Remote Site Anesthesia- An Overview

Creator: Dr. Swati Sharma
Published: 2023-01-27T18:06:54

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Remote site anesthesia means anesthesia delivered outside the operation theater. This topic explains the use of remote site anesthesia and its complications.

Written by

Dr. Swati Sharma

Medically reviewed by

Dr. Pandian. P

January 27, 2023

February 13, 2024

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Contents

What Is Remote Site Anesthesia?
What Are the ASA (American Society of Anesthesiologists) Guidelines for Non-operating Room Anesthesia?
What Are the Challenges of Anesthesia in Remote Sites?
What Are the Types of Essential Equipment Required for Anesthesia in a Remote Area?
What Are the Anesthesia Techniques Used in Remote Sites?
What Are the Choices of Drugs Used in Remote Anesthesia?
What Are the Procedures in Which Remote Site Anesthesia Is Used?
What Are the Complications of Remote Site Anesthesia?
Does Remote Anesthesia Benefit Child Patients?

Introduction

Anesthesia was used in operation theaters, but with the evolving time, it has moved outside the operation theaters to provide better patient comfort. These remote anesthesia have to provide safe anesthetic care in the non-operating room.

What Is Remote Site Anesthesia?

Remote site anesthesias are the location or areas where anesthesiologists (a doctor who gives anesthesia) are performing anesthesia somewhere outside the operation theaters. This area includes:

Radiology suites.
Endoscopy suites.
The dental clinic.
The burn units.
The psychiatric unit.
The renal unit.
The gynecology unit.

Remote anesthesia is used in different units to provide immobility to patients and go for better procedure outcomes.

What Are the ASA (American Society of Anesthesiologists) Guidelines for Non-operating Room Anesthesia?

Guidelines are:

A reliable oxygen source with backup.
A suction source.
Waste gas scavenging systems.
Adequate monitoring equipment.
A self-inflating hand resuscitator bag.
Safe electrical outlets.
Adequate patient and anesthesia machine illumination.
Sufficient space for an anesthesia care unit.
Emergency cart with a defibrillator.
Emergency drugs and other emergency equipment.
A means of two-way communication to request assistance.
Compliance of facility with all applicable safety.
It should provide appropriate postanesthesia management.
Adequately trained staff to support the anesthesia team.

What Are the Challenges of Anesthesia in Remote Sites?

The challenges are:

Equipment - Ideally, the doctor uses an anesthesia machine in operation theaters. But in remote sites, the machine used is not the same. They have some variations. The oxygen cylinders should be provided. Monitoring equipment for blood pressure and ECG (Electrocardiogram). The drugs for a case of emergency. Equipment checklists include anesthesia drugs, resuscitation drugs, defibrillators, laryngeal masks or oropharyngeal airways, warming devices, and a lead apron for the radiology room.
Staff - Staff working in these remote areas should be fully trained to handle anesthesia cases.
Procedures - There should be proper lighting, patient bedding, and proper planned procedure to follow with informed consent and postoperative care involved.
Patient - The preoperative evaluation of the patient is important. The patient should inform about the fasting guidelines, consent, and postoperative complications.

What Are the Types of Essential Equipment Required for Anesthesia in a Remote Area?

All the equipment is not possible in the remote site, but important equipment should always be present. The different types of equipment required are:

Suction Tubes - According to size, suction tubes and catheters are used.
Oxygen - Oxygen should be present through some reliable sources like oxygen cylinders.
Airway - According to size, child or adult airway tubes and masks should be present. Facemasks and nasopharyngeal or oropharyngeal airways should be arranged.
Drugs - All the basics needed for life support during an emergency should be on site. Drugs like Epinephrine, Atropine, and glucose are required.
Monitor - Monitoring the parameters is one essential step in anesthesia. Parameters like temperature, heart rate, respiratory rate, and oxygen are important. ECG, pulse oximeter, and thermometer are important.
Equipment - The site should have a defibrillator, adequate lighting, and safe electrical outlets.

