From a medical point of view, an induced coma is an unconscious state into which a person is placed for a certain period of time. In this case, there is a deep inhibition of the activity of the subcortex and brain, a complete shutdown of all reflexes.
This measure is justified when doctors see no other way to stop irreversible changes that threaten life. These include compression effects, hemorrhages and bleeding.
If the patient is undergoing major surgery or complex surgery, coma can replace general anesthesia.
How does an induced coma manifest?
If the patient is put into a medically induced coma, the metabolism of brain tissue slows down and the intensity of blood flow decreases. Induction into a coma should be carried out only in intensive care units and intensive care units, under the constant supervision of doctors. Drugs that depress the central system are used - barbiturates and their derivatives. Doses are selected individually and correspond to the stage of surgical anesthesia.
Symptoms of a medically induced coma are as follows:
- immobilization and complete relaxation of muscles;
- unconsciousness, absence of all reflexes;
- body temperature drops;
- blood pressure decreases;
- Heart rate decreases:
- atrioventricular conduction slows down;
- the work of the gastrointestinal tract is blocked.
This condition causes oxygen deficiency, so the patient is immediately connected to a ventilator - a breathing mixture of oxygen and dehumidified air is supplied. Thanks to this, carbon dioxide is released from the lungs, and the blood is saturated with oxygen.
The duration of a medically induced or induced coma may vary. When the patient is in this state, all vital signs are recorded on special equipment. They are constantly monitored by specialists and an anesthesiologist.
Sedation depth
The effect of the drug when administered into a medicated state varies. Sedation is possible at several levels:
- Short . Contact with the environment is maintained, but coordination is impaired, and there is a slight decrease in intellectual abilities.
- Moderate . The reaction to sounds and tactile manipulation remains.
- State of deep sedation . Contact with the world completely disappears. Awakening requires stimulation, which is very painful. There may be difficulties in breathing. Hemodynamics remain stable.
How to diagnose coma?
Today, several methods are used for these purposes. First of all, encephalography is used to monitor the activity of the cerebral cortex. The patient is connected to this device constantly.
Cerebral blood flow is measured using the following methods:
- local laser flowmetry, when a sensor is inserted into the brain tissue;
- radioisotope measurement of blood circulation.
A ventricular catheter is inserted to measure intracranial pressure. It is periodically necessary to take a blood test from the patient's jugular vein to avoid cerebral edema.
The following imaging methods are used for diagnosis:
- computed tomography;
- magnetic resonance imaging:
- positron emission computed tomography.
It is very difficult to say when a coma can be considered hopeless. Experts are still discussing this issue. In many Western countries, it is believed that a patient has no chance of recovery if the vegetative state continues for more than six months. Other factors are also taken into account: clinical assessment of the general condition, causes of the syndrome.
Symptoms of coma
The following symptoms indicate the development of artificial sleep:
- slow breathing;
- lower heart rate;
- muscle relaxation;
- vasoconstriction;
- cessation of digestion;
- decrease in body temperature.
During a coma, intracranial pressure drops and the volume of fluid in the body decreases. Cerebral circulation weakens, consciousness is completely switched off.
The patient becomes vulnerable to any negative factors. Any disturbances in vital functions are fatal.
How to treat?
It is important to understand that an induced coma is not a disease. This is a cycle of targeted actions that ensure that patients are placed in a coma due to medical conditions, such as stroke or pneumonia.
The duration of the coma depends on the nature and severity of the disease. This period can range from several days to several months. Conclusion from this condition can be carried out only after the cause and signs of the disease have been eliminated.
Before this, a comprehensive examination of the patient is required to determine his condition.
When is a medically induced coma necessary?
To understand what an induced coma is, you will need to imagine that the body is falling into deep sleep. In this state, the patient remains alive, but loses the ability to react to the environment, becomes insensitive to touch, pain, and attempts to speak to him.
Doctors induce an induced coma for several purposes:
- for faster recovery after serious illnesses and complex injuries;
- to get rid of pain that cannot be eliminated by other means;
- to restore damaged nerve tissue.
The procedure helps reduce the risk of injury in patients suffering from prolonged seizures. If a patient has cerebral edema, a medically induced coma slows down tissue metabolism, helps narrow intracranial vessels, and normalize blood pressure. After serious surgical interventions, artificial sleep allows you to avoid complications that threaten the patient’s life. If emergency brain surgery is performed, the method can replace general anesthesia.
During a stroke, a comatose state helps restore nerve cells. The procedure improves the functioning of the central nervous system after resuscitation and severe intoxication.
If the patient requires an induced coma, the indications for the procedure may be as follows:
- Brain surgeries.
- Surgical intervention in the heart.
- Asphyxia in newborns.
- Complicated pneumonia.
In case of serious head injuries, the method helps prevent the development of intracranial hemorrhages. In patients who have undergone neurosurgical operations, the procedure helps reduce recovery time. Medication-induced sleep allows you to normalize metabolic processes in the body of infants exposed to oxygen starvation while in the womb. An artificial coma for pneumonia helps to carry out therapeutic manipulations that are important for saving the patient. For complicated pulmonary diseases, the procedure takes a short period of time.
Medically induced coma provides effective treatment for rabies. For patients with this diagnosis, the method helps resist severe brain damage.
Consequences
Neurosurgeons believe that the consequences that may occur after a medically induced coma depend on the reason that became the basis for putting a person into this state. Ventilation has many side effects. Complications may occur in the respiratory system, which will provoke the development of tracheobronchitis, pneumonia, stenosis, and there is also the possibility of the formation of fistulas in the walls of the esophagus.
