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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.

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.

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Bibliography / Reference

Collection of Pages - Last revised Date: December 10, 2019