Thursday, May 18, 2017, 01:58 AM | Source: The Conversation
Kate Leslie, Megan Allen
Feeling tired or being unable to concentrate is common even days after surgery. But there are simple ways to help speed up your recovery. Jason Jones/Flickr, CC BYYou have a small operation under general anaesthesia and go home the same day. Two days later you’re back at work, but you can’t concentrate and have a desperate desire to take a nap. Why does this happen and how can you prevent it?
General anaesthesia is a reversible drug-induced coma, during which you are unconscious, don’t feel pain and don’t remember anything. This is precisely what you want when you’re having an invasive or painful procedure.
However, some people suffer lingering effects in the days after anaesthesia. These include drowsiness, slowed reaction times, and difficulty concentrating, remembering new information and finishing complex tasks.
Thankfully, these unwanted effects usually wear off by the next day, but sometimes they last for a few more days or even weeks. Then they can really disrupt your ability to work or get anything done at home.
The effects of general anaesthesia may appear to linger for days after surgery for many reasons. Tiredness after a procedure is commonly attributed to anaesthetics. But modern anaesthetics wear off completely in a couple of hours, so the real picture is usually more complicated.
The surgical condition for which you had the procedure may have stopped you leading a full and active life for some time, resulting in lack of fitness and less reserve for recovery.
The surgery itself causes tissue injury. After surgery, your body undergoes repair and recovery, which drives a higher baseline metabolic rate and draws on your nutrient stores. So it isn’t surprising such intense activity at a cellular level results in feeling tired after surgery.
If you ignored your doctor’s advice to take it easy before or after surgery, that could also explain why you’re feeling tired.
Then there’s pain treatment before and after the procedure, which can also contribute to grogginess.
Strong painkillers you take before or after surgery, like oxycodone, can also make you feel drowsy. But side effects cease once you stop taking them. from www.shutterstock.comFor instance, opioids (such as oxycodone) and gabapentinoids (such as pregabalin) are strong pain medicines often prescribed after surgery. They are important in ensuring a comfortable recovery and rapid return to normal life, but may result in grogginess and confusion, especially in higher doses.
Opioids are usually needed for only a few days after surgery and these side effects stop when you stop taking them.
Finally, general anaesthetics interfere with your body clock. This could be because anaesthetics interfere with brain hormones, such as melatonin, and messenger chemicals called neurotransmitters.
While melatonin tablets can treat jet lag, which is also a disruption of the body clock, there is no good evidence to use melatonin for anaesthesia-induced body-clock disruption in humans.
An operation is a major life event. Make sure you get adequate rest and have enough support at work and home before your surgery.
A bit of anxiety is normal before surgery and can also be exhausting. You can reduce your anxiety by asking for clear explanations of what to expect, and by maintaining a warm, comfortable and calm waiting environment.
If you are very anxious, your anaesthetist can give you a sedative “pre-med” before you go to theatre. But the use of sedatives is a balancing act, as the calming effect before the procedure is desirable but not the “hangover” drowsiness afterwards, which may last for several hours.
Your anaesthetist is the medically trained specialist who can not only give you a “pre-med” but will look after you during your operation and plan your recovery.
He or she will develop an individualised anaesthetic plan based on short-acting anaesthetics and a combination of pain-killings drugs.
Your anaesthetist will also advise you how to best control your pain after surgery and when you return home. This will often involve using simple pain medicines, such as paracetamol and anti-inflammatory drugs, as well as opioids, which you will need to treat strong pain. Using simple pain medicines will help to reduce the doses of opioids that you need, and help you to avoid the nausea, constipation and grogginess that goes with them.
After a procedure, you can combat the disruption to your body clock by practising good “sleep hygiene”. This involves maximising cues to the body that it is time to sleep in the evening. These could include avoiding stimulants like caffeine and alcohol, going to bed at a similar time each night, being in a dimly lit room and engaging in calming or restful activities before sleep, like reading.
Making sure you are exposed to bright sunshine during the day and avoiding back-lit screens on technology devices in the evening can also help.
Lingering grogginess after general anaesthesia is hardly ever sinister. But if it is persistent, getting worse rather than better, or is associated with confusion, weakness or numbness, then you must see your doctor.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
Megan Allen Critical Care
Kate Leslie Critical Care
You have a small operation under general anaesthesia and go home the same day. Two days later you’re back at work, but you can’t concentrate and have a desperate desire to take a nap. Why does this happen and how can you prevent it?