What Are the Anesthesia Techniques Used in Remote Sites?

The anesthesia used in these remote sites can be:

Regional Anesthesia - Regional anesthesia uses combined spinal and epidural anesthesia. The patient remains conscious and can communicate, which is a safety measure. But the monitoring of the vital signs is an important parameter.
General Anesthesia - General anesthesia with airway maintenance is important. It requires monitoring the level of consciousness, oxygenation, ventilation, and vital signs.
Total Intravenous Anesthesia (TIVA) - Anesthesia drugs are given by injecting into veins and require the patient's airway to be maintained by a laryngeal mask. The procedure which uses total intravenous anesthesia is lithotripsy (procedure for kidney stone breakage), in vitro fertilization, and fetal reduction in ultrasound rooms.
Sedation - Sedation is a state of unconsciousness with the airway maintained by the patient, and the patient can even respond to commands. These are used, but sedatives require an appropriate amount of dose.

What Are the Choices of Drugs Used in Remote Anesthesia?

The choice of a drug for anesthesia depends upon the procedure being performed. Some commonly used drugs in remote-site anesthesia are:

Midazolam is mainly in pediatric patients.
Fentanyl.
Propofol.
Ketamine.
Ketofol - A combination of Ketamine and Propofol.
Remifentanil.
Prix cream in cases of lithotripsy (procedure for kidney stone breakage).

What Are the Procedures in Which Remote Site Anesthesia Is Used?

Procedures are:

Neuroradiology Procedures - This procedure requires general anesthesia. It includes diagnostic and radiology procedures.
Cardiac Catheterization Procedures - It is used in procedures like the repair of atrial or ventricular septal defects. It is used in pediatric patients. The anesthesia used should be under the anesthesiologist and cardiologist.
Pediatric Sedation and Anesthesia - Child patients require more immobility and sedation. General anesthesia or sedation is mostly used in children to proceed with the procedures.
Gastrointestinal Endoscopy - The most common procedures included in gastrointestinal endoscopy are upper gastrointestinal endoscopy and endoscopy related to the pancreas.
Diagnostic Imaging Procedures - Magnetic resonance imaging (MRI) and computerized tomography (CT) require anesthesia.

What Are the Complications of Remote Site Anesthesia?

Complications to remote site anesthesia are:

Laryngospasm (vocal cords get spasms, and the patient cannot breathe and speak).
Airway obstruction.
Inadequate anesthesia.
Prolonged anesthesia.
Vomiting.
Delirium (disturbed mind along with restlessness, illusions, and fever).
Emergency sedation whenever required.
Unplanned hospital admission.
An unexpected change in heart rate, blood pressure, or respiratory rate.

Does Remote Anesthesia Benefit Child Patients?

Yes, remote anesthesia has benefitted child patients. The demand for child anesthesiologists to travel outside the operating room to provide general anesthesia and treat infants and children has increased. The concept of anesthesia for the child in a non-operating room has created a stress-free environment for the patient. The remote site idea has made children anesthetized more safely and friendly during these diagnostic procedures. Parents are the plus factors who are always along with them.

Conclusion

Remote site anesthesia is the anesthesia used outside the operation theaters. Some common sites they use are the radiology suite, endoscopy suite, dental clinic, burn unit, renal unit, gynecology unit, and psychiatric unit. The remote concept of anesthesia has made many diagnostic procedures easier to perform on patients as these procedures require immobility, which is impossible for many patients. The procedures that require anesthesia are magnetic resonance imaging (MRI), computerized tomography (CT), and gastrointestinal endoscopy.

Frequently Asked Questions

1. What Is the Duration of the Effects of Anesthesia to Diminish?

The duration for the effects of anesthesia to diminish can vary depending on the type of anesthesia administered, the individual's metabolism, and the specific procedure performed. In general, the effects of anesthesia wear off gradually after surgery. Short-acting anesthetics typically wear off within a few hours, while longer-acting ones may take several hours. However, it is important to note that residual effects such as grogginess or drowsiness may persist for longer.

