienced
• 01:22in your doctor's office or
• 01:23your dentist office.
• 01:25We have regional anesthetic techniques,
• 01:27what we call monitored anesthesia
• 01:29care which is a very
• 01:30deep sedation
• 01:31and then general anesthesia.
• 01:35Regional anesthesia
• 01:36is an anesthetic technique by
• 01:38which we administer
• 01:40local an aesthetic in and
• 01:41around large nerves that provide
• 01:44sensation to significant sections of
• 01:46our extremities or torso.
• 01:49Those are sometimes done on
• 01:51nerves in the periphery
• 01:53and sometimes they're done on
• 01:55nerves closer to
• 01:57the spinal cord. And that
• 01:58doesn't mean that it's dangerous
• 02:00because it's closer to the
• 02:01spinal cord. It just means
• 02:02that you're getting more nerve
• 02:04coverage
• 02:05the closer you get to
• 02:06the source of the nerves.
• 02:09So for laboring women, the
• 02:10injection is around the low
• 02:12back, and so it numbs
• 02:14all the nerves from that
• 02:15injection site and a little
• 02:16bit above
• 02:17down to the feet.
• 02:21General anesthesia means that your
• 02:23body is completely asleep. You're
• 02:24not experiencing pain. What we
• 02:26are doing is creating
• 02:28a
• 02:29space around both the brain
• 02:31and the body which is
• 02:32characterized
• 02:32by unconsciousness,
• 02:34analgesia,
• 02:36amnesia
• 02:36and paralysis
• 02:38with the maintenance of physiologic
• 02:39function.
• 02:40And that physiologic function is
• 02:42monitored and maintained
• 02:44by your anesthesiologist
• 02:45while you are as we
• 02:46say sleeping.
• 02:50Another type of anesthesia
• 02:52is IV anesthesia,
• 02:54which like general anesthesia,
• 02:56it does afford one hypnosis
• 02:59and level of numbness, but
• 03:01usually you're not deep to
• 03:03the point where you need
• 03:04a breathing device for your
• 03:06airway to be protected. This
• 03:08is commonly seen
• 03:09in cases like colonoscopies,
• 03:11endoscopy,
• 03:12or eye surgery.
• 03:15Your basic physiology
• 03:17is not only being maintained,
• 03:19but an anesthesiologist
• 03:21focusing on
• 03:23you holistically
• 03:24and helping to make sure
• 03:26that you stay in good
• 03:27balance.
• 03:32One of the things that
• 03:33we are seeing in anesthesia
• 03:35is really a move towards
• 03:36what we call a perioperative
• 03:38home. Where patients are not
• 03:40under the care of an
• 03:41anesthesiologist
• 03:42only during the immediate preoperative
• 03:43and intraoperative period but really
• 03:46becoming involved in care three
• 03:47to six months prior to
• 03:49a patient coming to surgery,
• 03:50during surgery and then their
• 03:52postoperative care afterwards.
• 03:54And chronic pain medicine provides
• 03:56an ability
• 03:57to
• 03:58attenuate risk factors for the
• 03:59development of chronic pain after
• 04:01surgery,
• 04:02as well as to facilitate
• 04:04the development
• 04:05of comprehensive pain plans
• 04:07to
• 04:08minimize discomfort in the post
• 04:10operative period both in and
• 04:11out of the hospital.
• 04:14It's a very exciting time
• 04:15in anesthesia.
• 04:17We're always
• 04:18interrogating and really asking the
• 04:20questions.
• 04:21What does the data show?
• 04:23So that we can do
• 04:25this shared decision making with
• 04:26our patients.
• 04:28Anesthesiology
• 04:29has become extraordinarily
• 04:31safe,
• 04:32both because of the monitoring
• 04:34that we have, the medication
• 04:36that we have, and the
• 04:38vigilance
• 04:39that we have.