General anaesthesia is a reversible drug-induced coma, during which you are unconscious, don’t feel pain and don’t remember anything. This is precisely what you want when you’re having an invasive or painful procedure.
However, some people suffer lingering effects in the days after anaesthesia. These include drowsiness, slowed reaction times, and difficulty concentrating, remembering new information and finishing complex tasks.
Thankfully, these unwanted effects usually wear off by the next day, but sometimes they last for a few more days or even weeks. Then they can really disrupt your ability to work or get anything done at home.
The effects of general anaesthesia may appear to linger for days after surgery for many reasons. Tiredness after a procedure is commonly attributed to anaesthetics. But modern anaesthetics wear off completely in a couple of hours, so the real picture is usually more complicated.
The surgical condition for which you had the procedure may have stopped you leading a full and active life for some time, resulting in lack of fitness and less reserve for recovery.
The surgery itself causes tissue injury. After surgery, your body undergoes repair and recovery, which drives a higher baseline metabolic rate and draws on your nutrient stores. So it isn’t surprising such intense activity at a cellular level results in feeling tired after surgery.
If you ignored your doctor’s advice to take it easy before or after surgery, that could also explain why you’re feeling tired.
Then there’s pain treatment before and after the procedure, which can also contribute to grogginess.
Strong painkillers you take before or after surgery, like oxycodone, can also make you feel drowsy. But side effects cease once you stop taking them. from www.shutterstock.comFor instance, opioids (such as oxycodone) and gabapentinoids (such as pregabalin) are strong pain medicines often prescribed after surgery. They are important in ensuring a comfortable recovery and rapid return to normal life, but may result in grogginess and confusion, especially in higher doses.
Opioids are usually needed for only a few days after surgery and these side effects stop when you stop taking them.
Finally, general anaesthetics interfere with your body clock. This could be because anaesthetics interfere with brain hormones, such as melatonin, and messenger chemicals called neurotransmitters.
While melatonin tablets can treat jet lag, which is also a disruption of the body clock, there is no good evidence to use melatonin for anaesthesia-induced body-clock disruption in humans.
An operation is a major life event. Make sure you get adequate rest and have enough support at work and home before your surgery.
A bit of anxiety is normal before surgery and can also be exhausting. You can reduce your anxiety by asking for clear explanations of what to expect, and by maintaining a warm, comfortable and calm waiting environment.
If you are very anxious, your anaesthetist can give you a sedative “pre-med” before you go to theatre. But the use of sedatives is a balancing act, as the calming effect before the procedure is desirable but not the “hangover” drowsiness afterwards, which may last for several hours.
Your anaesthetist is the medically trained specialist who can not only give you a “pre-med” but will look after you during your operation and plan your recovery. He or she will develop an individualised anaesthetic plan based on short-acting anaesthetics and a combination of pain-killings drugs.
Your anaesthetist will also advise you how to best control your pain after surgery and when you return home. This will often involve using simple pain medicines, such as paracetamol and anti-inflammatory drugs, as well as opioids, which you will need to treat strong pain. Using simple pain medicines will help to reduce the doses of opioids that you need, and help you to avoid the nausea, constipation and grogginess that goes with them.
After a procedure, you can combat the disruption to your body clock by practising good “sleep hygiene”. This involves maximising cues to the body that it is time to sleep in the evening. These could include avoiding stimulants like caffeine and alcohol, going to bed at a similar time each night, being in a dimly lit room and engaging in calming or restful activities before sleep, like reading.
Making sure you are exposed to bright sunshine during the day and avoiding back-lit screens on technology devices in the evening can also help.
Lingering grogginess after general anaesthesia is hardly ever sinister. But if it is persistent, getting worse rather than better, or is associated with confusion, weakness or numbness, then you must see your doctor.
Common adverse reactions and complications after anesthesia:
After the end of general anesthesia, you may feel pain in the area of the operation. If upon arrival at the postoperative ward you still feel it, then inform the medical staff about it - you will be given pain medication.
This is a very common consequence of anesthesia, occurring in about 30% of cases. Nausea is more common with general than with regional anesthesia. Here are some tips that will help you reduce the risk of nausea:
An endotracheal tube during the phase of awakening from anesthesia can cause an unpleasant feeling of discomfort and scratchy in the throat. You need to take it calmly, try to breathe evenly and, most importantly, follow all the instructions of your anesthesiologist. Discomfort, dry mouth, and pain when talking or swallowing may also be felt for several hours after surgery, but may remain for two or more days. If the above symptoms do not go away within two days after the operation, contact your treating doctor. Sore throat is only a consequence of anesthesia.
