Anesthesia and Intensive Care

ANESTHESIA AND INTENSIVE CARE

Anesthesia and Intensive Care is a medical specialty that manages the anesthesia required during surgical or other medical procedures and provides intensive care treatment for critically ill patients.

Daviva Health Group’s Anesthesiology and Reanimation Department provides services with an experienced team of specialist physicians, through an innovative, modern, safe, and patient-safety-focused approach, and all anesthesia and intensive care processes are monitored with the latest information technologies of today.

What is Anesthesia and Intensive Care?

Anesthesia is one of the essential factors that make many medical procedures possible to perform safely and comfortably. Eliminating the sensation of pain is an indispensable prerequisite for diagnostic, therapeutic, and surgical interventions. Thanks to important advances in medicine, modern anesthesia practices have become extremely safe, controlled, and adaptable to the individual characteristics of the patient. Depending on the type of procedure, the patient's general condition, and the patient's medical history, the anesthesia method and the drug doses to be used during anesthesia are carefully planned and administered.

The Anesthesia and Intensive Care department is not only responsible for anesthesia during surgery. It also plays an important role in intensive care follow-up after major and/or critical surgical procedures, intensive care follow-up of critically ill patients, postoperative pain management, and the treatment of pain arising from other causes. In intensive care, where life support is provided for critically ill patients defined as patients with life-threatening or potentially life-threatening conditions in one or more organ systems, the Anesthesia and Intensive Care Department carries out patient care and treatment with a holistic, up-to-date, personalized, and comprehensive approach.

How many types of anesthesia are there?

There are 3 types of anesthesia: general, regional, and local. Regional anesthesia also has subtypes.

1. General anesthesia

General anesthesia is a controlled anesthesia method that causes the patient to lose consciousness during surgery, preventing them from feeling pain or other stimuli. Unlike natural sleep, it is a temporary loss of consciousness created entirely under medical supervision.

General anesthesia is usually initiated with fast-acting anesthetic drugs given intravenously. In some cases, especially in children, gas anesthesia may be administered via a mask.

During anesthesia, breathing, heart rhythm, blood pressure, and oxygen level are continuously monitored. This is because anesthetic drugs can affect the respiratory and circulatory systems.

In most surgeries, a tube is placed into the trachea to ensure safe breathing (intubation), and ventilator support is used if necessary. All of this process is controlled by a specialist anesthesiologist (anesthetist).

During general anesthesia, strong painkillers (analgesics), muscle relaxants, and, if needed, blood pressure-regulating medications may be used.

If fluid or blood loss occurs during surgery, intravenous fluid therapy and, when necessary, blood products are administered.

When the surgery is completed, the anesthesiologist stops the anesthetic drugs that were given. If necessary, additional medications may be administered to reduce the effects of the drugs. The patient is taken to the recovery room for close postoperative monitoring.

At this stage, breathing, heart rhythm, blood pressure, and oxygen level continue to be closely monitored. In addition, postoperative pain control is provided by the anesthesia team.

After more extensive or high-risk surgeries, follow-up in the intensive care unit may be required depending on the patient's general condition.

2. Regional anesthesia

Regional anesthesia is a method of anesthesia that prevents pain by numbing the nerves in the area where surgery will be performed while the patient remains conscious. The aim of this method is to provide effective numbness by administering the medication as close as possible to the relevant nerves. Thanks to targeted application, effective anesthesia can be achieved with lower doses.

Today, thanks to technological advances, these procedures are often performed under ultrasound guidance. The use of ultrasound allows the anesthesiologist to directly see the nerves and surrounding tissues and to guide the needle precisely. In this way, both the success rate increases and the risk of complications decreases.

Regional anesthesia provides effective pain control during surgery and can also contribute to long-lasting pain control after surgery. There are different types of regional anesthesia.

• Spinal anesthesia

Spinal anesthesia is a method that numbs the lower half of the body. Using a thin needle, the anesthesiologist inserts a needle between the vertebrae in the lower back and injects an anesthetic into the fluid surrounding the spinal cord. It is used for cesarean section, knee, hip, and foot surgeries, inguinal hernia, and urological procedures.

• Epidural anesthesia

Epidural anesthesia is administered from the lower back, similar to spinal anesthesia. However, the medication is injected into the epidural space outside the membrane surrounding the spinal cord. Its effect usually begins within 10–20 minutes. The most important advantage of epidural anesthesia is that a thin catheter can be placed into the epidural space. Through this catheter, painkillers can be administered in a controlled manner during and for several days after surgery.

3. Local anesthesia

Local anesthesia is numbing of only a limited area of the body. For example, dental procedures are mostly performed by applying local anesthesia to a part of the mouth.

Sedation

Sedation is a much lighter form of general anesthesia. As with all types of anesthesia, sedation may also suppress breathing and protective lung reflexes (swallowing, coughing). In principle, the safety conditions and preparation for sedation are the same as for general anesthesia. Sedation is used during uncomfortable or painful medical examinations (such as endoscopy, colonoscopy, or colon examination).

What is the anesthesia process like?

