Everything you need to know about anesthesia for rhinoplasty. Anesthesia for plastic surgery Who did the nose under local anesthesia

The issue of anesthesia care worries many patients almost to a greater extent than rhinoplasty itself. Patients ask plastic surgeons many questions. Is it possible to have a nose job under local anesthesia? What to do if you have any chronic diseases of the cardiovascular or respiratory system, for example, arterial hypertension, coronary artery disease or bronchial asthma? Are there any complications associated with anesthesia?

This publication will provide answers to the main questions. You will learn how anesthesia is administered and how to avoid unpleasant symptoms after general anesthesia.

Is local anesthesia used for rhinoplasty?

In most clinics in Moscow (and any other city) you will receive a definite answer: in theory, rhinoplasty can be done under local anesthesia, but in practice, in 99.9% of cases, general anesthesia is used, that is, anesthesia. It should be noted that the term “local anesthesia” is incorrect, although it is sometimes used by non-specialists. The terms "local" or "general" apply to anesthesia. As for anesthesia, this is a synonym for the term general anesthesia, and it cannot be local.

Local anesthesia can be infiltration, application, conduction or regional. The type of anesthesia is determined by the method of administering the anesthetic. For example, during infiltration anesthesia, the tissues on which manipulations will be performed are impregnated with it. With conduction anesthesia, the transmission of a nerve impulse along a specific nerve, which is its conductor, is blocked. Infiltration and conduction anesthesia are actively used in dental practice.

With topical anesthesia, an anesthetic is applied to the surface of the skin or mucous membrane. This method is often used in cosmetology before injection or hardware procedures that are accompanied by pain. It should be noted that even with such simple manipulations, the application method does not provide complete pain relief, and therefore its use in rhinoplasty is out of the question.

Regional anesthesia is often used in obstetrics to relieve pain during labor. For many women, epidural anesthesia, which is a variant of regional anesthesia, has helped them get through difficult births without excruciating pain. During rhinoplasty, regional anesthesia, that is, anesthesia of a large anatomical area, is not used.

As you can see, the remaining options for local anesthesia are conduction and infiltration. Considering the successful use of them in dental practice, there is hardly any need to fear the occurrence of pain. In dentistry, manipulations are performed on bone tissue, which should be accompanied by excruciating hellish pain, but the patient does not feel anything. This once again proves the effectiveness and reliability (sufficient duration of pain relief) of these types of anesthesia.

But what in practice? Plastic surgeons are unanimous in their opinion that rhinoplasty should be performed only under general anesthesia. In theory, you can operate under local anesthesia if you have a simple operation on the cartilaginous elements of the wings and the tip of the nose. However, even here it is better to use anesthesia.

Why is anesthesia better?

Pain is not the only problem with surgery. We must not forget about the duration of the operation and the emotional state of the patient. It is extremely difficult for a person to withstand the one and a half or two hours that rhinoplasty will take. During these two hours you must lie absolutely still. The slightest careless movement can undo the efforts of the plastic surgeon. All this time, the patient hears the ringing of surgical instruments and feels manipulations on the tissues of the nose, since proprioceptive sensitivity is partially preserved.

Rhinoplasty under local anesthesia is a much more emotionally and psychologically difficult, tedious and exhausting process than many may imagine. Even if such an anesthetic option is theoretically possible, the surgeon will recommend general anesthesia, and he will be absolutely right.

In practice, operations are performed under local anesthesia only in clinics that either do not have a full-fledged operating room with an anesthesia-respiratory apparatus, or do not have a qualified anesthesiologist-resuscitator on staff. If you were offered local anesthesia, citing the “simplicity” of the operation, it is better to get a consultation at another clinic. This will be the right decision.

General anesthesia for rhinoplasty

Anesthesia for rhinoplasty also has certain features. As a rule, combined general anesthesia is used, including intravenous and endotracheal administration of a narcotic drug. One drug enters the blood through a catheter, which is placed in a vein, the second - in the form of a gaseous mixture through the endotracheal tube.

This type of anesthesia treatment has maximum reliability and safety. What does reliability mean in relation to anesthesia? This means that the anesthesiologist-resuscitator fully controls the depth and duration of depression of consciousness. The possibility that the patient suddenly “wake up” in the middle of the operation is completely excluded. The person will return to consciousness immediately after returning from the operating unit to the ward, and not a minute earlier.

