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What are the spinal subarachnoid?
"They make the same journey ... skin, subcutaneous supraspinous ligament, interspinous, ligamentum flavum and then pierces the dura. In that case what we have is cerebrospinal fluid, which is what protects the neural structures. Anesthesia was placed there. While the volume of epidural anesthesia is between 10 and 20 ml of local anesthetic, in this case is only 1 or 2 ml. It takes a lot less. And the type of anesthetic used is different, because they need drugs that have higher density than cerebrospinal fluid. These are called hyperbaric anesthetic. The spinal needles are much thinner (there are 27 and up to 29, for example. Modern are 'pencil point' ... before coming beveled, not now. This is important because before, when drilling to the dura with a chisel, left a hole. With the most modern, no ... enter, and when you go as if it closed. And remember that a complication of spinal anesthesia is a headache drive. Before, when I left the hole, the fluid lost people there, and when the person tried to get up, the effect of gravity lost more ... so that protection was lost I said before ... and gave a very severe headache.
other reasons why people are afraid of this type of anesthesia?
"There are many. They think they can be presented bone lesions. People say that he will be injected into the column. One could not be injected into the bone ... if you're putting the needle and you hit a bone, it is impossible to go to inject ... if you touch the bone, nothing happens. "
And what are the real risks of anesthesia?
" You should discuss the operative risk. This is because, first, by the patient's own risk. There are a classification of the American Society of Anesthesiologists (ASA) which speaks of five degrees of risk. Grade 1: healthy patient, whose only condition is that it will operate. Grade 2: has a medical condition other than the surgery (is hypertensive, asthmatic or diabetic, for example), but is compensated. Grade 3: Has two diseases apart from surgery, but is compensated. Grade 4: have two or more diseases, but it is unbalanced, and Grade 5: Table of severity of involvement is so severe that the possibility of death is great. In this classification you can add the letter E, meaning emergency. It is not the same as having a handle 4 that a handle 4 in an emergency, which does not allow predictions of any kind.
Second comes the risk of the institution, because it is the same surgery at a clinic that has all the fittings to do is wrong somewhere or is inadequately equipped. It is important, for example, that the clinic has central oxygen ... not a bombonita. An accident can happen because it's over the happy bombonita ... you have blood bank ... there is instrumental, there is intensive. It is important that people know that much of the risk lies with the institution ... must ensure that in the clinic are all resources. Thirdly, comes the risk of surgery itself, not the same heart surgery that a hernia. The latter is the anesthetic risk, which is by no means the least, and is given by the institution where you work, the teams with which they count and monitoring. All risks are absorbed by one as anesthesiologist ... because if I'm in an institution that works with bottles, I'm taking a risk ... that risk is mine. Because one should work well measured risk, well calculated ... in theory. "
Because the anesthesiologist not only rightful place
anesthesia ..." Sure ... the anesthesiologist is the doctor's surgery internist. You must know all the diseases ... you can operate a small thing, but if you are asthmatic, hypertensive ... need to know to decide which drugs to use ... have to know the absolute management of all diseases. Still loses a certain percentage of patients, but now is much lower ... here was high risk, but since 86, the monitoring interoperatorio improved so that makes the difference. "
What is meant by monitoring interoperatorio?
" At Harvard we designed a device to measure blood oxygen level, continuously ... called pulse oximetry. And there's a device that measures the CO2 expired. Called capnography. These two inventions avoided the complications, mortality. Because what you are looking for is to look at what was once was blind ... intubated, and certified that the patient is bouncing CO2, which only makes the lung ... to introduce these two resources for monitoring, lowered the rate of complications. If you have a patient oxygenation appropriate, adequate blood pressure, heart rate right ... okay ... and are monitored second by second. Before you realized a problem when the surgeon said, the blood is dark ... what it is to prevent the event ... If the voltage drops to proceed. Basic monitoring is electrocardiography, oxygen saturation, capnography and noninvasive blood pressure. If regional anesthesia is the only thing you will not have is capnography.
extended monitoring What?