Before a planned surgical procedure, the anesthesiologist conducts a detailed pre-assessment interview with the patient. In this interview, the patient's general health status, existing illnesses, medications used, allergies, and previous surgeries are evaluated. The aim is to determine the safest and most appropriate anesthesia method for the surgical procedure. If necessary, the surgery may be postponed for the patient's safety.

General anesthesia is usually initiated with intravenous anesthetic drugs given through a vein. In some cases, especially in pediatric patients, anesthetic gases given via a mask may be preferred.

Throughout the surgery, the anesthesiologist continuously monitors respiratory function, heart rhythm, blood pressure, and oxygen levels with advanced monitoring devices. When necessary, they adjust the depth of anesthesia, regulate fluid and medication therapy, and keep the patient's vital functions under control.

What is the postoperative process like?

After the surgical procedure is completed, the patient is closely monitored in the recovery room (recovery unit). During this period, breathing, circulation, and level of consciousness continue to be monitored. In addition, postoperative pain control is provided by the anesthesia team.

After more extensive or risky surgeries, follow-up in the intensive care unit may be required depending on the patient's general condition. The intensive care process is often managed by a multidisciplinary team in which anesthesiologists also play an active role.

What is Intensive Care?

Intensive care is a unit where the vital functions of critically ill patients are supported and closely monitored. Intensive care is a special unit that provides the highest level of monitoring and treatment for critically ill patients whose condition is life-threatening but may improve with appropriate treatment.

In the intensive care unit, vital parameters such as patients' breathing, oxygen level, blood pressure, heart rhythm, and kidney function are continuously monitored. When necessary, life-support methods such as ventilator support (mechanical ventilation), intravenous drug therapies, and dialysis may be applied.

There are specialized intensive care units for newborns, pediatric patients, neurosurgical patients (for example, those who have had a stroke or severe head trauma), and patients undergoing cardiac and thoracic surgery. These units provide services with special equipment and specialist staff according to the patient's age and clinical condition.

The condition of patients in intensive care and the treatments applied require advanced knowledge and experience. Therefore, the intensive care team consists of specialist physicians, intensive care nurses, and other healthcare personnel.

The equipment used in the intensive care unit is designed to support vital functions and to temporarily sustain the functions of vital organs such as the lungs, heart, or kidneys when organ failure develops.

The need for intensive care may arise due to worsening of the patient's current condition, deterioration of a pre-existing disease, or the presence of certain risks (for example, the need for close postoperative monitoring or a risk of bleeding).

The aim of intensive care is to prevent progression of physiological deterioration in critically ill patients, preserve vital functions, and reduce the risk of mortality.

In intensive care medicine, anesthesiologists work closely with physicians from other specialties, specially trained intensive care nurses, and, when necessary, therapists. This interdisciplinary team provides 24-hour care to patients in intensive care units, which are specially equipped sections of the hospital.

In these units, patients' heart rhythm, breathing, blood pressure, and other vital functions are continuously monitored. The risk of infection increases in intensive care patients because the immune system may be weakened. Therefore, strict hygiene rules are applied in intensive care units.

Who is admitted to intensive care?

The Intensive Care Unit (ICU) is a special hospital department where critically ill patients are admitted and advanced monitoring and treatment are provided. Patients of all ages can be treated in the intensive care unit if the course of their disease requires close monitoring or if there is a life-threatening condition.

Patients with life-threatening organ failure such as acute heart, lung, or kidney failure; people with impaired consciousness after traumatic brain injury, stroke, or cardiac arrest; and patients with severe burns or severe infection (sepsis) are monitored in intensive care.

Intensive care monitoring is applied not only to manage the current life-threatening condition, but also to support the recovery of weakened organ function.

Intensive care is a unit that provides advanced supportive treatments that help patients with severe organ failure survive. In this special unit, patients are continuously monitored 24 hours a day, and necessary interventions are performed immediately.

Why is a patient intubated in intensive care?

Most often, depending on the patient's condition, breathing and oxygen must be supported with mechanical ventilation, which requires placing a tube into the trachea and using a ventilator. Sometimes, continuous medication is needed to maintain blood pressure and ensure normal perfusion of vital organs. In the event of infection, antibiotics are given. In cases of kidney failure, dialysis (or a similar technique) may be started urgently. If needed, heart or liver support may also be provided. Sometimes sedative medications are administered.

How many types of intensive care are there?

General Intensive Care

The General Intensive Care Unit provides care for adult patients with conditions that require special monitoring and medical treatment. It is dedicated to the management of postoperative patients, including those with respiratory failure, sepsis, stroke, cancer, organ failure, unstable polytrauma patients, and all surgical patients requiring continuous monitoring or life support.

Cardiovascular Surgery Intensive Care

The Cardiovascular Surgery Intensive Care Unit is a specialized care unit for the care of patients after aortic surgery, major vascular surgery, bypass surgery, and heart valve surgery. The responsible specialty is the Cardiovascular Surgery Department.

Coronary Intensive Care

Coronary Intensive Care units are specialized care units for the care of patients with critical heart conditions such as heart attack, acute coronary syndromes, and severe rhythm disorders. The responsible specialty is the Cardiology Department.

Neonatal Intensive Care

The neonatal intensive care unit is designed for the needs of premature, high-risk, and critically ill babies. Babies with congenital disorders and birth complications are also treated in the neonatal intensive care unit.