Regarding safety. Anesthetic risks are present, but they are minimal. The patient is prescribed a diagnostic examination at the stage of preoperative preparation. He undergoes a lot of tests, undergoes an ECG, and, if necessary, consults with specialized specialists. The operating team receives objective information about the health of the cardiovascular, central nervous and respiratory systems. If the diagnosis reveals deviations from the norm that increase the degree of anesthetic risk, rhinoplasty is not performed at all or is postponed until the identified abnormalities are completely corrected.

If there are no obvious or hidden diseases, anesthetic risks are minimal. During anesthesia, the function of the respiratory and cardiovascular systems is under the complete control of the anesthesiologist. The doctor closely monitors hemodynamic parameters. Breathing is provided by an anesthesia-respiratory apparatus (a person cannot breathe on his own, since narcotic substances have a muscle relaxant effect). Thus, the patient’s breathing is also under the control of the medical team.

Coming out of anesthesia: how to reduce symptoms?

To put it bluntly, nothing threatens the life and health of the patient during rhinoplasty. In fact, any trip on the highway is fraught with more dangers than a nose job, which is performed under anesthesia by an experienced and qualified medical team. The only problem may be recovery from anesthesia, which is accompanied by unpleasant symptoms.

After recovery from anesthesia, the patient may experience headache, dizziness, nausea, confusion, and some disorientation. The severity of symptoms depends on what drug was used for anesthesia and whether the dose was selected correctly. An experienced anesthesiologist will make sure that recovery from anesthesia is “clean” and easy; for him this is a matter of honor and an indicator of professional skill.

As for the patient, he can take certain measures in advance. On the eve of the operation, you should not drink alcohol, drugs with sleeping pills or strong sedatives. The exception is for medications prescribed by a doctor. Otherwise, sedative medications may enhance the effect of narcotic drugs. This is not dangerous to health, but recovery from anesthesia may be more difficult.

Rhinoplasty is best done under general combined anesthesia. Anesthesia does not threaten the life and health of the patient, and with proper preparation for the operation, recovery from it will occur with a minimum number of unpleasant symptoms.

Septoplasty is a surgical intervention that is aimed at correcting the nasal septum to improve respiratory functions. During surgery, the surgeon can correct the deformed structures of the septum (bone and cartilage) that separates the two nasal passages.

Rhinoplasty is a plastic surgery in which the shape of the nose is changed aesthetically or its reconstruction is performed, either partial or complete.

Plastic surgery - rhinoplasty

These operations are one of the complex plastic surgery interventions that are performed to eliminate difficulty breathing through the nose after an injury that has caused asymmetry or a shift in the position of the bridge of the nose. For any surgical intervention, pain relief is required: local anesthesia or general anesthesia.

What anesthesia is used for rhinoplasty? This is the main question that concerns all patients.

Anesthesia of the nasal area with local anesthetics in plastic surgery allows you to block pain in a specific area for manipulation. The patient remains conscious throughout the entire surgical procedure, feels all the manipulations being performed, is fully aware of everything that is happening around him, but does not feel pain. Local anesthesia in plastic surgery is used for rhinoplasty and septoplasty.

This method of pain relief is mainly used by those undergoing surgery who are not suitable for general anesthesia for nose correction surgery or minor surgery. For example, patients with acute neurological abnormalities who had an acute myocardial infarction less than six months ago, suffering from uncompensated heart failure, with stable or unstable angina, with hypertension and other diseases.

Local anesthesia is used when general anesthesia is contraindicated for the patient

The main positive side of local anesthesia is the absence of post-anesthesia complications. The rehabilitation period takes less time than when using medicated sleep during septoplasty or rhinoplasty.

The main negative factor is that the patient fully controls the course of the surgical intervention and is aware of all the actions performed by the surgeon.

If your doctor does not recommend using local anesthesia, it is best not to panic, but to listen to the advice. This method of pain relief cannot always be used in plastic surgery to perform surgery on the septum or to correct the shape of the nose.

Medication-induced sleep during rhinoplasty

Many patients are afraid of general anesthesia due to the high risk of complications after the operation. This surgical intervention to correct the nose is quite difficult in plastic surgery, and the use of medicated sleep for all manipulations is more relevant. The operated patient is completely immobilized and calm, which has a beneficial effect on the course of the surgical intervention.

