How does anesthesia work? - Steven Zheng

Prevodilac: Ivana Korom Lektor: Mile Živković

If you've had surgery,

Ako ste imali neku operaciju,

you might remember starting to count backwards from ten,

možda se sećate da ste odbrojavali unazad od 10,

nine,

devet,

eight,

osam,

and then waking up with the surgery already over before you even got to five.

i probudili se, operacija je završena, a niste izbrojali ni do pet.

And it might seem like you were asleep, but you weren't.

I možda vam izgleda kao da ste spavali, ali niste.

You were under anesthesia,

Bili ste pod anestezijom,

which is much more complicated.

što je mnogo komplikovanije.

You were unconscious,

Bili ste nesvesni,

but you also couldn't move,

ali niste mogli ni da se pomerate,

form memories,

da formirate sećanja,

or, hopefully, feel pain.

ili, nadamo se, da osećate bol.

Without being able to block all those processes at once,

Bez mogućnosti da se svi ti procesi blokiraju odjednom,

many surgeries would be way too traumatic to perform.

mnoge operacije bi bile isuviše traumatične.

Ancient medical texts from Egypt, Asia and the Middle East

Stari medicinski tekstovi iz Egipta, Azije i Srednjeg istoka

all describe early anesthetics

opisuju rane anestetike

containing things like opium poppy,

koji sadrže stvari kao što su opijum iz maka,

mandrake fruit,

mandragora

and alcohol.

i alkohol.

Today, anesthesiologists often combine

Danas, anesteziolozi često kombinuju

regional, inhalational and intravenous agents

lokalne, inhalacione i intravenozne agense

to get the right balance for a surgery.

kako bi dobili odgovarajuću ravnotežu za neku operaciju.

Regional anesthesia blocks pain signals from a specific part of the body

Lokalna anestezija sprečava signale bola iz određenog dela tela

from getting to the brain.

da dođu do mozga.

Pain and other messages travel through the nervous system as electrical impulses.

Bol i ostale poruke putuju kroz nervni sistem kao električni impulsi.

Regional anesthetics work by setting up an electrical barricade.

Lokalni anestetici grade električnu barikadu.

They bind to the proteins in neurons' cell membranes

Oni se vezuju za proteine u ćelijskim membranama neurona,

that let charged particles in and out,

koje propuštaju naelektrisane čestice,

and lock out positively charged particles.

i sprečavaju pozitivno naelektrisane čestice da uđu.

One compound that does this is cocaine,

Jedna supstanca koja ovo radi je kokain,

whose painkilling effects were discovered by accident

čiji efekti umanjivanja bola su slučajno otkriveni

when an ophthalmology intern got some on his tongue.

kada je jedan stažista oftalmologije slučajno polizao malo.

It's still occasionally used as an anesthetic,

I dalje se ponekad koristi kao anestetik,

but many of the more common regional anesthetics

ali mnogi uobičajeniji lokalni anestetici

have a similar chemical structure and work the same way.

imaju sličnu hemijsku strukturu i rade na isti način.

But for major surgeries where you need to be unconscious,

Ali za velike operacije gde je potrebno da budete bez svesti,

you'll want something that acts on the entire nervous system,

želećete nešto što deluje na ceo nervni sistem,

including the brain.

uključujući mozak.

That's what inhalational anesthetics do.

To omogućavaju inhalatorni anestetici.

In Western medicine, diethyl ether was the first common one.

U zapadnoj medicini, dietil etar je prvi najčešći.

It was best known as a recreational drug

Bio je najpoznatiji kao rekreativna droga

until doctors started to realize that people sometimes didn't notice

dok lekari nisu shvatili da ljudi nekad nisu primećivali

injuries they received under the influence.

povrede koje su zadobijali dok su bili pod njenim uticajem.

In the 1840s, they started sedating patients with ether

1840-ih su počeli da uspavljuju pacijente etrom,

during dental extractions and surgeries.

tokom vađenja i operacija zuba.

Nitrous oxide became popular in the decades that followed

Azot suboksid je u narednim decenijama postao popularan,

and is still used today.

a i danas se koristi,

although ether derivatives, like sevoflurane, are more common.

iako su uobičajeniji derivati etera, kao što je sevofluran.

