The Two Most Dangerous Aspects of General Anesthesia

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The two most dangerous aspects of general anesthesia are at the beginning, which is called the induction phase, and at the conclusion, which is called the emerging phase.

The general anesthesia patient has the endotracheal tube inserted into their windpipe. The anesthesiologist needs to view the vocal cords to be sure that the tube is passing between them and therefore into the trachea, the windpipe, and not behind it into the esophagus, the food pipe. Furthermore, when the endotracheal tube is probably inserted and its balloon cuff is inflated, then the anesthesiologist must listen to the chest to hear that the breath sounds are equal on both sides, and observe the exhaled carbon dioxide monitor be sure that it is recording exhaled air at 4%, versus room air which is less than 1%.

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Laparoscopic Cholecystectomy

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The gallbladder is a bile storage organ which is attached to the bottom surface of the liver. It stores bile which is an emulsifier for fat, and after a fatty meal, a hormone causes the gallbladder to contract, squeezing the bile into the common bile duct, the main bile duct, and from there into the first part of the small intestine, the duodenum. The problem with bile storage in some patients, particularly women who are over the age of 40, overweight and have had children, the stagnant bile can form gallstones. This can cause severe pain, and sometimes infection.

The modern way to remove a gallbladder is using the laparoscope. Small incisions are made into the abdomen, the gallbladder is grasped at its top surface, and the connection between the gallbladder and the common bile duct, the cystic duct, must be must be observed to be sure that the common bile duct is never injured. An injury to the common bile duct results in a serious lifelong disaster, with scarring and repetitive obstruction of bile flow, resulting in jaundice, liver failure, and sometimes infection.

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