Gastroscopy of the stomach. How to do gastroscopy of the stomach

Gastroscopy, also known as FGDS, consists of studying the surface of the mucous membrane of the stomach, duodenum and esophagus using a special flexible gastroscope. This procedure is short, but it is important to carry it out correctly. In particular, when conducting an FGDS, you need to understand how to breathe, how to behave, and also how to prepare for the study.

How the research works

In order not to be nervous and behave correctly during gastroscopy, you need to understand how it is carried out. In general, everything goes like this:

The patient's mouth is irrigated with anesthetic to prevent the gag reflex.
The patient is placed on the left side on the couch. A mouthpiece is inserted into his mouth.
The tip of the device is inserted into the mouthpiece and when the patient takes a deep breath, the tube is pushed into the esophagus.
Next, the device tube moves synchronously with the breathing cycle. The specialist slowly turns and lowers it, trying to study the condition of the organs as much as possible.
The image from the end of the device is transmitted to the monitor, which allows you to record and carefully study the video.
Next, the device, an endoscope, is slowly removed. After this, numbness of the tongue and part of the esophagus continues to be felt. You need to wait 2-3 hours until everything goes away completely. During this time, you should not take any food, and general supervision by specialists is also recommended.

The procedure is quite uncomfortable, but not as unpleasant as many people think.

General preparation for the procedure

Gastroscopy is not a particularly painful, but unpleasant procedure. To endure it with minimal discomfort, you should follow a few simple recommendations.

During the several days preceding FGDS of the stomach, you should adhere to a special diet. From your diet you will need to exclude all those foods that irritate the mucous membrane of the digestive system. These products include marinades, smoked meats and dishes with a high content of spices.
The day before the procedure, the last meal should be no later than 8 pm. The optimal dinner menu is low-fat dishes: vegetables or unsalted or lightly salted porridge with water.
Soon after waking up, it is recommended to drink water or weak tea without sugar - this will help cleanse the walls of the stomach.
It is advisable to refrain from smoking at least a few hours before FGS. The fact is that tobacco smoke irritates the digestive system, as a result of which it begins to more actively secrete mucus, which complicates the examination.
If possible, you should stop taking blood thinning medications (in particular, aspirin) for a few days before gastroscopy, and on the day of the procedure, stop taking any medications. When performing FGS, there is a risk of injury to the gastric mucosa, and therefore bleeding. And the thicker the blood, the faster this internal bleeding will stop.
Overly impressionable people are allowed to take mild sedatives (but it is better to consult a doctor first).

How is breathing performed during the procedure?

In order for FGDS to be as painless as possible, it is necessary to behave correctly and, in particular, to breathe correctly during its implementation. The principle of breathing is somewhat similar to that of yoga. Usually the doctor instructs about proper breathing before the actual procedure, but if you know in advance what the essence is, then you can relax faster and more effectively and worry less about the progress of the procedure.

Here is the basic principle of breathing when the procedure is performed:

You must breathe strictly through your nose. Breathing through your mouth will only interfere with the procedure.
You need to inhale and exhale very slowly, the slower the better.
Swallowing saliva, no matter how much you want to, is prohibited; it must be allowed to flow out.
You need to breathe as evenly as possible. Uneven breathing can not only slow down the procedure, but, in extreme cases, injure internal organs. For exactly the same reason, it is forbidden to move or change the position of your body during the procedure.

It’s better to be mentally prepared for the procedure in advance than to start getting nervous during it and ruin something.

Let's sum it up

There is essentially nothing complicated about conducting FGDS. Preparation for the correct procedure is necessary, but it is quite minimal. During FGDS, it is quite important to know how to breathe correctly, but even if you do not know how, the doctor will instruct you in detail before the procedure. So you shouldn’t be afraid of gastroscopy - even though it causes some discomfort, it’s enough to just figure out how to do it in accordance with all the standards and requirements.

They occupy one of the leading places. In order to diagnose a particular disease, the patient is prescribed a number of procedures, the main one of which will be FGS. Many people know that there is nothing pleasant about it, and besides, some preparation is needed for the results to be reliable.

FGS is not a very pleasant procedure

One of the most reliable studies of the stomach, as mentioned above, is FGS. FGS stands for fibrogastroendoscopy, during which an endoscope, or as it is also called a gastroscope, is inserted into the patient’s stomach, with which you can clearly examine the stomach, its mucous membrane, and also take a biopsy for analysis.

