Anesthesia can be broadly divided into general anesthesia and local anesthesia. Anesthesiologists will make the most appropriate individualized anesthesia plan based on the type of surgery, the site of surgery, the length of time, as well as the patient's own factors, such as age, weight and so on, so how do anesthesiologists formulate anesthesia dosage for each individual and specify the awake time of the patient?
In fact, each anesthetic drug has its own recommended dosage as well as maintenance time, and the recommended dosage and maintenance time of commonly used anesthetic drugs are listed in the table below.
In addition, considering different patients' age, liver and kidney functions, different operation sites, time and methods, the selection and dosage of the corresponding anaesthetic drugs need to be adjusted accordingly.
Generally, anaesthesiologists will discontinue intraoperative maintenance drugs according to the surgical process and use appropriate antagonists (e.g., the opioid antagonist nalmefene, the benzodiazepine antagonist flumazenil, the muscarinic antagonist neostigmine, and the non-depolarising muscarinic specific antagonist suxoglucose sodium, etc.), so that the patient's awakening is basically achieved immediately after the end of the surgery, or within a few minutes, and in a comfortable and safe manner.
It should be noted that the timing of patient's awakening depends on the situation. If the patient has a poor baseline condition, a long operation time, or a lot of bleeding during the operation, the anaesthesiologist will prolong the awakening time accordingly, or transfer the patient to the intensive care unit (ICU) for postoperative resuscitation and extubation.
A good anaesthesiologist not only has to learn anaesthesiology well, but also has to learn to think and solve the problems encountered preoperatively, intraoperatively and postoperatively, as well as having the ability to make judgement!
For example, handling the patient based on the patient's bedside report values and analysing what caused the patient's emergency? How to deal with the emergency? As mentioned in this popular article, how to control the dosage of various anaesthetics in general anaesthesia, rationally adjust the dosage regimen for individual differences, and appropriately cope with perioperative emergencies are the necessary skills of anaesthesiologists, and also an important reference to evaluate the level of anaesthesiologists.
Finally, the anaesthesiologist's philosophy of drug administration is to use the simplest anaesthetics to give patients the most comfortable anaesthesia experience under the premise of patient's life safety.
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