Anesthesia

Anesthesia is a procedure that is administered to control pain, heart rate, blood pressure and other vital parameters during a surgical procedure. It is temporary state which allows the patient to recover and gain control of his coordination a few hours after a surgical procedure.

Anesthesia is an exact procedure which requires theoretical and practical expertise. Any kind of dosage variation can be fatal to the patient. During general anesthesia, patients are advised to abstain from eating and drinking 12 hours before the procedure as it may lead to aspiration associated complications during the procedure. Thorough examination of the patient history is done to evaluate for drug sensitivity and allergic patterns with respect to the type of anesthesia administered. Anesthetics such as inhalants or IV forms are given depending upon the type of surgical procedure.

General anesthesia

General anesthesia is administered during complicated procedures such as cardio thoracic surgery, oncogenic or organ specific surgery. In this procedure, the patient goes into a stage of total unconsciousness with administration of anesthetic gases and intravenous anesthetics such as halothane, Sevoflurane, Enflurane, Desflurane, Isoflurane, Propofol, etomidate and thiopental. Some anesthetics such as Propofol are hypnotic in nature. It has been widely used because of its nature to bring back the patient to conscious state a few hours after the surgical procedure. In addition to the inhalant and intravenous forms of anesthesia which are administered, neuromuscular blockage is also required as it helps in respiratory ventilation along with intubation. Most of these neuromuscular blockade agents are derived from curare compounds which is a skeletal muscle relaxant.

Local anesthesia

Local anesthetics are either administered as a combination with general anesthetics are as a post-operative anesthetic agent. Most of the local anesthetics are amides and esters. Some of the local anesthetic amides include lidocaine, prilocaine, ropivacaine and etidocaine. The ester forms of these anesthetics include tetracaine, procaine, cocaine and benzocaine. Local anesthetic drugs are given directly in the region where the surgical procedure has to take place. Most dental procedures involve the administration of local anesthetics. The patient is conscious and experiences numbness only in the region where the procedure is being done.

Regional anesthesia

This form of anesthesia is given to block pain in a larger area of the body where the procedure is done. Patient is sedated in most cases. Regional anesthetic drugs usually work on the principle of nerve block caused in the peripheral region. This includes a procedure called spinal anesthesia where the drug is administered in a specific area of the spine to numb the corresponding region of the body. Regional anesthesia is administered at a specific location to numb the region for surgical intervention. Local anesthetics are administered either in the topical or injectable form to desensitize the area of surgical intervention.

Risk factors of anesthesia

Malignant hyperthermia is one of the rare yet life threatening complications of anesthesia. This adverse reaction is caused when succinyl choline (muscle relaxant) is administered. In this reaction, the muscle fibers of the body tend to dissociate from each other. Spinal and epidural anesthetic procedures have headaches as side effects due to the leakage of cerebrospinal fluid from region of injection. Nausea, vomiting and nerve damages are some of the predominant side effects of anesthetic procedures. These are controlled by administration of IV medications. In some patients, the insertion of endotracheal tube during procedures such as bronchoscopy may lead to sore throat for a few days. Apart from all the presumptive risk factors and side effects of anesthetic drugs, some have toxic effects on liver and kidneys. In such conditions, patients are examined for tolerance and toxicity before administering anesthetic gases such as halothane.

Paraesthesias

Paraesthesias, also spelled paresthesias, is a medical term that refers to abnormal sensations in the body, typically involving a feeling of tingling, pricking, numbness, or "pins and needles." These sensations are often described as uncomfortable or abnormal and may be experienced in various parts of the body, such as the hands, feet, arms, legs, or other areas.

Paraesthesias can be caused by a variety of underlying medical conditions or factors, including:

• Nerve Compression or Irritation: Pressure on or damage to nerves, such as in conditions like carpal tunnel syndrome or sciatica, can lead to paraesthesias.
  
• Nerve Disorders: Diseases that affect the nervous system, like peripheral neuropathy, multiple sclerosis, or diabetic neuropathy, can result in abnormal sensations.
  
• Poor Circulation: Reduced blood flow to specific body parts can lead to paraesthesias, as tissues may not receive sufficient oxygen and nutrients.
  
• Vitamin Deficiencies: Deficiencies in certain vitamins, particularly B vitamins like B12 and folate, can contribute to nerve-related symptoms, including paraesthesias.
  
• Infections and Inflammatory Conditions: Conditions like shingles, Lyme disease, or autoimmune diseases can cause nerve inflammation and lead to abnormal sensations.
  
• Medications and Toxins: Some medications or exposure to toxins can induce paraesthesias as a side effect.
  
• Trauma or Injury: Physical injury or trauma to nerves or tissues can result in temporary or chronic paraesthesias.
  
• Psychological Factors: In some cases, paraesthesias may be related to psychological stress or anxiety.
  

Some medications have the potential to affect the nervous system and cause these symptoms. It's important to note that individual responses to medications can vary, and not everyone will experience paraesthesias as a side effect. Here are some categories of medications and specific drugs that are known to be associated with paraesthesias:

• Chemotherapy Drugs: Several chemotherapy agents, such as paclitaxel, vincristine, and cisplatin, can cause peripheral neuropathy, leading to paraesthesias in the hands and feet.
  
• Anticonvulsant Medications: Some anticonvulsants, including phenytoin and carbamazepine, may cause paraesthesias as a side effect.
  