Trembling as a consequence of anesthesia is a fairly common problem, as it causes great discomfort, although more often it does not pose a danger to the body and lasts about 20-30 minutes. Trembling can occur after general anesthesia, and also occur after epidural and spinal anesthesia.
During anaesthesia, there is no muscle tone, which can cause pressure due to the position of the nerve, which can cause a loss of sensation at the site of pressure, lasting several weeks. After an operation performed under spinal or epidural anesthesia, insensibility of the legs is observed for several hours, it may also be difficult to empty the bladder - if necessary, a urinary catheter is installed.
Residual effect of anesthetics can be manifested as a slight decrease in blood pressure, in addition, dehydration, which is not uncommon after surgery, can lead to the same effect. A decrease in pressure can cause dizziness, weakness, and fainting.
There are many causes that can cause a headache. These are the drugs used for anesthesia, the operation itself, the dehydration and anxiety of the patient. Most often, the headache disappears a few hours after anesthesia and is quite simply stopped by painkillers. Severe headache may be a complication of spinal or epidural anesthesia, and its treatment may require bed rest for several days.
This is usually an adverse reaction to anesthesia medications, but itching can also be an allergic reaction, so be sure to tell your doctor if it occurs.
During the operation, the patient lies in one fixed position on a hard operating table for quite a long time, which can cause "fatigue" of the back and eventually lead to lower back pain after the operation.
These pains are most common in young males and are most often associated with the use of muscle relaxants during anesthesia. Pain in the muscles are the consequences of anesthesia (general anesthesia), they are symmetrical, localized more often in the neck, shoulders, upper abdomen and last about 2-3 days after surgery.
After surgery in intensive care unit
Depending on the severity of the operation, postoperative monitoring in the intensive care unit may be necessary. As needed, you will be prescribed medications, possibly in the form of injections/droppers. Unfortunately, it is inevitable that the wound after the operation will hurt for some time. If you feel severe pain, you must immediately inform the staff so that the necessary measures can be taken.
Depending on the operation performed, you may have: a gastric tube, drains and a urinary catheter.
Probes, used to evacuate the contents of the gastrointestinal tract. This is a forced measure and it is necessary to understand the importance of this procedure. The gastric tube helps you to avoid vomiting in the postoperative period, because. all gastric contents will drain through it into a special container. You may experience discomfort and sore throat.
If necessary, enteral feeding is carried out through the tube, i.e. the introduction of balanced mixtures to provide your body with nutrients and vitamins. In the first day (and in some cases even longer) after the operation, you can not eat or drink. You will receive all the liquid necessary for the body through intravenous infusion and through a tube.
Drainage - a treatment method involving the removal of discharge from wounds, natural, purulent and other pathological cavities, the contents of hollow organs.
Drainage - rubber or plastic tubes of various diameters, thin rubber strips, dry aseptic swabs.
If you cannot urinate on your own, a urinary catheter is placed in your bladder to help you urinate.
(See About the intensive care unit) (Active link)
The staff of the unit wishes you a speedy recovery !
Anesthesia is a desensitization used during operations and painful procedures. In the new program, we will immerse ourselves in the daily work of an anesthetist. We will talk about the types of anesthesia, the preparation of a suitable anesthesia plan and the importance of cooperation between the anesthesiologist and the patient. Markko Pärtelpoeg, head of the Operations Center of the Regional Hospital and anesthesiologist, shares his experience.
You can listen to the broadcast in Estonian here: https://soundcloud.com/regionaalhaigla/tervisepooltund-episood-52-anestesioloog-kui-patsiendi-narkoosiaegne-raviarst
People have different ideas about anesthesia and anesthesia, and many people have experienced local anesthesia at the dentist. The second extreme is general anesthesia, in which a person, in fact, is on controlled breathing and does not feel anything. Please tell us in more detail what types of anesthesia are and in what cases one or the other type is used.
It can be said about anesthesia that there is general and local anesthesia, which also includes local anesthesia. General anesthesia means that the patient is asleep and does not know anything about what is happening during the operation. In the case of local anesthesia, a part of the body or limb of the patient is made insensitive to pain, and operations are generally more easily tolerated by the patient. Local anesthesia does not affect the work of the cardiovascular system so much, the person is conscious, and if something bothers him, he can always say about it. Each operation is attended by an anesthetist and anesthetist nurse who oversee the entire process.
