Surgery, or surgical intervention, as a treatment method, is a fact that causes anxiety in many people. However, based on research and my own experiences as a physician, I can say that when surgical treatment is recommended to patients as a treatment method, they are often not afraid of undergoing surgery but rather fear anesthesia.
In addition, the fear of not waking up from anesthesia, expressed by patients for years and the awareness stories during surgery under anesthesia, which have even become the subject of movies, support this fear. However, thanks to advancing technology and new anesthetic drugs, this fear has almost disappeared.
SAFER THAN TRAFFIC
As is known, anesthesia makes a part or the entire body insensitive to pain. Thus, when a patient decides to undergo surgery, they also decide to consent to a state where their consciousness is completely or partially closed, and they have no control over their own body. This is where the expertise of the anesthesiologist comes to the forefront. Anesthesiologists are specialists in anesthesia as well as in first aid, intensive care, and pain treatment. Your anesthesia doctor, who controls vital functions such as respiration and circulation during surgery, is your protector in every way. The patient is under the supervision of the anesthesia specialist throughout the surgery and afterwards until full consciousness is regained. Research has shown that a procedure performed by a skilled anesthesia team is much safer than driving a car.
THE ANSWER IS PAIN
On the other hand, the response of the body to surgical intervention is ‘pain’ because the incision starts to ache first. The size of the incision, whether it is small or large, is directly proportional to the amount of pain after surgical intervention. Therefore, it is not sufficient for the patient to feel no pain only during the surgery. Postoperative pain treatment is crucial for both the patient’s comfort and the success of the operation. Because regardless of how successful the surgical treatment or operation is, since the visible part of the process for the patient and their relatives is the postoperative period, pain management and treatment after the surgery carry a different importance. Thanks to all kinds of technology and anesthetic drugs available today, the period during and after surgery is much more comfortable in terms of pain.
Today, we talked to the expert in the field who has devoted years to anesthesia, TOBB ETU Hospital Medical Director, Anesthesia Professor Dr. Necati Çanakçı, about “anesthesia during surgery, postoperative pain treatment, and recovery period” which we may encounter at any stage of our lives. I asked Dr. Çanakçı about the mysteries and intriguing aspects of this topic on behalf of you, and he answered.
One of the most curious topics is “General Anesthesia.” Could you explain general anesthesia step by step to our readers?
When patients arrive at the operating room, they are greeted by the anesthesia doctor, taken from the stretcher to the operating table by the operating team with the assistance of the anesthesia doctor. After that, the anesthesia doctor connects the patient to a blood pressure monitor, electrodes of the heart monitor, and the finger clip cable of the pulse oximeter (which measures oxygen in the blood). These allow the monitoring of the patient’s vital functions closely throughout the surgery. If necessary, 3-5 minutes of oxygen can be given with a mask before starting anesthesia. After that, drugs that will reduce painful stimuli, create the special sleep state called anesthesia, and provide muscle relaxation are administered to the patient through the intravenous route. Later, an anesthetic gas mixed with oxygen is given to the patient through a tube placed in the patient’s trachea by the anesthetist. Anesthesia continues as long as these gases are given; shortly after they are stopped, the anesthesia ends, and the patient wakes up. At every stage of this process, the anesthesia doctor is constantly with the patient, making necessary treatments related to the course of the surgery.
Why are patients more afraid of general anesthesia than surgical treatment or surgery?
It is quite natural for the patient to experience anxiety or fear during the consciousness loss process caused by anesthesia. In fact, there are many reasons for this, but we can categorize the fear of anesthesia under three headings: “What if I don’t wake up?”, “What if I cannot sleep and feel everything during surgery?”, “What if I experience severe pain after surgery?”…
In the end, with the addition of common phrases such as ‘couldn’t tolerate the anesthesia’, ‘the anesthesia was too heavy’, to these unknown and uncontrollable fears, the anxiety of the patients increases a little more.
Ultimately, anesthesia is a branch of science. Although there are many complications of anesthesia theoretically, in practice, it can be said that anesthesia application by an anesthesia team in a fully equipped hospital is safer than driving a car.
What about those who are curious about anesthesia in simple procedures such as endoscopy, i.e., sedoanalgesia? This method involves the patient falling asleep, but it is not general anesthesia; it is local anesthesia. Could you talk about this frequently used method?
