Patient safety is paramount in healthcare and is especially salient in the realms of anesthesia and surgery. Anesthesia has been particularly successful in overhauling practices to greatly improve safety. Often, there are circumstances where the use of general anesthesia may be deemed unnecessary, given the associated risks (Smith et al., 2023). But on the other hand, there are also medical and safety concerns that indicate the use of general anesthesia in situations that would have otherwise not required its use.
Individuals with severe intellectual disability or developmental disorders may have difficulty cooperating or comprehending instructions during medical procedures (Chaudhary et al., 2017). While sedation is often a viable alternative to general anesthesia, general anesthesia is indicated for patients who may have severe management concerns which cannot be safely handled with the use of sedation or restraints to prevent movement that would disrupt the procedure. A similar strategy may be employed for patients with dementia or patients with severe cognitive impairment. Furthermore, studies have found that patients in this population who received general anesthesia had more positive return appointments compared to patients who received conscious sedation (Chaudhary et al., 2017).
Some patients may have extreme anxiety or phobias related to medical procedures, making it challenging for them to tolerate even minor procedures. In these scenarios, general anesthesia may be employed to alleviate anxieties and ensure patients are comfortable throughout their procedures. Some patients may have behavioral issues or aggression and may pose a risk to themselves and others during medical procedures (Appukuttan, 2016). General anesthesia can also be used in these settings.
Patients with certain neurological conditions may experience involuntary movements or muscle spasms that indicate general anesthesia, depending on the procedure’s needs, to protect patient safety and procedure outcomes. Examples of these neurological conditions include Parkinson’s disease or cerebral palsy. However, these patients should only receive general anesthesia if they can be cared for in a post anesthesia care unit or intensive care unit (van den Bersselaar et al., 2020). Patients with cerebral palsy may have physiological characteristics, including generalized hypotonia, gastrointestinal reflux, and impaired pharyngeal function, that require special attention perioperatively. These characteristics may require patients to go under general anesthesia and intubation to secure their airway (Chaudhary, et al., 2017).
In emergency situations where there is an urgent need to perform a procedure, general anesthesia may be preferred over other types of anesthesia due to its rapid onset and ability to provide complete unconsciousness. However, this should always be done under the guidance of an experienced anesthesiologist (Jensen et al., 2010). On the other hand, general anesthesia can pose a larger risk of complications such as pulmonary aspiration during emergency situations (Jensen et al., 2017).
Ultimately, the primary concern and goal of anesthesia is to ensure the safety, comfort, and well-being of the patient during a procedure. While it is important to be judicious about the use of general anesthesia given the risks it can pose, it is also important to recognize when patients may have conditions and patient safety concerns that indicate general anesthesia. Anesthesia providers should form a plan that is individualized to the patient, taking note of relevant social, behavioral, and medical conditions.
References
Staheli, Britton. and Bryan Rondeau. “Anesthetic Considerations in the Geriatric Population.” StatPearls, StatPearls Publishing, 5 August 2023.
Smith, Guerin, et al. “General Anesthesia for Surgeons.” StatPearls, StatPearls Publishing, 5 August 2023.
Jensen, A G et al. “Scandinavian clinical practice guidelines on general anaesthesia for emergency situations.” Acta anaesthesiologica Scandinavica vol. 54,8 (2010): 922-50. doi:10.1111/j.1399-6576.2010.02277.x
Appukuttan, Deva Priya. “Strategies to manage patients with dental anxiety and dental phobia: literature review.” Clinical, cosmetic and investigational dentistry vol. 8 35-50. 10 Mar. 2016, doi:10.2147/CCIDE.S63626
Chaudhary, Kapil et al. “Anesthesia for intellectually disabled.” Journal of anaesthesiology, clinical pharmacology vol. 33,4 (2017): 432-440. doi:10.4103/joacp.JOACP_357_15
van den Bersselaar, Luuk R et al. “Anaesthesia and neuromuscular disorders: what a neurologist needs to know.” Practical neurology, practneurol-2020-002633. 27 Oct. 2020, doi:10.1136/practneurol-2020-002633