Who is at greater risk of anesthesia during surgery?

Wang Jin, Gao Xinyue, Department of Anesthesiology, Pudong New Area Punan Hospital, Shanghai

A young man was going to have mixed hemorrhoid surgery. When signing the preoperative interview, he hesitated and asked: "It is understandable that surgery has risks, but isn't anesthesia just a shot of medicine so that it doesn't hurt? How can there be risks? I am so young, can't I just have partial anesthesia? Do I have to choose full anesthesia and spend more money?"

Anesthesia is an extremely important and risky part of an operation. In order to minimize the risk, before each anesthesia, the anesthesiologist must systematically and comprehensively evaluate the patient's physical health status, including current medical history, past medical history, allergy history, and surgical history. Simply put, the level of anesthesia risk depends on the possibility of anesthetics causing damage to important organs. If certain damage is inevitable, it depends on the severity of the damage. Different anesthesia methods cannot reduce anesthesia risks, but can only avoid certain known anesthesia risks.

So, how is the risk of an anesthesia procedure specifically assessed? This requires an important grading standard, which is currently based on the American Society of Anesthesiologists (ASA) grading, which is divided into five levels:

Class I: Normal and healthy patients, with basically no anesthesia risk;

Class II: patients with mild systemic diseases, with little anesthetic risk;

Grade III: patients with severe systemic diseases, limited daily activities but not completely incapable of working, with certain anesthesia risks;

Grade IV: Patients with severe systemic diseases, completely incapacitated and often facing life threats, with high anesthesia risks;

Grade V: Dying patients who are unlikely to survive 24 hours with or without surgery and have extremely high anesthesia risks.

Are you confused by these medical terms? Don’t worry, here are some common diseases that will affect the risk of anesthesia.

1. Hypertension

Patients with hypertension may experience complications such as hypotension, hypertension, and cerebrovascular accident during and after surgery. They need to receive antihypertensive treatment before surgery to improve the function of important organs.

2. Heart disease

Patients with heart function above ASA grade II have poor tolerance to anesthesia and high anesthesia risk. Patients with rapid atrial fibrillation can only be considered for anesthesia if their ventricular rate is less than 100 beats per minute before anesthesia. For patients with ischemic heart disease, the current cardiac compensatory function needs to be confirmed before anesthesia. If a myocardial infarction has occurred within 6 months before surgery, anesthesia is not recommended. For patients with bilateral bundle branch block and no response to drugs, a temporary pacemaker needs to be installed before surgery.

3. Respiratory diseases

Patients who have difficulty breathing when walking a short distance or who still have difficulty breathing at rest are more likely to suffer from respiratory insufficiency after surgery and have a higher risk of anesthesia.

4. Endocrine system diseases

1. Thyroid disease

Patients with uncontrolled hyperthyroidism and those with larger thyroid tumors are at higher risk for anesthesia.

2. Diabetes

If the fasting blood sugar of diabetic patients cannot be controlled below 8.0mmol/L, there is a certain risk in receiving anesthesia.

5. Urinary system diseases

Anesthesia may cause varying degrees of damage to renal function, the specific degree of which varies depending on the different surgeries and the individual constitution of the patient.

6. Blood system diseases

Anemia patients have a higher risk of anesthesia. In addition, if the patient's platelet count is less than 60×109g/L, spinal anesthesia should not be chosen to prevent hematoma caused by incomplete coagulation function. Patients with other blood diseases, such as leukemia and hemophilia, need special preoperative preparation by the hematology department when receiving anesthesia.

7. Digestive system diseases

Patients with jaundice, ascites, hypoproteinemia and coagulation disorders have increased anesthetic risks and postoperative mortality.

8. Other diseases

Dehydration and electrolyte imbalance, two seemingly insignificant conditions, can also increase the risk of anesthesia.

Having said so much, do you feel a chill in your spine? Do you feel that every disease will increase the risk of anesthesia? The young man at the beginning of this article was young and healthy, thinking that there was no risk of anesthesia. In fact, the anesthesiologist found that the skin on his waist was damaged and scratched, and recommended that he choose general anesthesia to avoid the risk of anesthesia caused by skin infection.

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