In the case of local anesthesia, the situation seems unsettling when you are awake and see how doctors and surgeons operate on you. How do patients usually handle it?
Anxiety, as a rule, arises from ignorance. The most important thing is preliminary information and explanatory work. Therefore, it is very important that the operation plan is approved by the surgeon, then the patient comes to the anesthetist and talks with him about the method of anesthesia. Never any injection is made by force or against desire. It all depends on the general condition of the patient and the nature of the operation. This is the collaboration between the anesthesiologist and the patient. Of course, there are operations that cannot be performed with local anesthesia. It is of great benefit that the operation performed under local anesthesia does not affect the general health of the patient so much, does not turn off brain activity during the operation, recovery is faster. Pain is blocked in the place where the surgical injury occurs. This reduces the body's stress response and ensures faster recovery.
For which operations is local anesthesia used?
As a rule, these are operations in case of injuries of the limbs, operations on blood vessels that are performed on the limbs, prosthetics of large joints that are severely injured. The idea is to block the pain impulse in the human brain. If necessary, you can always give the patient a sedative medicine, that is, the most important thing is that the patient is aware in advance that he will not feel pain during the operation, and all discomfort will be prevented by an injection.
Will the patient be able to communicate with the surgeon during this procedure and be explained what is happening?
Yes, it already depends on the agreement with the surgeon. Of course, during a complex and large-scale operation, the surgeon must focus on the operation, but there is such an opportunity. The patient can always contact the anesthesia nurse or listen to music. If there is an appropriate agreement with the surgeon, he will always be happy to tell you what he is doing, and sometimes show photos.
General anesthesia is more serious, it makes people afraid of losing control. In addition, people are afraid of unexpected allergic reactions or that the body simply cannot tolerate anesthesia. How great is the danger in reality, and how can complications be avoided during anesthesia?
Nearly half of complications are due to drug reactions or similar problems. Therefore, it is very important to visit the anesthesiologist after deciding on the operation. Understanding that the anesthesiologist simply comes to "put" the patient to sleep is somewhat outdated. The anesthesiologist is rather the attending physician of the patient during anesthesia. You must first talk with him about concomitant diseases, medications taken, your thoughts and fears in order to draw up an adequate anesthesia plan that will be easier for the patient to endure. To avoid the risk of side effects or allergic reactions. All this can be prevented, but for this you should first discuss all the details with the anesthesiologist.
Is it possible to check the reaction of the body in advance with a small amount of the drug in order to avoid possible surprises?
We do not conduct such testing. If there are suspicions of allergic reactions to certain drugs, this is done by allergists who conduct special testing. Unfortunately, the intermediate testing mentioned above is not carried out. As in the case of a bee sting with a small amount, some patients may get a strong reaction, so it is with medicines. Others will need a very large amount to cause an allergic reaction. A referral to an allergist can be given by both the anesthesiologist and the family doctor. During the conversation, we will find out what the risks are and which drugs are best avoided.
What is general anesthesia and what happens to the patient during it?
The goal is to put the patient to sleep so that he does not feel anything and wakes up after the operation as quickly as possible, and also recovers to the preoperative state as quickly as possible. There are three aspects here: pain relief treatment, sufficient sleep, and suitable conditions for the operation. Anesthesia is divided into three stages. First - a preliminary acquaintance with the patient, informing him, planning pain relief treatment. Then - monitoring during the operation, maintaining his vital signs so that there are no fluctuations. And finally - a quick awakening after surgery and recovery without pain and stress, whether in the department or at home.
I know that, for example, cutting out tonsils was previously performed without general anesthesia, but now this practice is preferred. On what basis is the decision made whether to give the patient general anesthesia? What if pain, discomfort, risks of complications are on one side of the scale, and an operation on the other, during which the patient does not feel anything?
The decision is still made in cooperation between the surgeon and the patient. Nowadays, undoubtedly, general anesthesia is a more convenient option for both the surgeon and the patient. Speaking specifically about the removal of the tonsils, then anesthesia can be performed in such a way that the pain from the operation will not be felt, but there is a risk of a gag reflex. For some, working in the mouth can be quite uncomfortable. As a rule, the decision was still made in favor of general anesthesia, it is more comfortable and painless for the patient. Recovery after tonsil removal is usually very quick and easy. It is also more convenient and faster for the surgeon to perform the operation when the patient is under general anesthesia.
