Anesthesia-Online

Aftermath of general anesthesia

introduction

A patient who was operated on under general anesthesia comes to the recovery room for further monitoring after an operation. The ECG, blood pressure, pulse and oxygen saturation (vital signs) as well as the general condition of the patient are monitored there. The patient remains in the recovery room until he wakes up from the anesthesia and his vital signs are stable enough to be transferred to the ward.

General anesthesia can cause some aftermath and complications after surgery, which are explained in more detail below. Overall, potential complications can be detected quickly and reliably using modern monitoring methods and, in most cases, treated well.

Possible consequences of general anesthesia

Postoperative nausea and vomiting

A very common side effect after general anesthesia is nausea with vomiting (PONV = postoperative nausea and vomiting). This occurs in approximately 20 to 30% of all patients. There is an increased risk in women, children, non-smokers, with long periods of anesthesia (longer than 2 hours), with postoperative administration of opioids or with the use of inhalation anesthetics (including Flurane). If the patient has motion sickness, it also makes nausea and vomiting likely.

The PONV risk can be estimated based on the above risk factors.The so-called apple score, which takes some of the risk factors into account, is often used for this. If the risk is very high, inhalation anesthetics should be avoided and drug prophylaxis initiated. In addition to dexamethasone, 5-HT3 antagonists (Sertrone), histamine H1 antagonists (dimenhydrinate), the neuroleptic droperidol is also suitable.

In addition to dexamethaosn (due to its delayed onset of action), the substances mentioned above can also be used to treat postoperative nausea with vomiting. In contrast to prophylactic therapy, they are administered in lower doses.

Breathing disorder

Sometimes you wake up Narrowing of the airways come. Especially smokers or people with pre-existing Lung disease how asthma or COPD can one spasm (Cramping of the muscles) of the bronchi. If the Narcotics act longer (so-called overhang), the respiratory drive can be reduced.

By consistent monitoring and the gift of Bronchodilator substances the narrowing of the bronchi can be lifted.

Cardiovascular system

As a reaction to the exertion of the body from the operation and general anesthesia, the Blood pressure both to high as well as too low be. In patients who have a Heart disease can have Arrhythmia until Infarct occur after general anesthesia. In order to counteract possible complications in the case of existing diseases of the heart, these patients are given particularly strict means after general anesthesia EKG supervised.

Muscle tremors

The Muscle tremors is also known as shivering designated. The heat regulation of humans is canceled by the anesthesia. In addition, a lot of body heat is lost through the open surgical field. Therefore, patients are warmed during longer, larger procedures during the operation. After the operation, the brain areas of the temperature control notice a discrepancy to the normal state. That's why this is Muscle tremors to rewarm one of the more frequent aftereffects of anesthesia.

One problem with muscle tremors is the movement of the body Intensify pain can. On the other hand, the body needs a lot oxygen for the operation so that it goes to the Insufficient supply of organs can come with oxygen. This can be dangerous for patients with pre-existing heart disease, which is why they are often only awakened when they reach normal body temperature.

In order to generally counteract the occurrence of muscle tremors, the Patient also in the recovery room warmed. If it does happen, the anesthetist (Anesthetist) break the tremors with medication (e.g. the opioids pethidine or clonidine).

Tiredness / restlessness

Some patients respond to that Anesthetics especially sensitive and accordingly take longer to wake up. The narcotics can be used with Antagonists (Substance that counteracts the anesthetic) be toned down to speed up the process. fatigue Having general anesthesia is perfectly normal and not a cause for concern.

On the other hand, some patients are very excited after awakening. One reason for this can be post-operative pain, which can be suppressed with pain medication. The excitement resulting from the surgical procedure can also be responsible for the restlessness.

sleep disorders

In the context of postoperative delirium, which often occurs in older patients, the patient can, in very rare cases, develop sleep disorders that last for several days. Due to a general restlessness, the patients report problems sleeping through the night. Regular waking up at night is common. As a rule, the symptoms regress within a few days to weeks. If there is no improvement, the normal sleep-wake rhythm can be disturbed by the anesthesia to such an extent that drug treatment of the sleep disorder is necessary.

Read more on the topic: Difficulty falling asleep

a headache

A rather rare after-effect of general anesthesia is headache. These are usually not due to the side effects of the medication, but can occur due to incorrect positioning of the patient during or a lack of fluids after the operation. Headaches often occur with regional anesthesia (spinal / epidural anesthesia).

In addition, the headaches usually do not last long. Pain therapy (e.g. with paracetamol or ibuprofen) may be necessary to relieve the pain.

