Anesthesia procedure

Anesthesia means the elimination of pain and consciousness in the broader sense and was previously usually referred to as narcosis. Analgesia simply means the elimination of pain and is the most important component of anesthesia. It can be performed for the purpose of an operation, but also for the treatment of acute or chronic pain of various kinds.

Anesthesia machine

While local anesthesia (topical anesthesia) for minor procedures is often administered by the surgeon or dentist themselves, general anesthesia is administered by the patient themselves. (general anaesthesia) and regional anaesthesia (anaesthesia of an entire body region) in most cases by specialist anaesthetists together with anaesthetic nurses. The reason for this is that anesthesia not only eliminates pain, but can also have other effects on various important organ systems. For this reason, anesthetized patients must be closely monitored. This means that the effects of anesthesia or interventions on vital organ functions can be avoided or treated immediately.

Thanks to their many years of specialist training, our anesthesia staff have the necessary knowledge and experience to ensure the greatest possible safety for our patients.

All the procedures we use are based on international standards and the latest scientific findings. In order to improve further, we therefore frequently carry out studies (especially beyond national borders in collaboration with other large university hospitals). However, before a study could be considered for you, we would provide you with specific information and obtain your written consent.

The prevention of post-operative pain, nausea and vomiting (so-called PONV) is a major concern for us. We achieve this through the carefully balanced use of modern anesthetics and effective pain management techniques such as EDAs (epidural anesthesia) and PCAs (patient-controlled analgesia). All patients can receive follow-up care from our acute pain service.
The specialists at the Institute of Anesthesiology not only perform anesthesia at the highest professional level, the University Hospital Zurich also has the training of young doctors as another core task. These are colleagues who have completed at least six years of study on the way to becoming a specialist in anesthesiology (an additional five years). Training is always provided by an experienced senior physician. To ensure that difficult procedures and the coordination of the entire team are not performed on patients for the first time, a simulation program is available for all doctors at the Institute of Anaesthesiology. In analogy to aviation, the necessary skills are learned and deepened here.

To make your treatment even safer, we were one of the first institutes in the world to implement Patient Blood Management (PBM ). PBM is a clinical, multidisciplinary and patient-centered treatment concept for the reduction and prevention of anemia and blood loss as well as the rational use of blood products.

General anesthesia

General anesthesia is also known as“general anesthesia“. Surgical pain is eliminated by putting the body into a sleep-like, pain-insensitive state. The painkillers and sleeping pills required can be administered directly to the circulatory system by ventilation (“inhalation”) or by infusion (“intravenous”). Your anesthetist will assess the advantages and disadvantages of general anesthesia before the operation based on the planned operation, any concomitant illnesses and taking into account your individual wishes. Depending on the constellation of these factors, general anesthesia or regional anesthesia is advantageous.

Regional anesthesia

With regional anesthesia, only one region of the body is made insensitive. In so-called central nerve blocks, nerves that arise from the spinal cord are temporarily anesthetized with local anesthetics. This means that larger areas of the body can be anesthetized, e.g. both legs and/or the abdomen and parts of the chest. An example of this is regional anesthesia close to the spinal cord with spinal anesthesia or epidural anesthesia (this term is synonymous with epidural anesthesia).
An important basic requirement for regional anesthesia is normal blood coagulation. You will therefore also be asked about this point during your anesthesia consultation.

Spinal anesthesia

After thorough disinfection and local anesthesia of the skin in the area of the lumbar spine, a local anesthetic is injected into the cerebrospinal fluid around the spinal cord and eliminates pain, sensation and movement in the lower half of the body. This procedure is suitable for certain temporary interventions in the lower half of the body.