Considering patient comfort, speed, safety and ease of operation, is general anesthesia the general trend?
We want to reduce the stress of the patient, because in a stressful situation we feel insecure, we cannot concentrate, we feel bad. Operations in such a tense state also weaken the body. Since the immune system is largely dependent on the level of stress, we try to make the process more comfortable for the patient so that his body becomes stronger and recovers faster. It also reduces pain after surgery. A person recovers faster and can return to their daily activities sooner if operational stress is kept to a minimum.
What is the process of awakening after anesthesia? Will waking up after major surgery be longer and more uncomfortable?
Of course. After anesthesia, anesthesia is never done, it is always associated with the operation. They are interconnected. If the operation is more complex, prolonged and is accompanied by a more significant surgical trauma, anesthesia should be deeper. Recovery in this case will also be slower. Of course, at present, drugs for anesthesia are so developed that their action is shorter, and they are easier to tolerate. The biggest problem for the anesthesiologist is that all drugs have side effects: nausea, lowering blood pressure, slowing the heartbeat. If we managed to avoid side effects, the patient slept peacefully during anesthesia, and his life dynamics remained stable, then the awakening will be faster and calmer.
Under what risk factors is anesthesia for patients excluded or more dangerous?
Undoubtedly, age and comorbidities are at higher risk. In the case of a healthy person, the risks are now practically insignificant. Any medical intervention comes with risks. In the case of diseases and older age, the risk is much higher, because the older the person, the more fragile his body is, and the smaller changes can unbalance it.
Have there been situations when, on the one hand, an operation was necessary to save a life, and, on the other hand, the risk of anesthesia was also great? On what basis is the choice made?
These risks are interrelated. Patients in the intensive care unit also sleep under anesthesia. Their risks should be assessed based on surgery, comorbidities, age, and anesthesia used. All this is assessed as a whole.
There are news in the media about people in serious condition who are put into an artificial coma. Why is this being done?
Thus, time is given for the recovery of the body. Blocked stress, pain irritation. Sometimes this is necessary so that the patient can endure all the manipulations that must be performed during intensive care. If he cannot breathe on his own, the machine should do it for him. Or the patient has large drains, tubes inside, which cannot be tolerated without anesthesia.
Does keeping a patient in an artificial coma mean that it is easier for the body to recover from a serious condition?
Yes, the body is resting. It is possible to carry out those methods of treatment and manipulation that cannot be carried out in the waking state. When the body recovers, it will no longer be necessary to carry out any large-scale procedures, then the anesthesia begins to ease, and the patient wakes up.
Previously it was about allergies. What is done in a situation where a person has a life-threatening allergy to anesthetics, but anesthesia is still necessary?
Fortunately, modern medicine and the pharmaceutical industry are so developed that in each group of drugs we have drugs with different mechanisms of action - painkillers, sleeping pills. Thus, we can always choose the drug to which the patient is not allergic.
If a person has a planned operation, in a day or two, how should he prepare for it?
Before the operation, it is very important to rest, because he must be in the best possible condition, eat and drink well. There should be no stressful situations, life should be as normal as possible, without big problems. Then the recovery after the operation will be faster.
Much is said about ethical questions in a situation where the patient is unconscious and important decisions must be made, but one cannot ask him. Is the surgeon fully responsible?
As a general rule, the patient should still be informed in advance of what will happen during the operation. If you mean the operation, then the decisions that are made during its implementation are also agreed in advance.
However, what if an unexpected event occurs during the operation, which happens infrequently, but still can happen? For example, you need to perform an amputation. In this case, will they contact relatives?
Will proceed from the best and safest treatment for the patient. Such decisions during surgery are made based on the best medical knowledge.
You said that anesthesiology has recently been a rapidly developing field. If we now look into the future several years ahead, what new methods can we expect?
No significant fundamental changes are known, this area is developing gradually. Technique is advancing rapidly, and patient monitoring monitors are becoming more powerful. Now we connect the patient to the monitor, and in the future it will become wireless. In addition, monitoring of brain activity and the depth of anesthesia are being actively studied. It is very important that the depth of anesthesia is optimal throughout the operation. Hemodynamics, the work of the vascular system and the heart also depend on this. Anesthesia, on the one hand, should be deep enough so that the patient does not feel or remember anything.
