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TED-Ed: Lessons Worth Sharing, How does anesthesia work? - Steven Zheng

How does anesthesia work? - Steven Zheng

If you've had surgery, you might remember starting to count backwards from ten, nine, eight, and then waking up with the surgery already over before you even got to five.

And it might seem like you were asleep, but you weren't. You were under anesthesia, which is much more complicated. You were unconscious, but you also couldn't move, form memories, or, hopefully, feel pain. Without being able to block all those processes at once, many surgeries would be way too traumatic to perform. Ancient medical texts from Egypt, Asia and the Middle East all describe early anesthetics containing things like opium poppy, mandrake fruit, and alcohol. Today, anesthesiologists often combine regional, inhalational and intravenous agents to get the right balance for a surgery. Regional anesthesia blocks pain signals from a specific part of the body from getting to the brain. Pain and other messages travel through the nervous system as electrical impulses. Regional anesthetics work by setting up and electrical baracade. They bind to the proteins in neurons' cell membranes that let charged particles in and out, and lock out positively charged particles. One compound that does this is cocaine, whose painkilling effects were discovered by accident when an ophthalmology intern got some on his tongue. It's still occasionally used as an anesthetic, but many of the more common regional anesthetics have a similar chemical structure and work the same way. But for major surgeries where you need to be unconscious, you'll want something that acts on the entire nervous system, including the brain. That's what inhalational anesthetics do. In Western medicine, diethyl ether was the first common one. It was best known as a recreational drug until doctors started to realize that people sometimes didn't notice injuries they received under the influence. In the 1840s, they started sedating patients with ether during dental extractions and surgeries. Nitrous oxide became popular in the decades that followed and is still used today. although ether derivatives, like sevoflurane, are more common. Inhalational anesthesia is usually supplemented with intravenous anesthesia, which was developed in the 1870s. Common intravenous agents include sedatives, like propofol, which induce unconsciousness, and opioids, like fentanyl, which reduce pain. These general anesthetics also seem to work by affecting electrical signals in the nervous system. Normally, the brain's electrical signals are a chaotic chorus as different parts of the brain communicate with each other. That connectivity keeps you awake and aware. But as someone becomes anesthetized, those signals become calmer and more organized, suggesting that different parts of the brain aren't talking to each other anymore. There's a lot we still don't know about exactly how this happens. Several common anesthetics bind to the GABA-A receptor in the brain's neurons. They hold the gateway open, letting negatively charged particles flow into the cell. Negative charge builds up and acts like a log jam, keeping the neuron from transmitting electrical signals. The nervous system has lots of these gated channels, controlling pathways for movement, memory, and consciousness. Most anesthetics probably act on more than one, and they don't act on just the nervous system. Many anesthetics also affect the heart, lungs, and other vital organs. Just like early anesthetics, which included familiar poisons like hemlock and aconite, modern drugs can have serious side effects. So an anesthesiologist has to mix just the right balance of drugs to create all the features of anesthesia, while carefully monitoring the patient's vital signs, and adjusting the drug mixture as needed. Anesthesia is complicated, but figuring out how to use it allowed for the development of new and better surgical techniques. Surgeons could learn how to routinely and safely perform C-sections, reopen blocked arteries, replace damaged livers and kidneys, and many other life-saving operations. And each year, new anesthesia techniques are developed that will ensure more and more patients survive the trauma of surgery.


How does anesthesia work? - Steven Zheng Comment fonctionne l'anesthésie ? - Steven Zheng 麻酔はどのように効くのか?- スティーブン・鄭 Como é que a anestesia funciona? - Steven Zheng Как работает анестезия? - Стивен Чжэн

If you’ve had surgery, you might remember starting to count backwards from ten, nine, eight, and then waking up with the surgery already over before you even got to five. Se você fez uma cirurgia, você pode se lembrar de começar a contar de dez, nove, oito e depois acordar com a cirurgia já terminada antes mesmo de chegar a cinco. Ameliyat geçirdiyseniz, on, dokuz, sekizden geriye doğru saymaya başladığınızı ve daha sonra beşe bile başlamadan önce ameliyatla uyandığınızı hatırlayabilirsiniz.