General anesthesia is preferred for rhinoplasty

During the operation, the patient is unconscious, so there is no pain or awareness of the manipulations being performed. The surgeon and anesthesiologist carefully monitor the condition of the patient during surgery, and the medical staff monitors the operated patient until he fully awakens.

After waking up, it is not recommended to drink a lot for a couple of hours and you should not eat food, as nausea and vomiting may occur. Follow all the recommendations of the anesthesiologist, and when recovering from plastic surgery, stop smoking and drinking alcoholic beverages. If you experience negative feelings, immediately notify the medical staff so that the observing doctor can provide timely assistance.

Feeling after anesthesia

When the local anesthesia completely wears off and the patient regains sensitivity in the nasal area, pain gradually appears, up to severe pain. In such a situation, it is important to immediately tell the medical staff about such pain sensations in order to promptly relieve the condition with painkillers.

After the operation, the patient may experience severe pain, so it is necessary to be under observation

After surgery, under the influence of medicated sleep, the patient is monitored by an anesthesiologist until he fully awakens. When the operated patient wakes up, the doctor will ask a couple of simple questions to assess his well-being. In the first hours after anesthesia, you may experience dry mouth, dizziness, nausea, as well as chills and pain in the nose. Most often, the patient experiences drowsiness, which goes away within 24 hours.

Postoperative complications in surgery can develop both after medicinal sleep and local anesthesia. It all depends on the general condition, the individual characteristics of the patient’s body, and compliance with the recommendations of the surgeon and anesthesiologist.

A person who decides to undergo rhinoplasty is faced with many questions, one of them is what anesthesia is best to use for rhinoplasty. It is very difficult to give an unambiguous answer to this, because much depends on the client’s health status, the extent of surgical intervention and other factors. In order to understand this issue, it is important to familiarize yourself with all types of anesthesia used during rhinoplasty. You also need to highlight the advantages and disadvantages of each method.

For a procedure such as rhinoplasty, anesthesia is most often carried out using three methods:

local anesthesia;
general intravenous anesthesia;
general endotracheal (inhalation or mask).

Each of them has disadvantages and advantages. Let’s look at how justified the use of each of them is by looking at them in more detail.

Local anesthesia

Most often, rhinoplasty under local anesthesia is performed in cases where the scope of surgical intervention is minimal. Rhinoplasty with this type of anesthesia is also acceptable when general analgesia is not possible due to contraindications or other objective reasons.

Typically, rhinoplasty under local anesthesia is performed if it is planned to correct the tip of the nose or remove a hump. If a more extensive intervention is expected, general anesthesia is preferred. When performing rhinoplasty, infiltration anesthesia is used, that is, the nasal tissues are “impregnated” in layers with an anesthetic drug.

The anesthetic effect of local analgesia is explained by the fact that the drug blocks the transmission of pain impulses in the area where the drug is administered. But at the same time, temperature and tactile sensitivity is preserved, that is, the patient can feel heating of tissues (for example, during coagulation - cauterization, in order to stop bleeding), or pressure.

The most commonly used drugs are:

Xylocaine;
Marcain;
Lidocaine.

Before anesthesia, be sure to perform an allergy test for an anesthetic!

It is important to understand that this anesthesia has some contraindications, including:

Mental disorders.
Intolerance (individual sensitivity) to local anesthetics.
State of psychomotor agitation.
Respiratory disorders.

Also, the reason for refusing local anesthesia in favor of general anesthesia may be the patient’s desire, because often the client is horrified by the possibility of not only feeling, but also partially seeing the doctor’s actions, even if there is no pain.

It should be understood that local anesthesia is always a risk, because there is no guarantee that even an outwardly calm and balanced person who does not have mental disorders will not move in a stressful situation. That is why in 100% of cases, when choosing local anesthesia, the patient is additionally given intravenous injections of fairly strong drugs from a number of sedatives.

General anesthesia

If rhinoplasty with a large volume of work is planned, then general anesthesia is most often chosen. There are two main methods for doing this:

The drug is administered intravenously.
Mask anesthesia, in the case of rhinoplasty - endotracheal.

Regardless of which method the doctor chooses, the preparation for them will be similar.

Preparation for general anesthesia

General anesthesia is a deep, drug-induced sleep in which consciousness and any sensitivity are completely lost.

