Local anesthesia refers to the use of local anesthetics to temporarily block the conduction function of some peripheral nerves, so that the corresponding areas controlled by these nerves can produce anesthesia.

Local anesthesia can be divided into broad sense and narrow sense, and broad sense local anesthesia includes spinal anesthesia. That is what we usually call epidural anesthesia and spinal anesthesia (subarachnoid anesthesia) or a combination of the two.

Commonly used local anesthesia includes surface anesthesia, local infiltration anesthesia, regional block anesthesia and nerve block anesthesia.

Esters and other local anesthetics: procaine, tetracaine, etc. Amides: lidocaine, ropivacaine, bupivacaine, etc. There is a maximum dosage!

Local anesthetic is poisonous!

It is mainly because the concentration of local anesthetics in the blood exceeds the tolerance of the body, causing various clinical symptoms of excitement or inhibition of the central nervous system and cardiovascular system.

Mild dizziness, tinnitus and numbness of the tongue. Severe convulsions, convulsions, and even respiratory and cardiac arrest lead to death.

The main reasons are as follows: ① One-time consumption exceeds the limit; ② Drugs mistakenly enter blood vessels; ③ Local anesthetics were absorbed too quickly at the injection site; ④ The tolerance of individual differences to local anesthetics decreased. Therefore, in order to effectively prevent local anesthetic poisoning, "all doctors" need to: ① strictly limit the dose to prevent overdose; (2) reverse pumping when injecting drugs to prevent blood from entering; ③ Adrenaline was added to slow down the absorption of local anesthetics; (4) reduce the dosage for patients with poor health, and so on.

In addition to local anesthesia in a narrow sense, there is spinal anesthesia:

Intraspinal anesthesia is a method of injecting local anesthetic into epidural space or subarachnoid space to block nerve roots. According to the different injection cavities, it can be divided into epidural block and subarachnoid block.

The anatomical structure of puncture is: skin-superficial fascia-deep fascia-supraspinous ligament-intermuscular ligament-ligamentum flavum reaching the epidural space. This is the process of epidural puncture. However, subarachnoid puncture needs to pierce the dura mater and arachnoid membrane to reach the subarachnoid space.

It can be seen that this operation is invasive, and it needs to puncture so many anatomical structures to reach the intervertebral space. Moreover, this operation is blind, that is, the anesthesiologist operates according to personal experience.

Moreover, it is necessary to talk about the concept of complications.

Complications of spinal anesthesia: 1, headache. Puncture of the dura mater can lead to the change of the patient's posture (too much head up, no supine position), and some even fine needle puncture can lead to it. Generally, it can be recovered within one week.

2, urinary retention.

3, nervous system complications. Due to the tissue toxicity of local anesthetics and the anatomical variation of patients.

Special attention should be paid to general spinal anesthesia with epidural block.

Complications of general anesthesia: POCD (postoperative cognitive dysfunction) in the elderly is worth discussing, but the specific mechanism is not completely clear. At present, it is believed that acute mental disorder syndrome is caused by the further disorder of the central neurotransmitter system caused by many factors on the basis of the degeneration of the central nervous system in the elderly. Risk factors are: old age, cardiovascular and cerebrovascular diseases, long-term drug use, alcoholism, psychological factors and so on. Trigger factors: stress reaction, surgical trauma, intraoperative bleeding, electrolyte disorder, etc.

2. "General anesthesia is really terrible. General anesthesia is not safe at all." Is this correct?

The invention of modern anesthesia, aseptic technology and antibiotics can be said to be the three cornerstones of the development of modern medicine.

In the past, the level of anesthesia was low, and large-scale operations such as chest and heart surgery were greatly restricted, so these operations could not be carried out at all.

It is the development of modern anesthesiology, anesthesia machine, monitor, various anesthesia equipment (such as visual laryngoscope, fiberoptic bronchoscope, ultrasound-guided nerve block, etc. ), the invention of narcotic drugs, the skills of anesthesiologists (arteriovenous catheterization, intubation, etc. ) and the improvement of intraoperative management make modern surgery possible and safe! So as to ensure the safety of patients' lives, relieve patients' pain and save patients' lives (ICU extended from anesthesiology department).

Specialty scope of anesthesiology: clinical anesthesia, first aid resuscitation, critical illness medicine, pain diagnosis and treatment, cardiopulmonary bypass, etc.

Since everyone says that general anesthesia is unsafe, I can only ha ha. Strictly speaking, there is no scientific evidence that general anesthesia is harmful to the body and brain intelligence.

I would like to briefly talk about my own views here.

Why does death occur during anesthesia?

First of all, for anesthesiologists, the most important thing in the whole operation process is breathing and circulation.

Breathing: Breathing is the safety of the respiratory tract (airway safety), and there is something wrong with the airway. Such as: ① airway difficulty, respiratory tumor compression (tracheal compression), laryngeal spasm, tracheal spasm, tongue drop, reflux aspiration (the mortality rate of aspiration is 50% to 75%), foreign body blocking airway, oropharyngeal cavity inflammatory lesion and allergic laryngeal edema. Respiratory depression caused by drug residues in recovery period can lead to death.

Circulation: hypertension, hypotension, cardiovascular diseases (myocardial ischemia caused by infarction in the operating center, etc. ), pulmonary embolism, amniotic fluid embolism, massive hemorrhage, allergic toxic shock, etc. Will lead to death.

These things can only say that the human body is a complex body, and we need to ensure its safety. The above problems will only lead to death if the anesthesiologist can't handle the patient. Professional and effective anesthesia itself will not lead to death.

To sum up, local anesthesia is not absolutely safe, and general anesthesia is not absolutely harmful. All anesthesia has certain risks, but these risks are not absolute. It is precisely because of the anesthesiologist's perfect preoperative evaluation, intraoperative management, postoperative pain management and follow-up that the perioperative life safety of patients can be guaranteed.