"The equipment they are given anesthesia. Now there is talk of anesthesia systems. This means that they are machines integrate all basic and advanced monitoring of the patient: to unite all previous invasive pressure (it is a puncture in an artery and a catheter is placed there, and with an electronic system gives you continuous blood pressure), the depth of anesthesia or bioespectral index (BIS), which records brain activity and how it will be reduced to the extent that anesthesia is deeper or shallower. If you're between 40 and 60 are anesthetized. If you're over 60 you're awake, you're under 40, you are too deep .... Can be measured, too, the level of analgesia, and there are monitoring EEG and muscle relaxation. It has been so accurately that you can know the concentration of anesthetic into what is inspiring, as is exhaling, and what is in blood. These measurements allow the patient leaves the operating room awake ... and painless. That is the success of anesthesia. Of course, not only the machines are needed, but specialized staff.
What were the mortality rates before, and what now?
"Before hovered between 33 and 40%. Now die three to six patients per thousand. It has been a dramatic decline. But the country does not keep statistics well. And remember that there is a mortality in the operating room and other hospital (intensive care). "
In other countries, patients have the right to request a consultation with an anesthesiologist ...
" The ideal would have it. If you go to work and go to consultation with the anesthesiologist, he should evaluate you ... known, he will explain the procedures, how you prepare ... and to reach an agreement. If the patient says he does not want general anesthesia, for example, and can, as the anesthesiologist should be respected. Patient choice is paramount. It is concerned agree that the patient, the surgeon and the anesthesiologist. The relationship with the anesthesiologist should continue in the postoperative control ... he must ensure, for example, because you throw up, because the pain is treated correctly ... There are technical. It will be talking about what is known as perioperative medicine. It's not just leave it in the operating room before and I treat you after you have surgery to get out very well from the surgery. The unfortunate thing is that here only three or four institutions have preanesthetic. The most common is preanestesic. One comes to the patient's room the night before and tells you everything. "
Does the patient can choose their anesthesiologist?
" Sure. Among the options you have the institution. In so doing the patient more confident going into surgery. If you do not know one can even ask the doctor who wants to be in the hands of whom he most trusts. That creates a certain commitment. If he says they are all good, is committed to the institution, which is not bad ".
Venezuela What is safe?
" Yes. Every time we exercise the profession safer. "
What are the spinal subarachnoid?
"They make the same journey ... skin, subcutaneous supraspinous ligament, interspinous, ligamentum flavum and then pierces the dura. In that case what we have is cerebrospinal fluid, which is what protects the neural structures. Anesthesia was placed there. While the volume of epidural anesthesia is between 10 and 20 ml of local anesthetic, in this case is only 1 or 2 ml. It takes a lot less. And the type of anesthetic used is different, because they need drugs that have higher density than cerebrospinal fluid. These are called hyperbaric anesthetic. The spinal needles are much thinner (there are 27 and up to 29, for example. Modern are 'pencil point' ... before coming beveled, not now. This is important because before, when drilling to the dura with a chisel, left a hole. With the most modern, no ... enter, and when you go as if it closed. And remember that a complication of spinal anesthesia is a headache drive. Before, when I left the hole, the fluid lost people there, and when the person tried to get up, the effect of gravity lost more ... so that protection was lost I said before ... and gave a very severe headache.
other reasons why people are afraid of this type of anesthesia?
"There are many. They think they can be presented bone lesions. People say that he will be injected into the column. One could not be injected into the bone ... if you're putting the needle and you hit a bone, it is impossible to go to inject ... if you touch the bone, nothing happens. "
And what are the real risks of anesthesia?
" You should discuss the operative risk. This is because, first, by the patient's own risk. There are a classification of the American Society of Anesthesiologists (ASA) which speaks of five degrees of risk. Grade 1: healthy patient, whose only condition is that it will operate. Grade 2: has a medical condition other than the surgery (is hypertensive, asthmatic or diabetic, for example), but is compensated. Grade 3: Has two diseases apart from surgery, but is compensated. Grade 4: have two or more diseases, but it is unbalanced, and Grade 5: Table of severity of involvement is so severe that the possibility of death is great. In this classification you can add the letter E, meaning emergency. It is not the same as having a handle 4 that a handle 4 in an emergency, which does not allow predictions of any kind.