2. How Long Does the Numbing Effect of Local Anesthesia Last?

The numbing effect of local anesthesia typically lasts for a few hours. The specific duration can vary depending on factors such as the type and concentration of the local anesthetic used, the location of the injection, and individual variations in metabolism. It is important to note that while the numbing effect may wear off after a few hours, it is normal to experience some residual numbness or tingling sensation for a bit longer. The healthcare provider will provide instructions on managing any post-anesthesia discomfort and when to expect the full return of sensation.

3. How Much Time Does It Typically Take to Regain Consciousness After Anesthesia?

The time it takes to regain consciousness after anesthesia can vary depending on several factors, including the type and dosage of anesthesia administered, the individual's response to the medication, and the duration of the surgical procedure. In general, most individuals regain consciousness within minutes to an hour after anesthesia. However, it is important to note that it may take some time to fully recover and feel alert due to the lingering effects of anesthesia. The medical team will closely monitor the recovery and provide appropriate care until one is fully conscious and ready to be discharged.

4. Explain What Is Twilight Anesthesia?

Twilight anesthesia, also known as monitored anesthesia care (MAC), is a type of anesthesia that provides sedation and pain management during certain medical procedures. It involves administering medications to induce a state of conscious sedation, where the patient remains responsive but relaxed and comfortable. The medications used in twilight anesthesia can include a combination of sedatives, analgesics, and sometimes a local anesthetic. This form of anesthesia allows patients to undergo procedures while being in a relaxed and sleepy state, reducing anxiety and discomfort. It is commonly used for minor surgeries or diagnostic procedures.

5. How Painful Is Wisdom Teeth Removal Without the Use of Anesthesia?

Wisdom teeth removal without the use of anesthesia can be quite painful. The procedure involves extracting impacted teeth, which can cause significant discomfort due to the pressure and force required. Without anesthesia, the patient would likely experience intense pain during the extraction process. Anesthesia is typically administered during wisdom teeth removal to ensure the patient's comfort and minimize pain.

6. What Is the Recommended Limit for the Number of Times Someone Can Undergo Anesthesia Safely?

The recommended limit for the number of times someone can undergo anesthesia safely depends on various factors, including the individual's overall health, age, and specific medical conditions. While there is no fixed number, repeated exposure to anesthesia can carry potential risks. Healthcare providers carefully assess each case and weigh the benefits against the risks when determining the frequency of anesthesia administration. It is essential to have open and thorough discussions with the healthcare team to understand the specific considerations and make informed decisions regarding multiple anesthesia exposures.

7. Which Type of Anesthesia Is Typically Employed for Breast Lumpectomy?

The type of anesthesia typically employed for breast lumpectomy is usually regional anesthesia, specifically a technique called thoracic epidural anesthesia. This involves the administration of a local anesthetic into the space around the spinal cord in the thoracic region. Thoracic epidural anesthesia provides effective pain relief during and after the surgery, allowing the patient to remain conscious and comfortable. It also allows for better preservation of respiratory function and early mobilization compared to general anesthesia. However, the specific anesthesia approach may vary depending on the patient's medical history, surgeon's preference, and individual circumstances.

8. Are There Any Methods to Reverse Memory Loss Following Anesthesia?

Currently, there are no specific methods to reverse memory loss following anesthesia. While it is relatively common to experience temporary memory impairment or difficulty with recall immediately after anesthesia, most individuals recover their normal cognitive function within a few days to weeks. However, in rare cases, some individuals may experience long-term or persistent memory problems after anesthesia. Suppose if an individual has concerns about post-anesthetic memory loss, it is important to discuss them with the healthcare provider, who can evaluate the specific situation and provide appropriate guidance and support.

