Anesthetics used in our offices
For a local anesthesia the operative area is injected with a solution containing an anesthetic (e.g. xylocaine) and is thus made insensitive. This solution has an added vaso-constrictive agent (adrenaline) which leads to less bleeding and an increased duration of the insensitivity. With anesthetics in the fingers, toes, ears, or nose the circulation is not affected, so vaso-constrictive agents are not used in these places.
For hand surgeries we often use regional anesthetic methods: the upper part of the affected arm is covered with a double cuff, much like a blood pressure cuff. A fine cannula (Venflon) is inserted into the arm vein. The extremity in question is then raised and then “wrapped” from front to back with a bandage thus achieving a state of bloodlessness that simplifies the operation. Finally the cuff that is closer to the body is put under pressure. Now the anesthetic agent (Ivracaine 0.5%) is injected into the previously inserted plastic cannula, which distributes over the entire arm up to the cuff. After about 10 minutes, the pressure between the two cuffs is retroverted. Here the tissue has in the meantime become insensitive as a result of the anesthetic, and thus the cuff pressure can be maintained without a problem for up to around an hour. After releasing the cuff pressure, full sensitivity returns after about 10 minutes. During regional anesthesia, blood pressure, pulse, oxygen saturation of the blood and the heart rate are continuously monitored, and for larger procedures and with older patients, an infusion is used.