And it might seem like you were asleep, but you weren’t. E pode parecer que você estava dormindo, mas não estava. Ve uyuyor gibisin, ama değildin. You were under anesthesia, which is much more complicated. Você estava sob anestesia, o que é muito mais complicado. You were unconscious, but you also couldn’t move, form memories, or, hopefully, feel pain. Bilinçsizdiniz ama aynı zamanda hareket edemez, anılar oluşturamaz ya da umarım acı hissedemezsiniz. Without being able to block all those processes at once, many surgeries would be way too traumatic to perform. Sem poder bloquear todos esses processos de uma só vez, muitas cirurgias seriam traumáticas demais para serem realizadas. Без возможности заблокировать все эти процессы одновременно многие операции были бы слишком травматичными для выполнения. Tüm bu işlemleri bir seferde engelleyememekle birlikte, birçok ameliyat gerçekleştirmek için fazla travmatik olur. Ancient medical texts from Egypt, Asia and the Middle East all describe early anesthetics containing things like opium poppy, mandrake fruit, and alcohol. Les anciens textes médicaux d'Égypte, d'Asie et du Moyen-Orient décrivent tous les premiers anesthésiques contenant des choses comme le pavot à opium, le fruit de la mandragore et l'alcool. Textos médicos antigos do Egito, Ásia e Oriente Médio descrevem os primeiros anestésicos contendo coisas como papoula do ópio, mandrágora e álcool. Mısır, Asya ve Orta Doğu'dan gelen eski tıbbi metinlerin hepsi afyonlu haşhaş, mandrake meyvesi ve alkol gibi şeyleri içeren erken anestezikleri tanımlar. Today, anesthesiologists often combine regional, inhalational and intravenous agents to get the right balance for a surgery. Hoje, os anestesiologistas geralmente combinam agentes regionais, inalatórios e intravenosos para obter o equilíbrio certo para uma cirurgia. Regional anesthesia blocks pain signals from a specific part of the body from getting to the brain. A anestesia regional bloqueia os sinais de dor de uma parte específica do corpo de chegar ao cérebro. Bölgesel anestezi, vücudun belirli bir bölümünden gelen ağrı sinyallerini beyine ulaşmasını engeller. Pain and other messages travel through the nervous system as electrical impulses. Ağrı ve diğer mesajlar sinir sistemi boyunca elektriksel darbeler olarak geçer. Regional anesthetics work by setting up and electrical baracade. Les anesthésiques locorégionaux fonctionnent par mise en place et baracade électrique. Os anestésicos regionais funcionam através da instalação e barcade elétrico. Bölgesel anestezikler kurarak ve elektrikle boğarak çalışır They bind to the proteins in neurons' cell membranes that let charged particles in and out, and lock out positively charged particles. Ils se lient aux protéines des membranes cellulaires des neurones qui laissent entrer et sortir les particules chargées et bloquent les particules chargées positivement. Eles se ligam às proteínas nas membranas celulares dos neurônios que permitem a entrada e saída de partículas carregadas e bloqueiam partículas carregadas positivamente. Они связываются с белками в клеточных мембранах нейронов, которые пропускают заряженные частицы внутрь и наружу, и блокируют положительно заряженные частицы. Nöronların hücre zarlarındaki proteinlere bağlanır ve yüklü parçacıkları içeri ve dışarı yerleştirir ve pozitif yüklü parçacıkları kilitler. One compound that does this is cocaine, whose painkilling effects were discovered by accident when an ophthalmology intern got some on his tongue. Un composé qui fait cela est la cocaïne, dont les effets analgésiques ont été découverts par accident lorsqu'un interne en ophtalmologie s'en est mis sur la langue. Um composto que faz isso é a cocaína, cujos efeitos analgésicos foram descobertos por acidente quando um estagiário de oftalmologia colocou um pouco na língua. Одним из соединений, которые делают это, является кокаин, чей обезболивающий эффект был обнаружен случайно, когда стажер-офтальмолог получил его на язык. Bunu yapan bir bileşik, bir oftalmoloji stajyerinin dilini biraz aldığında ağrı kesici etkileri tesadüfen keşfedilen kokaindir. It’s still occasionally used as an anesthetic, but many of the more common regional anesthetics have a similar chemical structure and work the same way. Il est encore parfois utilisé comme anesthésique, mais bon nombre des anesthésiques régionaux les plus courants ont une structure chimique similaire et fonctionnent de la même manière. Ainda é usado ocasionalmente como anestésico, mas