Anesthesia refers to the process of controlling pain or other sensations during surgeries or any other procedures (capable of causing pain) by using medicines known as anesthetics. Anesthetics are either given through injections or through inhaled vapors or gases. This medicine is used for blocking pain, making a person unconscious during surgery, etc. It also helps to control the blood pressure, blood flow, heart rate, and breathing rate of any person.
An anesthesiologist determines the quantity and types of anesthesia a person would require. Immense care is taken while administering anesthetics as any change in the prescribed quantity can lead to adverse effects.
The various types of anesthesia are either given to the patients through injections or gases and vapors. The ways through which the various anesthesia are administered are as follows:
The following people are eligible for the various types of anesthesia:
A person having various health and mental conditions should discuss it with his/her doctor so that the proper quantity of anesthesia can be determined. Otherwise, those patients may suffer from adverse reactions.
General anesthesia has certain side effects if not administered in the proper manner:
Other types of anesthesia may have effects like prolonged period of numbness, allergies, etc.
Post-treatment guidelines include:
Anesthesia may last for 45 minutes to 4 hours depending upon the anesthetic drug used. While local anesthesia may last for an hour or so, general anesthesia or the epidural and spinal anesthesia usually lasts for 3-4 hours.
The cost depends on the procedure.
Once the effects of anesthesia wear off, the patient gains his/her consciousness.
Some herbal and homeopathic alternatives are available which can be used as alternatives for the various anesthetic drugs.
An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the large intestine called the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.
Genesis of fistula-in-ano
Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.
A clinical evaluation, including a digital rectal examination under anesthesia, is carried out to diagnose anal fistula. However, few patients may be advised screening for rectal cancer, sexually transmitted diseases and diverticular disease.
The only cure for an anal fistula is surgery. The type of surgery will depend on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.
Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. After this stitches are used to keep the plug in place.
Whatever the surgical technique, one can experience minor changes in continence. Patients usually don’t require antibiotics after surgery but have to take pain medication. They may also have to use gauze to soak up drainage from anus. After surgery, patients should seek help if they have increased pain or swelling, heavy bleeding, difficulty in urination, high temperature, nausea or constipation. If you wish to discuss about any specific problem, you can consult a General surgeon.
Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.
With endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.
Endometriosis can cause pain — sometimes severe — especially during your period. Fertility problems also may develop. Fortunately, effective treatments are available.
The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual cramp that's far worse than usual. They also tend to report that the pain increases over time.
Common Signs and Symptoms of Endometriosis may include:
Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before your period and extend several days into your period. You may also have lower back and abdominal pain.
Pain with intercourse. Pain during or after sex is common with endometriosis.
Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.
Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
Other symptoms. You may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.
The severity of your pain isn't necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all.
Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as Pelvic Inflammatory Disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.
When to see a doctor
See the doctor if you have signs and symptoms that may indicate endometriosis.
Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.
Although the exact cause of endometriosis is not certain, possible explanations include:
Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
Transformation of peritoneal cells. In what's known as the "induction theory," experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
Immune system disorder. It's possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that's growing outside the uterus.
Several factors place you at greater risk of developing endometriosis, such as:
Never giving birth
Starting your period at an early age
Going through menopause at an older age
Short menstrual cycles — for instance, less than 27 days
Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
Low body mass index
One or more relatives (mother, aunt or sister) with endometriosis
Any medical condition that prevents the normal passage of menstrual flow out of the body
Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless you're taking estrogen.
The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg. Inspite of this, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.
Ovarian cancer does occur at higher than expected rates in women with endometriosis. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.
Diagnosis: To diagnose endometriosis and other conditions that can cause pelvic pain, the doctor will ask you to describe your symptoms, including the location of your pain and when it occurs.
Tests to check for physical clues of endometriosis include:
Pelvic exam. During a pelvic exam, the doctor manually feels (palpates) areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Often it's not possible to feel small areas of endometriosis, unless they've caused a cyst to form.
Ultrasound. A transducer, a device that uses high-frequency sound waves to create images of the inside of your body, is either pressed against your abdomen or inserted into your vagina (transvaginal ultrasound). Both types of ultrasound may be done to get the best view of your reproductive organs. Ultrasound imaging won't definitively tell the doctor whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas).
Laparoscopy. Medical management is usually tried first. But to be certain you have endometriosis, the doctor may advise a surgical procedure called laparoscopy to look inside your abdomen for signs of endometriosis.
While you're under general anesthesia, the doctor makes a tiny incision near your navel and inserts a slender viewing instrument (laparoscope), looking for endometrial tissue outside the uterus. He or she may take samples of tissue (biopsy). Laparoscopy can provide information about the location, extent and size of the endometrial implants to help determine the best treatment options.
Treatment for endometriosis is usually with medications or surgery. The approach you and the doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant.
Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.
The doctor may recommend that you take an over-the-counter pain reliever, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others), to help ease painful menstrual cramps.
If you find that taking the maximum dose of these medications doesn't provide full relief, you may need to try another approach to manage your signs and symptoms.
Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue.
Hormone therapy isn't a permanent fix for endometriosis. You could experience a return of your symptoms after stopping treatment.
Therapies used to treat endometriosis include:
Hormonal contraceptives. Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they're using a hormonal contraceptive. Using hormonal contraceptives — especially continuous cycle regimens — may reduce or eliminate the pain of mild to moderate endometriosis.
