How general anesthesia work? The mysteries of pain and consciousness in modern medicine

Today met 170 years of the first surgery under general anesthesia. It seems silly, but that day in 1846 the Massachusetts General Hospital marked a before and after in medicine. Or, perhaps, rather, in society as a whole.

Before anesthesia, about half of the patients died by trauma which they both operations. But despite its importance and the time it makes live with it, the mysteries of anesthesia remain a challenge for contemporary medicine. How this thing called anesthesia work?


general-anesthesia
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From local to general

Shortly after John Collins Warren and William Morton, undertake this operation on October 16, 1846, the news of the new technique based on ether spread like wildfire. It is missing a name that differentiates this from opium, alcohol used so far. And it was Oliver Wendell Homes who popularized the term “anesthesia” to describe “drug – induced insensitivity”. Hypnosis, analgesia, hemodynamic stability and muscle relaxation: Although, to be precise, four objectives are established today.

Broadly speaking there are two main types of pharmacological agents: local and general. Local, such as lidocaine, “cut” the transmission of the nerve signal to the brain by inhibiting the function of the sodium channel of nerve cells. In essence, isolated areas near the puncture but have no effect on consciousness or perception of other body areas.

General anesthetics are another matter. Cause what we call one state of general insensitivity to pain . The key is to be able to induce loss of consciousness in the patient while maintaining intact the other vital functions. The patient is not aware of what happens around him, but breathes “normal” (with the help of assisted breathing) and maintains its constant. Very often, several drugs are needed to get the right result.

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How general anesthesia work

Here comes the surprise: we know very little about how these general anesthetics work. Especially when we compared with the locals. The most popular are called volatile anesthetics or inhaled; i.e. anesthetics administered through the respiratory tract, generally are related to the ether, the first general anesthetic we discovered, and its main action is concentrated in the central nervous system.

There are two key factors that make it difficult to know how these agents act. The first is that volatile anesthetics, unlike almost all other drugs we use, behave in slightly different ways. This makes it very difficult to ascertain precisely what nervous system structures act or fail to act.

On the other hand, his taste for lipids does not help. It is much easier to study how they operate water-soluble drugs than those who have a soft spot for fat to act. At least, as to what clarify its structure and the way they interact with proteins is concerned.

Advancing in the dark

We know that, somehow, anesthetics manage to disrupt synaptic transmission. How they do it is more complex to figure out. Traditionally, anesthetics have been seen as non – specific agents that altered neuronal membrane and modified the physical properties of the lipid component.

In recent years, theories have changed and we have found that mainly affect ion channels and proteins crucial for transmission. That is, we have learned much about his ‘macroscopic’ behavior but the elusive nature of the molecular mechanism of action and relative variety of drugs available have made it very difficult to find a common property that explains the anesthetic action.

It is said that the brain are neurons firing in the dark. In this case, the image is good for us. Despite its importance, anesthesia we are still resisting and the progress we get are fighting the darkness that every day is less.

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