Fri. May 24th, 2024
Patient Who Dies Clinically

General anaesthesia isolates the patient’s body from brain control, which, at that moment, becomes clinically dead since it does not suffer, does not feel, and does not defend itself. To keep the patient safe in this situation of reversibility, the intervention of a specialist who acts as a “defence lawyer for the patient” is required, pointed out Ángel Noguerales. They highlighted the importance of the surgeon and the anesthesiologist being coordinated.


Anesthesiology is a modern medical speciality since the first intervention with general anaesthesia dates back to 1844, which has led to a significant advance in medicine, especially surgery. Noguerales has indicated, who has pointed out that to be an anesthesiologist, it is necessary to Overcome the six Medicine degree courses and five speciality courses in Anesthesiology, Resuscitation and Pain Therapy.

How General anaesthesia differs from local anaesthesia?

General anaesthesia differs from local anaesthesia in that the first one loses consciousness and the first anaesthetic gases that were used from the mid-nineteenth century were nitrous oxide, ether and chloroform and, later, opium was administered (as an enhancer of the effects of gases), but since it was a product that could not be controlled in its natural state, it was abandoned. Later one of its components, morphine, which can be dosed, was isolated.

General anaesthesia

At present, there are several types of general anaesthesia, and thus it can be done by inhalation with nitrous oxide, ether and chloroform (both abandoned today), halothane, peritrane and others, but it can also be used intravenously with barbiturates or substances synthetic and both systems simultaneously, which is balanced anaesthesia.

In general anaesthesia, muscle relaxants (curare and derivatives) are usually used, which complement it, producing total muscle paralysis, which is why using artificial respirators is needed.

Spinal anaesthesia

Other types are spinal anaesthesia, which is to administer a local anaesthetic through the spinal or epidural route; the trunk, with which the local anaesthetic is introduced into a nerve trunk to produce anaesthesia of the affected area innervated by that nerve trunk and the intravenous one.

Local anaesthesia

Local anaesthesia consists of infiltrating a peripheral nerve or the area where it will be operated on (minor surgery) with a local anaesthetic. And thus, the transmission of pain is blocked, and the patient notices the manipulation but does not feel any pain when fully awake.

Sometimes, depending on the character of the patient, it is usually complemented with mild sedation.

The rectal route (used in paediatrics and the elderly) has practically been discarded, and the one that is commonly practised is the balanced one and consists of taking a little of the other general ones, with which the same anaesthetic level is achieved but with a lower dose of drugs and fewer side effects.

The decision of the anaesthetic technique to be used is exclusive to the anaesthetist, depending fundamentally on the patient and, secondly, on the surgeon’s needs.

Ángel Noguerales recalled that zero risk does not exist. Thus one in 200,000 patients die from the effect of anaesthesia in general, which is why the training of the anesthesiologist is essential in an intervention in which potent drugs are used in toxic doses that, once they enter the body, there is no way to extract them.

He also highlighted the importance of knowing the surgeon’s skills to determine the dose and duration of anaesthesia since someone with a lot of experience can perform appendicitis in ten minutes and someone with less experience can take more than an hour.

A few years ago, Ángel Noguerales commented that there was little control over the depth of anaesthesia and the anesthesiologist’s experience.

But currently, there are sensors available to accurately calculate the level and depth of anaesthesia in which the patient is, and thus the surgeon, if he has to do something that causes more pain, notifies the anaesthetist to increase the dose. The operated person does not respond to that stimulus.

Noguerales explained that local anaesthesia causes a blockage in the nerves of a particular area. In contrast, general anaesthesia, although its operation is not entirely known, implies the isolation of the brain so that it either does not receive harmful impulses and therefore does not reply, or your reply is blocked.

This way, a general anaesthetized patient is clinically dead, and only an anesthesiologist can bring him back. And for this, he has to have profound knowledge about the physiology of all the vital organs and the pharmacology of all the drugs he uses; he has aggregated.

Ángel Noguerales has pointed out that the anaesthetist does other tasks, such as post-surgical recovery, and is also competent in administering blood transfusions and serums. His work is essential in treating chronic pain in patients who, due to a pathological problem, are in great pain.

The anesthesiologist is there to defend the patient, Ángel Noguerales has reiterated, who has recognized that although the number of anesthesiologists in Spain has increased progressively, there are still fewer than are needed, because although in public hospitals they have to be present always one of these specialists, and in some private ones, not in all of them, due to the scarcity of specialists.

The ideal, according to Ángel Noguerales, is that each centre where there is significant surgery has its permanent staff since there are interventions that can wait hours, even days. Still, there are severe ones (cesarean section, traffic accidents), and in those cases, it is not possible to wait for the anaesthetist to arrive, even if located.

He has also referred to the side effects of anaesthesia, which are “minimal” and clinically not appreciated. He has commented that in times past, drugs and alcohol have been used since the blow to the head. To magic and spells.

Ángel Noguerales had also declared that the state of mind of the patient when entering the operating room is essential because, during the time he is under the effects of general anaesthesia, time will not exist for that person (dead time). When he regains consciousness, he will be in the same circumstances as when he lost her.

Thus, if you enter happily, you leave in that state of mind, said Ángel Noguerales, who commented that some patients say they have heard about it and that, which is unimportant, is because at some point, the level of amnesia decreases and the brain recovers part of consciousness (hearing), but the usual thing is that it does not know how to interpret the voices and without any transcendence. EFE

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