To ensure that no complications arise during anesthesia, and the patient feels great after emerging from it, it is important to follow the doctor’s recommendations. Preparation for general anesthesia is:

Compliance with diet and nutrition.
Correctly administered premedication.

Thus, it becomes clear that you need to start preparing for this manipulation in advance.

Diet

Modern views on preparing for anesthesia are much less strict, because previously the patient was forced to give up solid food 18 to 12 hours before the procedure. Now this period has been reduced to 6 hours, and you can drink water, tea or coffee 2-3 hours before the procedure.

The recommendation to abstain from food is due to the fact that during general anesthesia, the muscles of the whole body relax (except for the heart and respiratory muscles). This leads to the fact that the esophageal, gastric, and intestinal sphincters do not work properly, which can cause the reflux of their contents into the lungs.

Pneumonia due to damage to lung tissue by acidic gastric contents is one of the most severe complications of general anesthesia, which can cause the death of the patient.

Premedication

Very often, the prospect of general anesthesia frightens patients even more than the surgical intervention itself. That is why, even on the eve of Day X, before going to bed at night, the client must take a sleeping pill chosen by the doctor along with a tranquilizer and an antihistamine. The purpose of this preparation is not only to calm the patient, but also to reduce the secretion of biological fluids from all glands - this is extremely important during nasal surgery.

Intravenous anesthesia

Intravenous analgesia uses narcotic drugs that turn off the brain centers responsible for the perception of pain impulses. It is extremely important to correctly calculate the dose of the drug; for this you need to know the patient’s body weight. The advantage of this method is the rapid introduction of anesthesia, but the disadvantage is the short duration of the effect. The most commonly used drugs for this anesthesia are Viadryl, Sodium Oxybutyrate, Xenal, and Sodium Thiopental.

Endotracheal anesthesia

This type of anesthesia includes several stages:

administration of a small dose of intravenous anesthesia;
tracheal intubation.

The goal of the first stage is to carry out the second stage painlessly and as relaxed as possible, because tracheal intubation - insertion of a probe through which the anesthetic will be administered and ventilation of the lungs will be carried out - is an unpleasant procedure.

Advantages of this type of anesthesia:

There is a lower risk of developing cardiovascular or pulmonary insufficiency, because the level of oxygen in the blood is always at the proper level.
The dosage is as accurate as possible, due to the fact that the drug enters directly into the trachea and does not evaporate.
Airway patency is ensured, because the nose is not able to perform its functions due to bleeding, etc.
There is no risk of gastric contents refluxing into the lungs.

Patients also consider complete unconsciousness, which means preserved nerve cells, to be one of the main advantages. And considering that rhinoplasty surgery is carried out right before the patient’s eyes, this is important.

The choice in favor of endotracheal anesthesia is also associated not only with the need for a long-term effect of analgesia (pain relief), but also with the fact that with this method it is easier to control blood pressure, heart rate, respiration and other indicators of the patient’s condition.

Contraindications

Unfortunately, this pain relief cannot always be used. Endotracheal anesthesia should be avoided if:

the patient suffers from acute inflammation of the upper respiratory tract;
the patient has a manifestation of hemorrhagic diathesis;
the patient suffers from bronchitis, pneumonia or other infectious pathology - tuberculosis, etc.

If there are local changes on the root of the tongue or the tissues of the soft palate - inflammation of the neoplasm, etc., then anesthesia is possible only through a tracheostomy (to prevent the spread of the pathological process).

Complications

Any type of anesthesia can cause a number of complications. The most common side effects of anesthesia are:

regurgitation - reflux of gastric contents into the lungs;
vomit;
injury by an endotracheal tube to the soft tissues of the respiratory tract (during endotracheal anesthesia);
heart rhythm disturbance (due to incorrect dosage of the drug, due to hypoxia, etc.)
drop in body temperature – hypothermia;
damage to peripheral nerves.

With the correct selection of drugs for anesthesia and compliance with the technique of its use, the likelihood of complications developing is extremely low

There's no need to be afraid

There are a whole lot of myths around all types of anesthesia, for example, that a person loses memory after them, his mental abilities decrease, and in general one may not “come out” of anesthesia. In fact, nowadays there are drugs and equipment that can reduce any risks to zero.

In addition, during the operation, the normal course of anesthesia is monitored not only by the surgeon, but also by the anesthesiologist together with an assistant. At the slightest negative reaction on the part of the patient’s body, the necessary assistance will be immediately provided.