muitos dos anestésicos regionais mais comuns têm uma estrutura química semelhante e funcionam da mesma maneira. Он до сих пор иногда используется в качестве анестетика, но многие из наиболее распространенных регионарных анестетиков имеют схожую химическую структуру и действуют одинаково. But for major surgeries where you need to be unconscious, you’ll want something that acts on the entire nervous system, including the brain. Mas para grandes cirurgias onde você precisa estar inconsciente, você vai querer algo que atue em todo o sistema nervoso, incluindo o cérebro. Но для серьезных операций, когда вам нужно быть без сознания, вам понадобится что-то, что воздействует на всю нервную систему, включая мозг. Fakat bilinçsiz olmanız gereken büyük ameliyatlar için, beyin de dahil olmak üzere tüm sinir sistemine etki eden bir şey isteyeceksiniz. That’s what inhalational anesthetics do. É isso que os anestésicos inalatórios fazem. Inhalasyonal anesteziklerin yaptığı budur. In Western medicine, diethyl ether was the first common one. Na medicina ocidental, o éter dietílico foi o primeiro comum. В западной медицине первым распространенным веществом был диэтиловый эфир. It was best known as a recreational drug until doctors started to realize that people sometimes didn’t notice injuries they received under the influence. Era mais conhecido como uma droga recreativa até que os médicos começaram a perceber que as pessoas às vezes não notavam os ferimentos que recebiam sob a influência. Он был наиболее известен как рекреационный наркотик, пока врачи не начали понимать, что люди иногда не замечают травм, полученных под воздействием. Doktorlar, insanların etkisi altında aldıkları yaralanmaları farketmediklerini farketmeye başlayana kadar en iyi eğlence uyuşturucu olarak biliniyordu. In the 1840s, they started sedating patients with ether during dental extractions and surgeries. В 1840-х годах они начали успокаивать пациентов эфиром во время удаления зубов и операций. Nitrous oxide became popular in the decades that followed and is still used today. O óxido nitroso tornou-se popular nas décadas que se seguiram e ainda é usado hoje. Закись азота стала популярной в последующие десятилетия и используется до сих пор. although ether derivatives, like sevoflurane, are more common. embora os derivados de éter, como o sevoflurano, sejam mais comuns. хотя эфирные производные, такие как севофлуран, более распространены. Inhalational anesthesia is usually supplemented with intravenous anesthesia, which was developed in the 1870s. A anestesia inalatória é geralmente complementada com anestesia intravenosa, que foi desenvolvida na década de 1870. Ингаляционная анестезия обычно дополняется внутривенной анестезией, разработанной в 1870-х гг. Common intravenous agents include sedatives, like propofol, which induce unconsciousness, and opioids, like fentanyl, which reduce pain. Os agentes intravenosos comuns incluem sedativos, como propofol, que induzem à inconsciência, e opióides, como fentanil, que reduzem a dor. Обычные внутривенные агенты включают седативные средства, такие как пропофол, которые вызывают потерю сознания, и опиоиды, такие как фентанил, которые уменьшают боль. These general anesthetics also seem to work by affecting electrical signals in the nervous system. Esses anestésicos gerais também parecem funcionar afetando os sinais elétricos no sistema nervoso. Эти общие анестетики, по-видимому, также воздействуют на электрические сигналы в нервной системе. Bu genel anestezikler, sinir sistemindeki elektrik sinyallerini etkileyerek de işe yarıyor. Normally, the brain’s electrical signals are a chaotic chorus as different parts of the brain communicate with each other. Normalmente, os sinais elétricos do cérebro são um coro caótico, pois diferentes partes do cérebro se comunicam. Обычно электрические сигналы мозга представляют собой хаотический хор, когда разные части мозга взаимодействуют друг с другом. Normalde, beynin elektriksel sinyalleri beynin farklı kısımlarının birbiriyle iletişim kurmasından dolayı kaotik bir korodur. That connectivity keeps you awake and aware. Essa conectividade mantém você acordado e consciente. Эта связь держит вас бодрствующим и осознанным. Bu bağlantı sizi uyanık ve farkında tutar. But as someone becomes anesthetized, those signals become calmer and more organized, suggesting that different parts of the brain aren’t talking to each other anymore. Mas à medida que alguém fica anestesiado, esses sinais ficam mais calmos e