One What are the types of pain relief?
Analgesia refers to the treatment of acute and chronic pain to reduce pain. Pain can be divided into: acute pain: pain from acute soft tissue and joint injuries, postoperative pain, obstetric pain, acute herpes zoster pain, gout; Chronic pain: Soft tissue and joint strain or degenerative pain, discogenic pain, neurogenic pain; Stubborn pain: trigeminal neuralgia, postherpetic neuralgia, intervertebral disc herniation; Cancer pain: late stage tumor pain, tumor metastasis pain; Special pain types: thromboangiitis, refractory angina, idiopathic chest and abdominal pain; Related disciplinary diseases: early retinal vascular embolism, sudden deafness, vasospastic diseases, etc.
The most common ibuprofen in pharmacies is an effective nonsteroidal anti-inflammatory drug with antipyretic, analgesic, and anti-inflammatory effects. Endogenous opioid peptide drugs can stimulate opioid receptors on the presynaptic and postsynaptic membranes of sensory nerves after being released by specific neurons, reducing the release of presynaptic membrane neurotransmitters and causing postsynaptic membrane hyperpolarization, ultimately weakening or blocking the transmission of pain signals and producing analgesic effects. Coffee drugs exert analgesic effects by stimulating μ receptors in the spinal glial zone, thalamus, ventricles, and periaqueductal gray matter, mimicking endogenous opioid peptides. When acting on opioid receptors in the limbic system and locus coeruleus, they can alleviate unpleasant, anxious, and pleasurable emotions caused by pain.
II What are the types of sedation?
Sedation is not anesthesia, it is intermediate between sleep and anesthesia. It only uses drugs to promote sleep and increase sleep depth. Once stimulated by external factors, it can wake up. The degree of sedation is divided into mild, moderate, and severe. Mild sedation is an anti anxiety measure; Moderate sedation is to keep the patient awake, respond to verbal commands, and not affect the patient's breathing and circulation; Patients with 'severe sedation' may respond to painful stimuli, but they are not easily awakened and may affect breathing.
III The main difference between sedatives and anesthetics
Sedatives: their pharmacological mechanisms mainly include sedation, hypnosis, and anti anxiety, without anesthetic effects. Representative drugs include barbiturates, which are mainly used in clinical practice to treat anxiety disorders, improve sleep and emotional disorders; It is mainly used for preparation before anesthesia surgery, and can also be used for stubborn epilepsy patients and advanced cancer patients who require strong analgesia.
Anesthetic and sedative drugs: for psychiatric prescriptions, using white prescriptions, they are strictly regulated drugs by the country, prone to addiction, and require special qualification review;
Anesthetic and analgesic drugs: The use of red prescriptions, known as anesthesia prescriptions, is more strictly controlled, easily addictive, and has greater harm and danger, requiring strict management.
General anesthesia refers to the temporary suppression of the central nervous system caused by anesthetics, clinically manifested as loss of consciousness, loss of systemic pain sensation, forgetfulness, reflex inhibition, and skeletal muscle relaxation. General anesthesia includes sedation (loss of consciousness), analgesia (inhibition and reduction of pain response), and immobilization (muscle relaxation), so the depth of anesthesia reflects the comprehensive state of sedation, analgesia, and immobilization.
Clinically, the depth of anesthesia is often determined by monitoring the patient's basic vital signs (heart rate, blood pressure, etc.). At present, the bispectral index (BIS) and four burst stimuli (TOF) can be used to monitor the depth of sedation and muscle relaxation, but there is no objective specific indicator for monitoring the degree of analgesia. During general anesthesia, the patient's consciousness disappears and they are unable to subjectively express the analgesic effect, but the pain response caused by nociceptive stimuli persists. Therefore, the analgesic effect can be evaluated by monitoring the pathophysiological changes caused by pain response.
The International Association for the Study of Pain defines pain as an unpleasant sensation and emotional experience that accompanies actual or potential tissue damage to the body, often used to refer to these injuries. As can be seen from the definition, pain is a nociceptive sensation that includes an individual's subjective experience. Pain is a whole composed of pain sensation and pain response, which are closely connected.
Pain sensation is based on the existence of consciousness and is influenced by factors such as sensation, level of focus, emotions, state of consciousness, and experience. Therefore, it is difficult to objectively measure pain under anesthesia. When nociceptive stimuli are applied to the body, in addition to the subjective sensation of pain, they also manifest as changes in pain responses to different pathological and physiological activities, such as changes in autonomic nervous system function affecting heart rate regulation, increased peripheral vascular tension causing a decrease in peripheral perfusion, nerve impulses inducing changes in EEG in the cerebral cortex, and sympathetic nervous system excitation causing an increase in pupil diameter. By analyzing changes in pain response to determine the depth of analgesia, multiple monitoring indicators have been derived.
Monitoring pain response in patients undergoing general anesthesia surgery is a relatively new research field. With the advancement of medical technology, some monitoring of pain response during general anesthesia surgery can be achieved under certain conditions, but ideal pain response monitoring indicators still need further exploration.