When choosing a pain relief method for rhinoplasty, it is highly advisable to listen to the recommendations of your surgeon and anesthesiologist. After all, doctors, seeing the results of your tests and knowing the required volume of surgical intervention, will choose the method that is best suited. A positive attitude and lack of fear of anesthesia will help your body endure both the operation itself and the rehabilitation period as easily as possible.

I will not tell you about how I wanted to have the operation, my story BEFORE, because I am sure that, like me, you are interested in completely different questions.

For me, choosing a surgeon was a long process. I read a lot of reviews, forums, looked at surgeons in several cities (I live in Moscow). At one of the forums there were words that excellent specialists work in Makhachkala. After some time, one of my friends, who was born in Makhachkala, told me that she planned to go there to have her septum corrected. I found out the details. In fact, rhinoplasty is very popular in Makhachkala and if you read the forums, many girls from other cities speak of local surgeons as very good specialists. In addition, what surprised me sooooo much is the price, which is 2-3 or even more times different from prices in other cities (the cost of a full rhinoplasty starts from 30 thousand - and this was at the beginning of 2015, when prices soared by All...).

There are many surgeons there, but there are about 7 of those who are talked about and written about. Make an appointment with a good surgeon several months in advance (or even half a year in advance), but there may be exceptions. There are groups on social networks where girls discuss surgeons and results.

I chose two doctors (I chose them based on reviews, I also found the surgeons’ phone numbers, contacted me via Whats App, showed my photos), and went to Makhachkala. I rented an apartment there, had two consultations on the day of my arrival and chose a doctor. We already had ready-made tests on hand. I think that for non-residents who come for the operation with ready-made tests, they go to the meeting - they may not be put in a six-month queue, but make an appointment for the day when there are those who refused the operation.

I was lucky, I got an appointment super quickly - a day after the consultation. There were no doubts about the surgeon - because I really saw how long the queue was to see him just for a consultation. The operation was performed on me by Amirkhanov H.K. Cost - 45 thousand rubles.

It is advisable to quit smoking a month before
within a week, start taking medications such as Ascorutin (strengthens the walls of blood vessels) and Wobenzym (increases immunity)
the day before and on the day of surgery, take the drug Dicynon!!! (stops bleeding).

Now about the local anesthesia and surgery itself. When I found out that rhinoplasty can be done under local anesthesia, I was quietly horrified and definitely said that this is not for me. BUT, the fact is that in Makhachkala many doctors do only local work. I asked a question to many girls - who went through this - what did it feel like.... And strangely enough, many answered that it doesn’t hurt, you won’t feel anything. Still, I decided to do it, especially since the doctor left me no choice..((

I’ll be honest - it hurt me at some points (when they inserted turundas, gave injections into my nose), it was not pleasant, I had a terrible headache. But my nervous system is very sensitive, cosmetologists can’t stand me because I twitch and scream in pain. This is different for everyone. But some people have a harder time with general anesthesia, so the choice is yours.

The operation went quite quickly - an hour or even less.

The first day and first night are the hardest. I hardly slept due to the inability to breathe through my nose. My mouth was dry. On the second day the tundra was removed and it became possible to breathe. But not for long..((for some time you will have to breathe either through your mouth or your nose. I didn’t rinse or wash anything until the plaster was removed, I just applied cream.

The result is in the photo. The nose was not changed much, but I only went for the operation to remove the hump and a little length.

You need to sleep on your back before removing the cast - it affects the uniformity of swelling, and of course, so as not to dislodge the cast.
After removing the cast, put on the cast at night for 2-3 weeks (does not apply to those who have surgery only on the tip) - this is necessary because the bones grow together and are fixed within months. after operation.
To quickly relieve swelling and restore the nose after removing the plaster, massage (massage the nose with your fingertips)
and of course, protect your nose from injuries and damage for the next 6 months, since after the OP the bones and cartilage remain traumatic (but you shouldn’t make this a panacea either, more than once my nose was subject to random “attacks” from my boyfriend..) ) but nothing happened to him)

About doctor's orders:

It's been a month since the surgery and I feel very good. I lead a normal lifestyle, without any restrictions.