The procedure consists of several stages:

First stage. The doctor administers local anesthesia, which in most cases involves treating the root of the patient’s tongue with lidocaine
Second phase. The patient is placed on his left side
Third stage. After the anesthesia has begun to take effect, which is about 5 or 10 minutes, a plastic ring is inserted into the person’s mouth, which must be clamped with the teeth.
Fourth stage. Then, the doctor will insert the endoscope through this ring. When the endoscope is inserted, the person will be asked to swallow
Fifth stage. After a couple of seconds, the endoscope will be in the stomach, the doctor will pump air into it so that the stomach straightens and begin the examination
Sixth stage. In a few minutes the doctor will take out the endoscope

Typically, gastric FGS is prescribed if:

There is suspicion of inflammation of the upper digestive tract
Peptic ulcer present
There is bleeding
There is a suspicion of a tumor

FGS is a very serious study, for which you need to carefully prepare in order to avoid unpleasant sensations and for the result to be reliable.

Preparation for FGS

A good morale is the key to easy research

Despite the fact that this process is quite unpleasant, if you follow all the recommendations of the doctor who will carry it out, you can avoid bad feelings.

Dinner should be very light, and preferably 4 hours before bedtime
8 hours before the procedure, eating is strictly prohibited, since any meal immediately before FGS can provoke an attack of vomiting, due to which the study will be impossible and will have to be scheduled for another day.
You should not smoke, especially before the procedure, as smoking exacerbates gag reflexes and also provokes the production of gastric mucus, which may cause the examination to take longer.
You cannot take medications, and in particular tablets that must be swallowed.

Before FGS, the following actions are allowed, if this is very necessary:

It is allowed to take medications that do not need to be swallowed. Usually these are tablets for lozenges under the tongue
You can do injections that cannot be done after the procedure
You are allowed to drink sweet, but weak, black tea or plain non-carbonated tea two hours before the procedure.

We should also talk about the evening meal before FGS, that is, dinner. It should be made exclusively from light foods that can be quickly digested in the stomach. It is usually recommended to eat a piece of fish with vegetables, or a piece of boiled chicken breast with a small portion of buckwheat, preferably well boiled.

A couple of days before FGS, you need to avoid spicy foods and also refrain from drinking alcoholic beverages. Products that should not be consumed even 10 or 12 hours before the test include:

Chocolate or chocolate candies
Seeds, both pumpkin and sunflower
Nuts
Fresh vegetables

Of course, if it is a healthy stomach, then all the foods will be digested in eight hours, but since we are talking about patients with digestive problems, they simply may not have time to digest and the study will either be delayed or give an incomplete picture.

The main thing is to follow all the doctors’ advice and not think that they are just saying this. The procedure is not very pleasant, and therefore few people would want to repeat it the next day because of their mistake.

Preparation for FGS on the day of the study

After waking up in the morning, the patient is prohibited from brushing his teeth and smoking, as this can cause the production of mucus in the stomach, which will prolong the pain.

When you go to the hospital, you need to take with you a referral from your attending physician for FGS, a passport and a medical insurance policy (and sometimes an insurance pension certificate), as well as a towel. In order to ensure the most comfortable procedure, it is best to:

Unbutton the top button on your clothing, especially on the neck, if there is one.
Unfasten the belt on trousers or jeans, as there may be a feeling of constriction
Warn the doctor who will perform the procedure about allergic reactions to medications
Relax, although it will be difficult to do this, since few people take FGS calmly
Breathe evenly, deeply and slowly, preferably through your mouth
Try not to swallow, although this will be very difficult
Think about something good. This will help you take your mind off

In some cases, examinations may be performed under general anesthesia. This is done when a person is intolerant to lidocaine or is in such a state that FGS with local anesthesia can cause any problems, in particular, a dangerous increase in blood pressure, a panic attack, etc. Also, in people with a low pain threshold, FGS is indicated only under general anesthesia.

Sometimes fibrogastroendoscopy is prescribed for the afternoon. Here it will be much more difficult to follow the doctor’s recommendations, but it still needs to be done.

It is also necessary not to eat anything for 8 or 10 hours, not to smoke before the procedure, etc. In general, follow all of the above points.

Possible complications after FGS

FGS is an informative method for examining the stomach

Complications after and during the FGS procedure are quite rare. But sometimes they can still happen.

Some of the most common complications that may occur include:

Bleeding that occurs if the endoscope accidentally touches the wall of an organ or damages a vessel
Asphyxia and aspiration pneumonia, which can occur if the correct preparation before FGS was not carried out, that is, the patient ate before the procedure, etc. This problem may occur due to the entry of undigested food into the respiratory tract.
This can be especially true if a biopsy was taken. A biopsy is the removal of samples of stomach tissue.

In order for the FGS to proceed as calmly as possible, you must fully comply with all the recommendations that are given, since the success of the procedure, as well as its speed, completely depends on them. Preparing for the FGS is not that difficult; you need patience and calm. During the FGS itself, doctors will try to help you, as they understand how unpleasant this process can be.