Sedation and sedoanalgesia applications are a type of local anesthesia we perform for simple procedures performed for diagnostic and therapeutic purposes both inside and outside the operating room to prevent pain or to reduce anxiety, even if there is no pain. In this method, anesthesia is provided with drugs administered through the intravenous route, and the patient is briefly put to sleep, but this is not general anesthesia. An example of sedoanalges
ia is the short-term sleep of patients during procedures such as gastroscopy performed by the gastroenterology department or dental treatments by dentists to reduce pain and anxiety.
So what is the role of the anesthesia doctor in this process?
The anesthesia doctor takes care of your close follow-up and medications for safe recovery, as well as after the operation, in a care unit called the recovery unit. Your vital signs and pain level are questioned. Because as the effect of anesthesia diminishes, pain and discomfort related to your surgery may begin to emerge. It is completely normal to eliminate this pain and additional local or regional blocks can be performed at the beginning of the recovery to prevent pain for a more comfortable postoperative period.
Doctor, how do you plan this pain treatment after the patient comes out of surgery as an anesthetist?
When you enter your patient room, your pain level is monitored at regular intervals under the supervision of nurses and doctors to ensure a painless, comfortable, and safe postoperative period. During your stay in the hospital, side effects due to medications are reviewed. All necessary precautions are taken. The reasons causing pain are questioned, and your multimodal pain treatment, which prevents pain through several pathways, is re-planned for each phase. At this time, a continuous pain relief level will be established in your blood or in the region where your pain nerves are located. Therefore, both the side effects of medications will be reduced, and a stable pain treatment plan will be provided.
So, does this postoperative pain management we discussed vary according to the type of surgery and the patient?
Your pain treatment plan is arranged specifically for the individual and the operation. It is important to know that the pain treatment of the patient will definitely be done according to the type of surgery to be performed and the intensity of pain that the surgery will cause. However, the doctor will decide on the application method of the pain reliever (pain control device, into the muscle, intravenous) to be applied. The drugs and dosages used to relieve pain vary depending on the type of surgery, location, age, and other factors. The anesthesiologist is aware of these and plans the treatment according to the patient.
Doctor, it has been a known fact for years that smoking is the greatest enemy of human health. What problems do smokers experience during and after anesthesia?
Anesthesiologists do not like the patient to be a smoker. Smoking patients experience some problems during anesthesia, especially in the waking period after anesthesia, and they also make anesthesiologists experience these problems. However, since they do not remember these experiences themselves, they continue to smoke after surgery in their postoperative lives. Recognizing that smoking addiction is a significant problem and not easy to cope with, our recommendation to patients may be to reduce the amount of smoked cigarettes as much as possible before the surgery and quit if possible. Our frequent experience is that quitting smoking for patients facing serious situations such as surgery is often an important and successful decision.
The popular treatment in recent years, patient-controlled analgesia (PCA), what is it?
In today’s technology, safe systems have been developed for patients to apply medications to themselves in postoperative pain treatment. Patients can self-administer controlled doses of pain relievers intravenously or through an epidural catheter by pressing a button.
Some patients avoid pressing the button even though they have pain. Is PCA safe?
PCA is an extremely safe application. Even if the patient presses the button more than the amount set by the anesthesiologist, it does not go to the patient.
So, how is the pain treatment of a patient who has completed their treatment in the hospital and is now discharged?
Since the acute postoperative pain period has been successfully overcome when the patient is discharged from the hospital, both the patient’s pain level will be below a certain limit, and the risk of experiencing chronic pain sensitivity in the future will be overcome. If deemed necessary, we can also adjust the pain treatment plan at home with orally administered drugs in the postoperative period. In conclusion, suffering from pain is not a fate; it is a choice made by you and your anesthetist. I wish you a healthy and pain-free life.
IN SHORT, NECATİ ÇANAKÇI
Prof. Dr. Necati Çanakçı was born in Balıkesir in 1956. He graduated from Ankara University Faculty of Medicine in 1979 and specialized in Anesthesiology and Reanimation at the same faculty. Dr. Çanakçı, who became a Professor in 2000, has significant studies and applications in pain science. Since 2007, he has been serving as the Chief Physician at TOBB ETU Private Hospital. (Published in Hürriyet Newspaper on March 15, 2013)