• Antidepressant Medications: Tricyclic antidepressants like amitriptyline and selective serotonin reuptake inhibitors (SSRIs) like fluoxetine have been associated with paraesthesias in some individuals.
  
• Antiretroviral Drugs: Certain medications used to treat HIV, such as zidovudine and didanosine, may lead to peripheral neuropathy and paraesthesias.
  
• Antibiotics: Some antibiotics, particularly fluoroquinolones (e.g., ciprofloxacin), have been linked to peripheral neuropathy and paraesthesias.
  
• Antifungal Medications: Antifungal agents, such as fluconazole, can occasionally cause peripheral neuropathy and associated symptoms.
  
• Antihypertensive Medications: Diuretics and calcium channel blockers are classes of drugs that may rarely induce paraesthesias.
  
• Statins: Statin medications used to lower cholesterol levels, like atorvastatin and simvastatin, have been reported to cause muscle-related paraesthesias in a minority of users.
  
• Immunomodulatory Drugs: Medications used for autoimmune diseases, like interferons and monoclonal antibodies, can result in paraesthesias.
  
• Local Anesthetics: Certain local anesthetics used in medical or dental procedures may lead to temporary paraesthesias.
  

Vitamin B3, also known as Niacin, is an essential nutrient that plays a crucial role in various bodily functions, including energy metabolism and maintaining the health of the nervous system. While niacin deficiency can lead to neurological symptoms, including paraesthesias (abnormal sensations like tingling or numbness), it is rare in well-nourished individuals.

However, high doses of niacin, often used in the treatment of certain medical conditions like high cholesterol, can indeed cause paraesthesias as a side effect. This is a well-known side effect of niacin therapy and is commonly referred to as the "niacin flush." The niacin flush involves a warm, tingling sensation, often accompanied by redness and flushing of the skin, particularly on the face and upper body. Some people may describe it as a temporary, uncomfortable form of paraesthesias.

The niacin flush is usually harmless and transient, lasting for about 15-30 minutes after taking a high-dose niacin supplement. Over time, the body may develop some tolerance to this side effect. Nevertheless, individuals who experience severe or persistent paraesthesias or other adverse effects from niacin should consult their healthcare provider. It's important to take niacin supplements as directed by a healthcare professional, as high doses can have potential side effects, including liver toxicity, gastrointestinal disturbances, and other adverse reactions.

Diagnosis and management of paraesthesias typically involve a thorough medical history, physical examination, and, if necessary, further diagnostic tests such as nerve conduction studies, electromyography, blood tests, or imaging studies. The underlying cause of paraesthesias must be identified and treated accordingly. Management may involve addressing the primary medical condition, physical therapy, medication, or lifestyle changes to alleviate the abnormal sensations and improve the patient's overall well-being.

Skin Biopsy

A biopsy of the skin is done to clear what is the condition of the skin such as psoriasis, to diagnose a disease such as skin cancer and to diagnose any bacterial or fungal skin infection. A skin biopsy is routinely done in a doctor's clinic as an outpatient procedure. You have to inform the doctor if you suffer any allergies to medications, especially any adverse reactions to local anesthetics or to iodine cleaning solutions. Keep the doctor informed if you are under any medication, are pregnant or suffer bleeding problems.

Skin biopsy procedures

If it is an excision biopsy, the entire suspect skin is cut out. Excision is normally done with a scalpel and the incision is closed up by stitches. If it is a punch biopsy, a sharp cutter is used to remove a small cylinder of skin. Stitches are made to close this type of biopsy wound as well. Such punch biopsies are quick, convenient and done for small wound. A pathologist can get a full thickness view of the skin. Sometimes more than one punch biopsy is necessary. The punch biopsy blade takes a small round core of tissue ranging from 2-6mm dia although 3-4mm is the usual size.

In a shave biopsy, the outermost part of a lesion is shaved off with a scalpel. Only if the top layer of the skin is suspected, a shave biopsy is adopted. A dermatologist will take a superficial slice of skin from the area of affected with a scalpel, dermablade or a razor blade. Although there are no stitches required, there will be a small scar that should heal in about a week's time. An aspiration is used to remove the skin that is fluid filled and not solid. The doctor inserts a small needle attached to a syringe into the lesion and the fluid is sucked out.

The biopsy site is cleaned with an iodine type solution with alcohol and with a sterile soap solution. A sterile towel is placed around the area once the skin is cleaned. A local anesthetic is injected into the skin to make it numb. You may feel a brief prick and stinging sensation as the medicine is injected. The doctor can perform the biopsy once the skin is numb. Now the tissue is removed and sent to the laboratory for analysis by a pathologist. If needed, the wound is stitched up.

A bandage is wound over the biopsy site. You may also be advised to wash the wound and apply antibacterial ointment and change the bandage daily. If you experience any pain in the biopsy site, consult the doctor about medication to relieve it.

• Unexpected bleeding may occur; especially if you are on any blood thinning medications such as aspirin. For instance, arterial puncture on the forehead or temple may take time to stop bleeding.
  
  
• There could be wound infections in about 1-5% of surgeries. There could be ulcerated or crusted skin wounds. Antibiotics may be used to clear this up.
  
  
• Infection is also common in diabetics, elderly patients and those on immunosuppressive medicines.
  
  
• If large scars, called keloids, there is an increased chance of forming a scar over the biopsy site.