In more detail about this method of examining the stomach as FGS, see the following video:

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How to breathe correctly during gastroscopy? “Professional” clients of the endoscopy room claim that proper breathing not only makes this procedure painless, but also minimizes discomfort. In most clinics, before performing an FGDS (fibrogastroduodenoscopy), they teach you to breathe correctly along with recommendations for preliminary preparation, but you can master the breathing technique yourself.

Before you start learning to breathe, you need to familiarize yourself with what will happen during FGDS:

First, premedication is given. The patient is given a subcutaneous injection of Atropine and irrigation of the oral cavity with an anesthetic drug. The use of medications is necessary to reduce the gag reflex that occurs when a gastroscope is inserted.
Next, the patient loosens the belts and fasteners on the clothes that prevent normal breathing, and lies down on the left side on the couch. And you also need to take off your glasses and remove your dentures from your mouth.
A person lying on his side is inserted into his mouth and asked to clamp it with his teeth. The mouthguard is necessary to prevent reflexive closing of the jaws at the time of insertion of the gastroscope.
A gastroscope is inserted through the hole in the mouth guard, and when it touches the root of the tongue, the endoscopist asks the person to take a deep breath. On inhalation, the tube easily enters the esophagus and the gag reflex does not occur or is minimally expressed.
Next, the doctor asks you to breathe deeply and evenly. In accordance with exhalations and inhalations, the gastroscope moves and rotates to fully examine the condition of the gastric wall. At this moment, the patient is not recommended to think that there is a foreign body inside him, but to concentrate on even, deep breathing. You can look at the screen, which shows the process of passing the probe. In almost all endoscopy rooms, the screen is positioned so that the image is convenient for viewing not only by the doctor, but also by the patient.
A biopsy of individual areas of the mucous membrane is taken, but it is performed under local anesthesia and is not felt by the patient.
After completing the examination, the gastroscopic tube is slowly removed.

The FGS (fibrogastroscopy) procedure can be considered complete, only the effect of the anesthetic will continue for about 2 hours, causing a feeling of numbness in the throat. Until the numbness goes away, you should not drink or eat.

Before undergoing the procedure, the specialist must familiarize the patient in detail with the methods of preparing and performing gastroscopy, as well as with subsequent conditions that may arise in a person.

Preliminary breathing training

According to the descriptions, FGDS does not look very scary, but once in the office among a variety of equipment, many experience fear and forget that they need to breathe correctly.

But proper breathing helps:

facilitate the passage of the gastroscope;

minimize the risk of damage to the esophagus and stomach during the procedure;

relieve pain.

The rules of breathing technique are simple:

breathe only through the nose;

exhalations and inhalations should be as deep as possible;

the stomach should participate in the breathing process (promotes relaxation of the abdominal and diaphragmatic muscles);

do not make swallowing movements (saliva flowing from a half-open mouth will flow freely into the tray provided).

It is recommended to practice at home, preferably with your mouth half open.

To do this you need:

retire to a room;

lie on your left side, place a piece of cloth under your cheek and insert a small hard object between your teeth;

in this position, take a long, slow breath through the nose, while the stomach is slightly retracted;

then the same long exhalation is made through the nose, while the abdominal muscles relax and the tummy sticks out slightly.

At the same time, you can think about something pleasant.

Several such trainings will help you relax during FGDS, and the procedure will take place with minimal discomfort.

Fighting Fears

Some patients learn to breathe at home, but when entering the endoscopy room they experience great fear and begin to breathe rapidly and shallowly. Shallow breathing during FGDS causes spasms and makes it difficult to advance the gastroscope. Often frightened patients experience pain in addition to discomfort. But how to deal with fear?

There is a step-by-step method:

Positive attitude. It is worth carefully familiarizing yourself with all the stages of FGDS and being confident that the procedure is safe and, if you behave correctly, will be painless.

Drop false shame. Many are embarrassed by the saliva flowing from the mouth and make swallowing movements. But during the process of swallowing, not only the respiratory rhythm is disrupted, but the esophagus also narrows, which makes it difficult to advance the gastroscope. You need to be prepared for the fact that the free flow of saliva is necessary for the examination and does not disgust the doctor.

Don't be afraid of a biopsy. Taking a small piece of tissue for histological analysis is necessary, but many people think that after this procedure their stomach will hurt for a long time. But in fact, a tiny piece is taken under local anesthesia, and the collection site is healed very quickly. The person from whom the biopsy was taken does not experience any discomfort and can eat comfortably after the numbness in the throat after anesthesia disappears.