Delirium

Under a post-operative delirium one understands a state mental confusion, the one with fear and Hallucinations can go hand in hand. On average, it takes seven days for the delirium to subside; in some cases, courses of up to a month have been described. Elderly patients are mainly affected.

It is controversial whether the anesthesia or the surgical procedure in and of itself is responsible for the development of delirium. In addition to old age, certain risk factors are previous brain damage, for example from dementia, serious illnesses and long operations. The delirium can be treated with medication.

Confusion including duration

A common aftereffect of anesthesia is confusion. This occurs in the context of a so-called postoperative delirium or transit syndrome. Older people (older than 65 years) are particularly affected.

A distinction is made between two different forms of postoperative delirium, a central excitatory (exciting) and a central depressive (dampening). In addition to confusion, general restlessness, hallucinations, movement disorders, and seizures can occur in the central excitatory form, whereas in the central depressive form, patients primarily show a delayed awakening and drowsiness. Furthermore, in both cases the patients are often disoriented in time and place.

The occurrence and duration of the symptoms vary from patient to patient. While in some patients the symptoms mentioned above appear as soon as they wake up, in others they can only manifest themselves after a few hours, days or weeks. The duration is also very different and ranges from days to weeks. In rare cases, confusion can persist for several months. As a rule, however, there is an improvement in the home environment.

forgetfulness

Another aftereffect that can occur in addition to confusion as part of postoperative delirium is forgetfulness. After a general anesthetic, the patients are often disoriented in terms of time and place and also show poor concentration. These symptoms occur mainly in older patients (older than 65 years). The time of occurrence and the duration of the forgetfulness vary greatly from patient to patient. In rare cases, the symptoms can persist for months. However, it should not be confused with dementia.

Hair loss

There is no direct connection between general anesthesia and increased hair loss. Nevertheless, numerous patients report increased hair loss in the days after an operation.

Hair loss can occur as a result of increased physical stress during the operation. The stress leads to an insufficient supply of the hair roots with oxygen and nutrients and consequently to a disturbed growth with hair loss. The exact mechanisms are not yet understood. As a rule, the hair regenerates within a few days after an operation.

In very rare cases, hair loss occurs as a side effect of the administration of some anesthetic medication.

Read more on the topic: Hair loss in women, hair loss in men

Blood pressure

Numerous anesthetic drugs have an effect on blood pressure. The most commonly used anesthetic propofol, for example, leads to a slight widening of the blood vessels (vasodilation) and a reduction in cardiac output, as a result of which blood pressure drops. Conversely, however, in very rare cases the intense physical strain with the release of stress hormones can lead to increased blood pressure.

For these reasons, the vital parameters (blood pressure, heart rate, O2 saturation, breathing rate) are monitored during general anesthesia. The symptoms of low or high blood pressure usually subside within a few hours to days after general anesthesia.

Read more on the topic: Symptoms of low blood pressure, high blood pressure

Aftermath in children

In children, the after-effects after anesthesia are similar to those in adults. However, nausea with vomiting occurring after the operation is rather rare and only occurs in around 10% of children. Due to the smaller airways, however, injuries to the oropharynx and consequently sore throats after anesthesia are more common. A temporary hoarseness due to irritation of the vocal cords from the ventilation tube is possible.

In addition, (young) children are often restless, agitated and tearful after anesthesia. This is due to the side effects of the centrally acting drugs of anesthesia and is not always a sign of severe pain in the child. These symptoms occur more frequently in children between the ages of 3 and 7.

Isolated studies in recent years have shown a lasting effect of anesthesia in children in the first year of life on memory performance. However, the results are still controversial and have been partially refuted by other studies.

Basically, over the last few years and decades, anesthetic procedures have been developed that show only a very low risk of serious complications and after-effects in children.

Read more on the topic: General anesthesia in children - what should you watch out for? Vomiting after anesthesia

After-effects of anesthesia during a gastroscopy

With a gastroscopy there is only a low risk of side effects and after-effects, as the anesthesia is usually not very long and the anesthetic drugs are only administered in low doses.

Propofol is also often used as an anesthetic in a gastroscopy, as in general anesthesia. For this reason, the typical side effects or after-effects of anesthesia can also occur during a gastroscopy.

In addition, local anesthesia in the oropharynx can result in a local numbness after the reflection. In addition, a strong feeling of pressure in the upper abdomen is possible due to the introduction of air into the moles (for better assessment).

Read more on the topic: Short anesthesia with propofol