Concept of combined anesthesia
The search for the so-called "ideal" substance that could be used for mono-anesthesia (exclusively intravenous or inhalation administration) has historically proved unsuccessful. Doctors faced a serious problem: in the early stages of anesthesiology, attempts to achieve a deep surgical stage of pain relief and full muscle relaxation while maintaining spontaneous breathing led to extremely negative consequences. Patients experienced marked depression of vital functions—primarily the respiratory and circulatory systems.
The modern approach is radically different and is based on the combined use of several drugs simultaneously. The main goal of such a combination is to utilize the effect of potentiation (mutual enhancement of drug action). This makes it possible to significantly reduce the required doses of potentially toxic chemical agents (such as ether or chloroform) that were used previously, thereby improving the safety profile of the surgical intervention.
Neuroplegia and neuroleptanalgesia (NLA)
The development of methods for targeted action on the nervous system has gone through several important stages since the middle of the last century.
Artificial hibernation
The technique of artificial hibernation and neuroplegia was developed in the 1950s by researchers Laborit and Huguenard. The essence of their approach was the administration of special lytic mixtures (so-called "cocktails") to patients. However, today this method has only historical value. The current status of deep neurovegetative blockade is unequivocal: it is no longer used. The main reason for abandonment is that chlorpromazine, which was part of the lytic mixtures, critically suppressed the patient's natural compensatory responses.
Neuroleptanalgesia (NLA)
Today, the most common and safest type of neuroplegia is neuroleptanalgesia. Its key effect is achieving potent analgesia without deep depression of the central nervous system.
The classic anesthesia scheme for NLA is as follows:
- Intravenous component: administration of a combination of Fentanyl + Droperidol.
- Endotracheal component: delivery of Dinitrogen oxide (nitrous oxide) mixed with oxygen.
Electronarcosis: physical methods of pain relief
In addition to pharmacological agents, hardware-based techniques have found a place in multicomponent anesthesia. The pioneer of electronarcosis is considered to be the French scientist Leduc, who conducted the first successful experiments on animals as early as 1902.
In clinical practice, this technique is implemented using a special "Electronarcosis" device. The procedure is not entirely isolated: electrical stimulation is necessarily combined with the administration of small doses of chemical analgesics, as well as sedatives and anticonvulsants.
Advantages of the method in obstetric practice: Electronarcosis has found its primary application specifically in obstetrics due to two unique properties:
- Unlike traditional chemical anesthetics, apparatus-based exposure does not suppress uterine contractility at all.
- Physical exposure cannot cross the placental barrier, which guarantees a complete absence of toxic effects on the developing fetus.
Acupuncture anesthesia (acupuncture)
Acupuncture anesthesia is a specific technique that requires special qualifications. It is important to understand that acupuncture generally does not provide complete pain relief sufficient for major surgical operations. However, it can significantly reduce the patient's pain sensitivity.
To achieve a clinically significant effect, the technique is always performed in strict combination with small doses of pharmacological analgesics. The main requirement for safety and efficacy is that the procedure must be performed exclusively by professional anesthesiologists who have undergone specialized acupuncture training.
Briefly: answers to topical questions
What specific pharmacological analgesics are used in combination with acupuncture anesthesia to achieve a clinically significant effect?
The methodological materials do not contain exact names of specific pharmacological analgesics used in combination with acupuncture anesthesia. It is only indicated that acupuncture itself does not provide complete pain relief, and therefore it is performed in combination with small doses of analgesics.
What are the stages of ether anesthesia according to Guedel's classification?
Guedel's classification of ether anesthesia includes four main stages. The first stage is called analgesia. The second stage represents excitement. The third stage is surgical or tolerant and is subdivided into four planes. The fourth stage is characterized by awakening of the organism.
What depolarizing and nondepolarizing muscle relaxants are used in modern multicomponent anesthesia?
Modern practice uses muscle relaxants of two different mechanisms of action. The group of nondepolarizing agents includes tubocurarine, atracurium, vecuronium, rocuronium, doxacurium, pipercuronium, pancuronium, metocurine, and mivacurium. The sole representative of depolarizing muscle relaxants is succinylcholine, also known as suxamethonium or diacetylcholine.
What is the mechanism of action of droperidol on central nervous system receptors during neuroleptanalgesia?
The presented educational materials do not describe the detailed mechanism of interaction of droperidol with central nervous system receptors at the molecular level. It is only known that typical neuroleptics, which include droperidol, block dopamine receptors in the mesolimbic pathway and the trigger zone of the vomiting center.
How does neuroleptanalgesia differ from ataralgesia in terms of the drugs used?
Neuroleptanalgesia uses the neuroleptic dehydrobenzperidol (droperidol) and the analgesic fentanyl. Ataralgesia uses sedative drugs, specifically diazepam, in combination with analgesics; a neuroleptic is not specified as part of this method.
NLA mnemonic: "Fen Drozhit Pod Kislorodom" (intravenously — Fentanyl and Droperidol, endotracheally — Dinitrogen oxide with Oxygen).
Class and exam questions
Why is Laborit and Huguenard's method of artificial hibernation not used today?
The lytic mixtures ("cocktails") for hibernation included chlorpromazine, which caused excessively deep neurovegetative blockade and dangerously suppressed the body's compensatory reactions.
What is the potentiation effect in combined anesthesia?
Potentiation is the mutual enhancement of the action of several drugs. This makes it possible to use significantly lower doses of toxic substances, reducing the risk of respiratory and circulatory depression.
Why is electronarcosis popular specifically in obstetric practice?
It does not cross the placental barrier, so it is completely safe for the fetus, and unlike chemical agents, it does not suppress the natural contractility of the uterus.
Can acupuncture completely replace drug-induced anesthesia?
No. Acupuncture significantly reduces pain sensitivity, but does not provide complete pain relief, so it is used only in combination with small doses of analgesics.
What else to study on this topic
- Mechanisms of potentiation of muscle relaxants and tranquilizers
- Pharmacological profile of fentanyl and droperidol
- Technical features of electronarcosis devices
- Anatomical and physiological basis of acupuncture analgesia
- Effect of chlorpromazine on the autonomic nervous system
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