I would also like to note two important points. First, the swelling from the nose may not go away evenly. As a result, it may seem that the nose is slightly crooked. This happened to me when the turundas were pulled out and I could see the nose from below. Also, after removing the plaster, it may also seem that it is crooked, but this is only a difference in the swelling, when it goes away everything will be ok

Second point... After removing the plaster, you will probably be surprised by the result - the nose still looks very swollen, and a day after removal it will swell even more (since the plaster holds back the swelling). More or less the result can be seen 2 weeks after removing the plaster. Well, finally only after 6 months. So please be patient.

Modern plastic surgery in many countries around the world places a clear emphasis on minimally invasive methods of correcting a person’s appearance: minimal labor and time costs, achieving maximum results, reducing possible pain to a minimum.

Rhinoplasty is quite difficult to imagine without the use of local or general anesthesia. It is quite difficult to compare the advantages and disadvantages of local and general anesthesia because these types of pain relief are used in different cases. Local anesthesia is necessary if a minor surgical intervention is planned, short in time, and also if there are certain contraindications to general anesthesia. In any case, the choice of anesthesia will depend on the complexity of rhinoplasty and the individual characteristics and wishes of the patient.

In this video you will see how anesthesia works. The video contains footage of a real operation (open rhinoplasty): Anesthesiologist: Konstantin Nikolaevich Donets, Surgeon: Edgar Kaminsky.

Features of performing rhinoplasty under local anesthesia

Local anesthesia has been widely used in pain management for many years. It can be isolated (i.e., the only one), or act as a part in a combined version. With this type of anesthesia, a small area of the face (the nose and adjacent tissues) is anesthetized, which is achieved due to the fact that the anesthesiologist scalds this area with a solution of a special anesthetic (or a combination of several drugs).

The anesthetic is quickly injected into the tissues, skin and other anatomical structures of the nasal cavity. Injections of anesthetic drugs of this type are very superficial, although in some cases rhinoplasty requires a deeper injection of anesthetic. Taking into account the fact that the drug is administered with long and thin needles, the process of administering the drug itself is completely painless for the patient.

It is immediately worth noting that at the injection site the drug will cause a sensation of tissue growth and an increase in temperature in the nasal cavity, but such feelings will not last long, so by the beginning of the operation they usually subside completely and the person simply ceases to feel half of his face. In some cases, oddly enough, the patient may well retain the ability to some deep sensitivity, so during the operation it will seem to him that something is happening in the nasal cavity, but there is no talk of any pain - he will feel it impossible.

Sometimes, in order to normalize the patient’s psycho-emotional state, reduce his feeling of anxiety before surgery, and also eliminate anxiety, local anesthesia during rhinoplasty is combined with sedation (putting a person into a state of drowsiness).

It is impossible not to note some of the disadvantages of local anesthesia during rhinoplasty:

The patient will see and feel everything the doctors do. This negatively affects his psycho-emotional state;
The quality of rhinoplasty decreases and its duration increases. When a person is conscious, doctors need to systematically monitor his behavior and position. In addition, seeing, for example, blood and sharp instruments, the patient may simply get scared and disrupt the operation;
Local anesthesia for rhinoplasty is not recommended by most foreign and domestic anesthesiologists and plastic surgeons.

At the same time, general anesthesia, despite the fact that it is more preferable when performing nasal surgeries, can cause certain complications after the doctors complete their work.

What drugs are used?

Rhinoplasty under local anesthesia is performed using special anesthetic drugs, which can be divided into two large groups:

Esters (Tetracaine, Novocaine, Dicaine, Chloroprocaine);
Amides (Etidocaine, Ropivacaine, Lidocaine, Bupivacaine, etc.).

Novocaine is usually used to perform infiltration anesthesia according to Vishnevsky. Seriously inferior in effect to modern anesthetic drugs. The same Dicain is approximately 15-20 times stronger than Novocain in terms of its main anesthetic characteristics. Lidocaine is considered a rather toxic drug, but at the same time it is a potent and universal anesthetic, because it can be used for epidural, conduction, infiltration, and terminal anesthesia.

Bupivacaine is the most powerful and long-lasting anesthetic drug. Can be used for various types of local anesthesia for rhinoplasty. The potency of Bupivacaine is slightly inferior to Naropin, but it is also an incredibly strong and powerful anesthetic used in infiltration and epidural anesthesia.

I created this project to tell you in simple language about anesthesia and anesthesia. If you received an answer to your question and the site was useful to you, I will be glad to receive support; it will help further develop the project and compensate for the costs of its maintenance.