Second comes the risk of the institution, because it is the same surgery at a clinic that has all the fittings to do is wrong somewhere or is inadequately equipped. It is important, for example, that the clinic has central oxygen ... not a bombonita. An accident can happen because it's over the happy bombonita ... you have blood bank ... there is instrumental, there is intensive. It is important that people know that much of the risk lies with the institution ... must ensure that in the clinic are all resources. Thirdly, comes the risk of surgery itself, not the same heart surgery that a hernia. The latter is the anesthetic risk, which is by no means the least, and is given by the institution where you work, the teams with which they count and monitoring. All risks are absorbed by one as anesthesiologist ... because if I'm in an institution that works with bottles, I'm taking a risk ... that risk is mine. Because one should work well measured risk, well calculated ... in theory. "
Because the anesthesiologist not only rightful place
anesthesia ..." Sure ... the anesthesiologist is the doctor's surgery internist. You must know all the diseases ... you can operate a small thing, but if you are asthmatic, hypertensive ... need to know to decide which drugs to use ... have to know the absolute management of all diseases. Still loses a certain percentage of patients, but now is much lower ... here was high risk, but since 86, the monitoring interoperatorio improved so that makes the difference. "
What is meant by monitoring interoperatorio?
" At Harvard we designed a device to measure blood oxygen level, continuously ... called pulse oximetry. And there's a device that measures the CO2 expired. Called capnography. These two inventions avoided the complications, mortality. Because what you are looking for is to look at what was once was blind ... intubated, and certified that the patient is bouncing CO2, which only makes the lung ... to introduce these two resources for monitoring, lowered the rate of complications. If you have a patient oxygenation appropriate, adequate blood pressure, heart rate right ... okay ... and are monitored second by second. Before you realized a problem when the surgeon said, the blood is dark ... what it is to prevent the event ... If the voltage drops to proceed. Basic monitoring is electrocardiography, oxygen saturation, capnography and noninvasive blood pressure. If regional anesthesia is the only thing you will not have is capnography.
extended monitoring What?
"The equipment they are given anesthesia. Now there is talk of anesthesia systems. This means that they are machines integrate all basic and advanced monitoring of the patient: to unite all previous invasive pressure (it is a puncture in an artery and a catheter is placed there, and with an electronic system gives you continuous blood pressure), the depth of anesthesia or bioespectral index (BIS), which records brain activity and how it will be reduced to the extent that anesthesia is deeper or shallower. If you're between 40 and 60 are anesthetized. If you're over 60 you're awake, you're under 40, you are too deep .... Can be measured, too, the level of analgesia, and there are monitoring EEG and muscle relaxation. It has been so accurately that you can know the concentration of anesthetic into what is inspiring, as is exhaling, and what is in blood. These measurements allow the patient leaves the operating room awake ... and painless. That is the success of anesthesia. Of course, not only the machines are needed, but specialized staff.
What were the mortality rates before, and what now?
"Before hovered between 33 and 40%. Now die three to six patients per thousand. It has been a dramatic decline. But the country does not keep statistics well. And remember that there is a mortality in the operating room and other hospital (intensive care). "
In other countries, patients have the right to request a consultation with an anesthesiologist ...
" The ideal would have it. If you go to work and go to consultation with the anesthesiologist, he should evaluate you ... known, he will explain the procedures, how you prepare ... and to reach an agreement. If the patient says he does not want general anesthesia, for example, and can, as the anesthesiologist should be respected. Patient choice is paramount. It is concerned agree that the patient, the surgeon and the anesthesiologist. The relationship with the anesthesiologist should continue in the postoperative control ... he must ensure, for example, because you throw up, because the pain is treated correctly ... There are technical. It will be talking about what is known as perioperative medicine. It's not just leave it in the operating room before and I treat you after you have surgery to get out very well from the surgery. The unfortunate thing is that here only three or four institutions have preanesthetic. The most common is preanestesic. One comes to the patient's room the night before and tells you everything. "
Does the patient can choose their anesthesiologist?
" Sure. Among the options you have the institution. In so doing the patient more confident going into surgery. If you do not know one can even ask the doctor who wants to be in the hands of whom he most trusts. That creates a certain commitment. If he says they are all good, is committed to the institution, which is not bad ".
Venezuela What is safe?
" Yes. Every time we exercise the profession safer. "
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