9. What Sensations Are Experienced During General Anesthesia?

During general anesthesia, the sensations experienced by an individual vary depending on the depth of anesthesia and the specific medications used. Generally, a person under general anesthesia does not feel pain or have any awareness of the surgery being performed. They are in a state of deep sleep and are unconscious. However, it is important to note that some individuals may experience dreams, confusion, or disorientation upon awakening from anesthesia. The anesthesiologist closely monitors the patient's vital signs and adjusts the anesthesia levels to ensure a safe and comfortable surgical experience.

10. Why Do Individuals with Red Hair Require Higher Doses of Anesthesia?

Individuals with red hair often require higher doses of anesthesia due to a genetic variation in a gene called MC1R. This gene produces a pigment called melanin, which gives color to hair, skin, and eyes. The MC1R gene variant commonly found in people with red hair is associated with reduced sensitivity to certain pain medications, including those used in anesthesia. As a result, higher doses of anesthesia may be needed to achieve the desired pain control and sedation level in individuals with red hair. Anesthesiologists consider this genetic variation when determining the appropriate dosage for patients with red hair.

11. How Long Does Anesthesia Remain in the Body?

The duration of anesthesia remaining in the body depends on various factors, including the type of anesthesia used, the individual's metabolism, and the specific medications administered. Generally, the effects of anesthesia wear off within a few hours after the procedure. However, some medications may have longer-lasting effects, and it is not uncommon to experience residual grogginess, drowsiness, or fatigue for some time after anesthesia. It is important to follow post-operative instructions provided by the healthcare provider and allow ample rest and recovery as the anesthesia gradually dissipates from the system.

12. How Does Anesthesia Continue to Impact the Body Over Time?

Anesthesia can continue to impact the body over time as it gradually clears from the system. While the effects of anesthesia typically wear off within hours or days, some individuals may experience lingering effects such as fatigue, drowsiness, or mild cognitive impairment for a longer duration. Certain types of anesthesia or underlying health conditions may also contribute to a slower recovery process. It is important to follow post-operative instructions, get plenty of rest, and allow the body time to recover from the effects of anesthesia fully. If there are any concerns or persistent symptoms, it is advisable to consult with the healthcare provider.

13. What Type of Anesthesia Is Administered During a Colonoscopy?

During a colonoscopy, a type of anesthesia called conscious sedation or moderate sedation is commonly administered. This involves the use of intravenous medications to induce a state of relaxation, drowsiness, and pain control. Conscious sedation allows the patient to remain conscious and responsive during the procedure while minimizing discomfort and anxiety. The sedative medications used in colonoscopy anesthesia include Midazolam and Fentanyl. The anesthesiologist or healthcare provider will determine the specific choice and dosage of anesthesia based on the patient's medical history, preferences, and the complexity of the procedure.

14. How Many Days Will the Chest Be Sore After Being Under Anesthesia?

Chest soreness after being under anesthesia can vary depending on the type of surgery and individual factors. Chest soreness or discomfort after anesthesia is common, especially if the surgery involves manipulation or procedures near the chest area. The duration of chest soreness can also vary but is typically temporary, lasting a few days to a week. It is important to follow the post-operative instructions of the healthcare provider, which may include pain management strategies to alleviate any discomfort. If a person has any concerns or the pain persists beyond the expected timeframe, it is advisable to consult with the healthcare provider for further evaluation.

15. How Much Time Does It Take for the Effects of Anesthesia to Wear Off After a Tooth Extraction?

The effects of anesthesia after a tooth extraction typically wear off within a few hours. However, the specific duration can vary depending on factors such as the type of anesthesia used, the individual's metabolism, and the complexity of the extraction. Some residual numbness or tingling sensation in the mouth and lips may persist for a few hours after the procedure. It is recommended to follow post-operative instructions from the dentist or oral surgeon for a smooth recovery and to manage any discomfort or swelling.

Sources

Dr. Pandian. P

General Surgery

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