Epidural anesthesia

After thorough disinfection and local anesthesia of the skin, a fine plastic tube (= catheter) is inserted in the thoracic or lumbar spine area (depending on the planned operation) via a hollow needle into the so-called epidural space in front of the spinal cord. After removing the hollow needle, the catheter is fixed to the skin. A pump is then connected, which controls the supply of the painkiller mixture. The device can be operated by the patients themselves postoperatively if required (so-called PCA = patient controlled analgesia). The catheter is usually left in place for about three days, as long as the greatest pain typically persists after an operation. While you have an epidural anesthesia catheter, you will be closely monitored by our pain service and visited daily. Naturally, a customized pain concept will be installed for your well-being after the end of catheter therapy.
Epidural anesthesia can also be used very well in combination with general anesthesia for major operations on the chest or abdomen. The epidural catheter is placed before anesthesia is induced and used for pain therapy during and after the operation. This is referred to as “combined anesthesia”.

Peripheral nerve blocks

If individual nerves are anesthetized at a greater distance from their exit from the spinal cord, this is referred to as peripheral nerve blocks or conduction anesthesia. With such partial anesthesia, smaller areas of the body can be anesthetized separately. One example of such a conduction anesthesia is the so-called plexus anesthesia on the arm. A nerve plexus that, among other things, transmits the sensation of pain in the arm is temporarily made insensitive. Such pinpoint local anesthesia procedures are also possible on the leg.

Tailor-made anesthesia procedure for every patient

Regional anesthesia also has specific advantages and disadvantages. The responsible anesthesiologist will determine whether general anesthesia or regional anesthesia offers the greatest advantage based on all factors and taking into account the patient’s personal wishes during your consultation.
In certain cases, both procedures can also be used together. For example, epidural anesthesia for major vascular, abdominal or thoracic surgery can be combined with general anesthesia. The advantage of this combined anesthesia is a quick and pain-free awakening, as the general anesthesia can be performed with fewer drugs. In addition, the epidural anesthesia continues to work after the operation and can be used for pain therapy for days if necessary.

Before anesthesia

In preparation for your operation, you will be informed in advance in the anesthesia consultation about the course of your individual anesthesia and the procedure on the day of the operation. You will have ample opportunity to ask questions on topics. For our information, please bring all the medical documents available to you and a list of the medication you are currently taking. Your family doctor will be happy to provide you with information. Information about past anesthesia, allergies and drug use (alcohol, nicotine, etc.) is also of great importance to us.

The risk associated with general anesthesia (general anesthesia) or partial anesthesia (regional anesthesia) is now very low thanks to highly developed monitoring and treatment options. The risk of complications depends largely on the patient’s state of health. Diseases and impairments of vital organ systems, e.g. the respiratory and circulatory organs, can be associated with an increased risk.

Your anesthetist will therefore ask you in detail about your state of health before anesthesia. Illnesses and injuries, previous operations and anesthesia, long-term medications and allergies provide an important basis for risk assessment. The interview is supplemented by a targeted physical examination and, if necessary, further clarifications. These can be laboratory tests, ECG (cardiac waveform) or a chest X-ray, which provide additional information about the condition of the heart and lungs.
During the medical consultation, the expected anesthesia risk and the best anesthesia procedure tailored to your needs will be discussed with you. If you have a serious pre-existing condition, further investigations will be carried out depending on the urgency of the procedure. The purpose of this is to achieve a sensible balance between the risk of anesthetic complications on the one hand and the benefits of anesthesia and surgery on the other.

The aim is always to provide you with the best possible and safest anesthesia and treatment. This is our concern!

The anesthesia consultation is led by PD Dr. med. Bastian Grande.

After the operation

After the operation, you will be taken to a recovery room. Monitoring (blood pressure, ECG, oxygen saturation) can be continued here. If you are well awake and any pain is well under control, you will be transferred to the ward.

Your anesthetist will prescribe pain therapy for the immediate period after the procedure. If the usual combination of painkillers is not sufficient, we can offer further pain therapy. We will also continue to accompany you post-operatively and the anesthesia team is available 24 hours a day.

Read the following pages and visit the information page of the Swiss Society for Anesthesia and Resuscitation SSAR/SGAR.

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