As a result of a medically induced coma, consequences such as impaired blood flow, pathological changes in the functionality of the gastrointestinal tract, which has not worked for a long time, and renal failure may occur. It is not uncommon for a patient to develop neurological disorders after recovering from this state.
A stroke causes brain damage, and irreversible consequences can occur in a matter of hours. To reduce the risk and remove the blood clot, the person is put into an induced coma.
But this method of treating some diseases is quite dangerous.
Differences from anesthesia
The main difference between drug-induced sleep and anesthesia is that the dose of the drug used for anesthesia is significantly less than during general anesthesia. Due to this, the immersion is less deep. Light sleep ensues and the ability to breathe on your own remains. There is no need to use auxiliary devices. In addition, this procedure is easier to tolerate and the condition returns to normal faster.
Sedation is a widely used manipulation in medicine. It has a number of features and is considered relatively safe. After its implementation, side effects due to the use of modern drugs are extremely rare.
Forecast and prospect
The saddest prognosis may be for subarachnoid hemorrhage. It occurs as a result of a head injury or rupture of an arterial aneurysm during a stroke. The shorter the period of time in a coma, the greater the patient’s chances of recovery.
Of course, this treatment method is risky, but a successful outcome is not uncommon. After such anesthesia, a person faces a long period of rehabilitation. It takes time for all body functions to be restored. Some people are able to return to normal life within a year, others take a little longer. During the rehabilitation period, it is imperative to undergo a comprehensive examination and follow all doctor’s prescriptions.
The most common complications after a coma can be the following:
- brain damage of various types;
- breathing problems;
- pulmonary edema;
- blood pressure surges;
- heart failure.
Such complications can cause first clinical and then biological death. Vomiting is no less dangerous - masses can enter the respiratory tract. Urinary retention can lead to bladder rupture and peritonitis.
Diagnosis during artificial sleep
After the state of artificial sleep has been created, diagnostic measures must be carried out. To monitor the effectiveness of medications used and the body’s vital signs, the following is used:
- an electroencephalograph that monitors the functions of the cerebral cortex in patients with strokes and traumatic brain injuries (the device is constantly connected to the patient);
- computed tomography, which clarifies the state of blood flow, allowing one to predict the further nature of the coma;
- a ventricular catheter that measures the pressure inside the skull, recording the degree of oxygen saturation of the body;
- a radioisotope diagnostic device that monitors blood circulation in the brain.
Constant monitoring of the patient’s condition serves to prevent arrhythmia, possible cardiac arrest, and promotes timely recovery from a coma.
Bedsores can become a dangerous consequence of a long stay in a coma. To avoid their occurrence, the medical staff periodically places the patient’s body in different positions.
Coma recovery
Exit from a medically induced coma is carried out in stages. In the process of removing a person from a comatose state, the ventilator (artificial lung ventilation) is turned off, and substances that support the artificially created state are removed from the body.
After awakening from artificial sleep, organs and systems are always weakened. Normal activity resumes after some time. Recovery takes a particularly long time in patients who have been in a coma for more than one month. In such cases, restoration of the lost ability to self-care and impaired motor activity will be required.
Medical prognosis
After an artificial coma has taken place, the prognosis is not always favorable. The most severe conditions are observed in persons exposed to strokes and severe head injuries. No more than 10% of patients manage to fully recover after drug-induced sleep. About 50% of patients who have been in this condition for several months are unable to lead a full life and die after some time. Up to 30% of patients who survive a coma are completely unable to work and acquire the official status of disabled people.
Despite the potential for an unfavorable outcome and the development of dangerous complications, induced coma is still used in various branches of modern medicine. Medication-assisted sleep is used in critical situations when other methods of saving human life are ineffective.
Share:
How does a person feel while in a coma?
The reactions have already been mentioned earlier; depending on the severity, a person may or may not feel touch. All people who have experienced coma claim that they heard everything that was happening around them, but could not understand whether it was a dream or reality.
Doctors also claim that when relatives often communicate with patients in a coma, they begin to experience active activity in the part of the brain responsible for facial recognition. Also, active impulses appear in the centers responsible for emotions.
Someone claims to have met with deceased relatives; all this happens in patients in a state of sleep, in which, as we know, anything can happen.
Are there coma qualifications?
Coma is conventionally divided into 5 degrees of severity, namely:
- 1st degree - precoma . Those affected by this gradually begin to experience general lethargy, a drop in reaction, a feeling of drowsiness, lack of sleep, and confusion in consciousness
.
It’s rare, but it still happens that everything happens the other way around, in excessive excitement
. Reflexes at this stage are preserved, while the work of all internal organs is already inhibited. Sometimes precoma is called nothing more than a state before a coma, and is not referred to as a coma at all. - 2nd degree - initial level of severity . Reactions to external stimuli begin to slow down. The person still has the ability to swallow liquid food and water, he can move his limbs, but only slightly.
- Grade 3 - moderate level of severity . The patient is already entering a state of deep sleep, contact with him becomes impossible
.
Only sometimes movements of the limbs can be observed, but they are rarely conscious
. The skin already has low sensitivity, a person walks under himself. - Grade 4 - high level of severity . There is a lack of feeling of pain, consciousness, tendon reflexes, and no reaction to light
. Not only body temperature is reduced, but also breathing pressure. - 5th degree - severe coma . The disturbance of consciousness becomes profound, reflexes are absent
. Breathing stops and the patient is transferred to an artificial respiration apparatus.