organizados, sugerindo que diferentes partes do cérebro não estão mais conversando entre si. There’s a lot we still don’t know about exactly how this happens. Bunun nasıl olduğunu tam olarak bilmediğimiz bir sürü şey var. Several common anesthetics bind to the GABA-A receptor in the brain’s neurons. Vários anestésicos comuns se ligam ao receptor GABA-A nos neurônios do cérebro. Несколько распространенных анестетиков связываются с рецептором ГАМК-А в нейронах головного мозга. Bazı yaygın anestezikler, beynin nöronlarındaki GABA-A reseptörüne bağlanır. They hold the gateway open, letting negatively charged particles flow into the cell. Ils maintiennent la passerelle ouverte, laissant les particules chargées négativement s'écouler dans la cellule. Eles mantêm a porta aberta, permitindo que partículas carregadas negativamente fluam para dentro da célula. Они держат ворота открытыми, позволяя отрицательно заряженным частицам проникать в клетку. Negatif yüklü parçacıkların hücreye akmasına izin vererek geçidi açık tutar. Negative charge builds up and acts like a log jam, keeping the neuron from transmitting electrical signals. La charge négative s'accumule et agit comme un embouteillage, empêchant le neurone de transmettre des signaux électriques. A carga negativa se acumula e age como um congestionamento, impedindo o neurônio de transmitir sinais elétricos. Отрицательный заряд накапливается и действует как бревна, не позволяя нейрону передавать электрические сигналы. Negatif yük oluşur ve nöronun elektrik sinyallerini iletmesini önleyerek günlük sıkışması gibi davranır. The nervous system has lots of these gated channels, controlling pathways for movement, memory, and consciousness. O sistema nervoso tem muitos desses canais fechados, controlando as vias de movimento, memória e consciência. Нервная система имеет множество таких закрытых каналов, контролирующих пути движения, памяти и сознания. Most anesthetics probably act on more than one, and they don’t act on just the nervous system. A maioria dos anestésicos provavelmente atua em mais de um, e não apenas no sistema nervoso. Anesteziklerin çoğu muhtemelen birden fazla üzerinde etki eder ve sadece sinir sistemi üzerinde etki etmezler. Many anesthetics also affect the heart, lungs, and other vital organs. Just like early anesthetics, which included familiar poisons like hemlock and aconite, modern drugs can have serious side effects. Assim como os primeiros anestésicos, que incluíam venenos familiares como cicuta e acônito, as drogas modernas podem ter sérios efeitos colaterais. Hemlock ve aconite gibi bilinen zehirleri içeren erken anestezikler gibi, modern ilaçlar da ciddi yan etkilere neden olabilir. So an anesthesiologist has to mix just the right balance of drugs to create all the features of anesthesia, while carefully monitoring the patient’s vital signs, and adjusting the drug mixture as needed. Assim, um anestesiologista precisa misturar o equilíbrio certo de drogas para criar todas as características da anestesia, enquanto monitora cuidadosamente os sinais vitais do paciente e ajusta a mistura de drogas conforme necessário. Anesthesia is complicated, but figuring out how to use it allowed for the development of new and better surgical techniques. L'anesthésie est compliquée, mais comprendre comment l'utiliser a permis le développement de nouvelles et meilleures techniques chirurgicales. A anestesia é complicada, mas descobrir como usá-la permitiu o desenvolvimento de novas e melhores técnicas cirúrgicas. Anestezi karmaşıktır, ancak nasıl kullanılacağını bulmak yeni ve daha iyi cerrahi tekniklerin geliştirilmesine olanak sağlamıştır. Surgeons could learn how to routinely and safely perform C-sections, reopen blocked arteries, replace damaged livers and kidneys, and many other life-saving operations. Les chirurgiens pourraient apprendre à effectuer régulièrement et en toute sécurité des césariennes, à rouvrir les artères bloquées, à remplacer les foies et les reins endommagés et à effectuer de nombreuses autres opérations vitales. Os cirurgiões poderiam aprender a realizar cesarianas de forma rotineira e segura, reabrir artérias bloqueadas, substituir fígados e rins danificados e muitas outras operações que salvam vidas. And each year, new anesthesia techniques are developed that will ensure more and more patients survive the trauma of surgery. E a cada ano, novas técnicas de anestesia são desenvolvidas para garantir que mais e mais pacientes sobrevivam ao trauma da cirurgia.