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease menopausal side effects, such as hot flashes, vaginal dryness and bone loss. Your periods and the ability to get pregnant return when you stop taking the medication.
Progestin therapy. A progestin-only contraceptive, such as an intrauterine device (Mirena), contraceptive implant or contraceptive injection (Depo-Provera), can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.
Danazol. This drug suppresses the growth of the endometrium by blocking the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis. However, danazol may not be the first choice because it can cause serious side effects and can be harmful to the baby if you become pregnant while taking this medication.
If you have endometriosis and are trying to become pregnant, surgery to remove as much endometriosis as possible while preserving your uterus and ovaries (conservative surgery) may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery — however, endometriosis and pain may return.
The doctor may do this procedure laparoscopically or through traditional abdominal surgery in more extensive cases.
Assisted reproductive technologies
Assisted reproductive technologies, such as in vitro fertilization (IVF) to help you become pregnant are sometimes preferable to conservative surgery. Doctors often suggest one of these approaches if conservative surgery doesn't work. If you wish to discuss about any specific problem, you can consult a gynaecologist.
It is often seen that the people are unhappy with the appearance of their chin and cheek. Some of them may feel that their cheekbones are too less projected or that their cheek are too flat. Well, if you are one of them and want to enhance your appearance, it can easily be done by chin and cheek enhancement surgery. This is a cosmetic procedure and utilizes a specially manufactured material which is compatible with the tissues for augmentation of your face's physical structure. Chin and cheek enhancement gives your face a better balance and harmony to your facial features.
Chin Implants: Chin implants help in enhancing the size and projection of your chin and make it proportionate to your forehead and mid face. A recessed chin seems like it has disappeared into your neck instead of appearing as a distinct facial feature.
Cheek Implants: Cheek implants help in increasing the projection of your cheekbones. They also add volume to areas of your face, which are recessed and flat.
Procedure: Before undergoing the surgery, a proper implant of the correct shape and size must be chosen according to your requirement. The implants are made of a soft, flexible and rubbery material, which gets inserted via an incision. Solid silicon is commonly used for cheek or chin implants. General anesthesia along with a sedative is used during the surgery on the patient.
A cheek implant requires 30 to 45 minutes to be carried out. It is performed in conjunction with other procedures like a facelift or a forehead lift, and the implants are incised through an incision. Sometimes the implant is inserted through an incision on the upper lip or the lower eyelid. For a chin implant, the procedure takes about an hour. The implant gets inserted through a pocket made in front of the jaw bone. For creating the pocket, an incision is made inside the mouth in the lower lip or under the chin.
After the surgery is complete, the affected areas are taped in order to decrease swelling. The sutures in the skin are removed within five to seven days. In case the sutures were made intra orally, they dissolve slowly. You need to make certain dietary changes and lifestyle modifications after the surgery. Some discomfort and swelling are likely immediately after the surgery.
Cheek and chin enhancement offer effective improvements to your facial appearance. It results in plump and youthful cheeks with an enhanced volume. The implants are considered to be quite safe. If you feel you require a chin or cheek enhancement, you should consult a doctor before taking this decision and then only choose the accurate implant. It is also important to consult a doctor several times after undergoing the surgery.
If you are thinking of undergoing some skin rejuvenation treatment, you should consider collagen induction therapy. This therapy, also called medical skin needling, is a minimally invasive skin rejuvenation treatment that aims at reducing the appearance of wrinkles and fine lines on your face, and other parts of your body.
Who requires collagen induction therapy?
• Collagen induction therapy suits several types of skin, and it is carried out by people who want to improve their skin laxity, eliminate wrinkles, smoothen lines, and slow down the aging process.
• It is also ideal for improving your appearance, in the case of scarring.
Before the treatment
• Before undergoing this therapy, you should consult an experienced doctor to determine whether the treatment will suit you or not.
• You should also ask the doctor about the procedure, its complications, benefits, and other facts related to collagen induction therapy.
• The treatment involves the use of micro needles on a roller which is moved over your skin for creating evenly spaced puncture wounds.
• As a result of the process, the body’s natural collagen production gets stimulated by the generation of a wound healing response.
• The roller that is used is similar to a tattoo needle, and minimal trauma is caused during the creation of the puncture holes.
• Sometimes, local anesthesia is used for minimizing discomfort. The length of the needles on the roller varies and depends on how deep the needles have to penetrate into the skin.
• Your skin is damaged so that your body is encouraged to produce elastin and collagen, which helps in plumping up and thickening your skin.
• This procedure is performed on your body and face. It usually takes around an hour for the treatment to be undertaken, depending on the area that is being treated.
• After undertaking a collagen induction therapy, it is likely for your skin to be pink in color.
• Some mild bruising and bleeding are also seen, which depends on the length of the needle used for the treatment.
• It usually takes two to three days to recover after the procedure. It is recommended for you to undertake a series of 2 to 5 sittings for maximum benefits and ideal results.
• It may take around 4 to 8 weeks for you to observe the benefits. You should use cosmeceutical grade skin care at home for better and enhanced results.
The collagen induction therapy is designed for stimulating your body’s natural collagen production that helps in improving your skin in several ways. You should consult a doctor and let him decide whether you are fit for the procedure.
Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.
Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:
Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to Death & Brain Damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:
Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.
Other’s are as listed below:
Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.
Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:
Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome. If you wish to discuss about any specific problem, you can consult a general surgeon.