Inhalational anesthesia is usually supplemented with intravenous anesthesia,

Inhalaciona anestezija se obično dopunjava intravenoznom anestezijom,

which was developed in the 1870s.

koja je razvijena 1870-ih.

Common intravenous agents include sedatives, like propofol,

Uobičajeni intravenozni agensi uključuju sedative, kao što je propofol,

which induce unconsciousness,

koji izaziva nesvesno stanje,

and opioids, like fentanyl, which reduce pain.

i opioide, kao što je fentanil, koji smanjuju bol.

These general anesthetics also seem to work

Ove opšte anestezije takođe funkcionišu

by affecting electrical signals in the nervous system.

tako što utiču na električne signale u nervnom sistemu.

Normally, the brain's electrical signals are a chaotic chorus

Obično su električni signali mozga haotični hor,

as different parts of the brain communicate with each other.

jer različiti delovi mozga međusobno komuniciraju.

That connectivity keeps you awake and aware.

Ta povezanost vas održava budnim i svesnim.

But as someone becomes anesthetized,

Ali kad je neko pod anestezijom,

those signals become calmer and more organized,

ti signali su mirniji i organizovaniji,

suggesting that different parts of the brain

što znači da različiti delovi mozga

aren't talking to each other anymore.

više ne komuniciraju jedni s drugima.

There's a lot we still don't know about exactly how this happens.

Mnogo toga još uvek ne znamo o tome kako se tačno ovo dešava.

Several common anesthetics bind to the GABA-A receptor in the brain's neurons.

Nekoliko uobičajenih anestetika se vezuje za GABA-A receptore u neuronima mozga.

They hold the gateway open,

Oni put drže otvorenim,

letting negatively charged particles flow into the cell.

puštajući negativno naelektrisane čestice da uđu u ćeliju.

Negative charge builds up and acts like a log jam,

Negativni napon raste i ponaša se kao brana

keeping the neuron from transmitting electrical signals.

onemogućavajući neurone da prenose električne signale.

The nervous system has lots of these gated channels,

Nervni sistem ima mnogo ovih kanala sa kapijama,

controlling pathways for movement,

koji kontrolišu putanje za pokret,

memory,

sećanja

and consciousness.

i svest.

Most anesthetics probably act on more than one,

Većina anestetika verovatno deluje na više od jednog,

and they don't act on just the nervous system.

i ne deluju samo na nervni sistem.

Many anesthetics also affect the heart,

Mnogi anestetici takođe utiču i na srce,

lungs,

pluća,

and other vital organs.

i druge vitalne organe.

Just like early anesthetics,

Baš kao i rani anestetici,

which included familiar poisons like hemlock and aconite,

među kojima su bili i poznati otrovi kao što su otrovna kukuta i jedić,

modern drugs can have serious side effects.

moderni lekovi mogu imati ozbiljne nuspojave.

So an anesthesiologist has to mix just the right balance of drugs

Zato anesteziolog mora da pomeša odgovarajući odnos biljaka

to create all the features of anesthesia,

da bi dobio sve osobine anestezije,

while carefully monitoring the patient's vital signs,

dok pažljivo prati vitalne znake pacijenta

and adjusting the drug mixture as needed.

i podešava mešavinu po potrebi.

Anesthesia is complicated,

Anestezija je složena,

but figuring out how to use it

ali nalaženje načina za njeno korišćenje

allowed for the development of new and better surgical techniques.

dozvolilo je razvoj novih i boljih hirurških tehnika.

Surgeons could learn how to routinely and safely perform C-sections,

Hirurzi su mogli da nauče kako da rutinski i bezbedno urade carski rez,

reopen blocked arteries,

otvore blokirane arterije,

replace damaged livers and kidneys,

zamene oštećene jetre i bubrege

and many other life-saving operations.

i mnoge druge operacije koje spašavaju život.

And each year, new anesthesia techniques are developed

I svake godine se razvijaju nove tehnike anestezije

that will ensure more and more patients survive the trauma of surgery.

koje će omogućiti da sve više pecijenata preživi traumu operacije.