Trust the doctor. An important factor is trust in the doctor and compliance with all requirements. Now FGDS is carried out in all clinics, there is always the opportunity to choose an endoscopist whose work inspires confidence and will allow you to relax.

Taking sedatives. Taking motherwort or valerian will help overcome the fear of examination. Even two hours before the procedure, you can dissolve a sedative tablet.

General anesthesia. For those who cannot cope with fear, diagnostic FGDS can be performed under general anesthesia. But anesthesia always puts an increased load on the liver: it’s worth considering whether you should agree to anesthesia or whether it’s better to calm down and try to breathe correctly.

Learning to breathe correctly during gastroscopy is not difficult. You just need to breathe evenly through your nose and listen to the doctor. If this seems difficult, then you should practice a little at home and have a positive attitude before the examination.

Stomach upset is most often not associated with food poisoning. The causes of discomfort in many cases are exacerbations of various chronic diseases of the gastrointestinal tract. In particular, the stomach, esophagus, pancreas or intestines may be bothersome.

Which doctor should I contact?

To establish the exact cause of the deterioration of the condition, you should visit a specialist - a gastroenterologist. The doctor conducts an examination and prescribes a comprehensive examination. In particular, the specialist recommends doing a gastroscopy of the stomach. This diagnostic method allows you to identify various organ pathologies.

In what cases is a study prescribed?

Gastroscopy of the stomach is recommended for pain in the epigastric region caused by food intake. As a rule, in this case, discomfort appears a few minutes after eating or on an empty stomach. The study is prescribed for frequent vomiting or nausea, belching with a sour taste. It is recommended if there is a constant feeling of fullness or Indications for the procedure include frequent vomiting with blood or food taken the day before, heartburn.

Gastroscopy of the stomach is used in cases of suspected pathology of the organ. Indications in this case include the likelihood of acute or chronic atrophic gastritis (disturbances in the production of gastric juice), peptic ulcer (a condition characterized by the formation of defects in the mucous membrane in the form of an ulcer) or its exacerbation and complications (bleeding, narrowing of the lumen, etc.). The study is prescribed if polyps (growths on the membrane), cancer and other pathologies are suspected. This diagnostic method is recommended for patients who underwent gastroscopy without gastroscopy, but no abnormalities were identified, despite the presence of subjective symptoms. During the procedure, a biopsy may be performed - a suspicious area of tissue is taken for subsequent examination under a microscope. This diagnostic method is considered the most important in identifying if the development of a peptic ulcer is suspected, the specialist takes a scraping from the mucous membrane. The resulting material is further examined using special methods for the presence of the pathogen - Helicobacter pylori.

Pre-diagnosis measures

Preparation for gastroscopy of the stomach includes not only physiological procedures. The psychological mood of the patient is also important. There is an opinion that during or after the procedure, unpleasant sensations arise in the area being examined. In this regard, many patients are afraid of this examination. The gastroenterologist, in turn, must convince the patient that the method is painless. It should be noted that modern equipment makes the procedure quite tolerable. However, despite the use of the most advanced video endoscopes, it is unpleasant for a person to swallow a camera hose. In this regard, experts advise patients to take sedatives to help prevent the gag reflex. Before the procedure, the patient should undergo the necessary tests - which ones will be prescribed by the doctor. For several days before the expected date of the study, it is recommended to follow a special diet. A gastroenterologist will tell you which foods you can and should not eat. Alcohol is prohibited. Twelve hours before the study, you must stop eating.

Immediately before the procedure, if psychological preparation for gastroscopy of the stomach does not give the desired effect, the patient may be asked to conduct an examination in his sleep. In this case, the patient is given a sleeping pill. The effect of the drug lasts approximately an hour. The patient falls asleep, and after waking up he learns about the successful gastroscopy. The medications used in this case are safe, they can be taken even with severe peptic ulcer disease for daily research. Experts note that this method of “unconscious” research has a side effect. After the diagnosis and awakening, the patient remains in a somewhat inhibited state. In this regard, on the day of the study it is not recommended to drive or engage in any other potentially hazardous activities. If you have diabetes or epilepsy, the patient should inform the doctor. You should also inform the specialist about intolerance or hypersensitivity to any medications (especially lidocaine or novocaine) or to certain products.

Alternative method

If the patient still does not agree to undergo the study in the traditional way, gastroscopy of the stomach with a capsule is recommended. In any case, the patient will have to swallow. But the capsule is significantly smaller than the hose - its length is about one and a half centimeters. Inside there is a camera that is designed for continuous operation for seven hours. After the procedure is completed, the capsule leaves the body naturally during bowel movements. When conducting research using this method, no special preparation is required. The patient simply swallows the capsule and washes it down with water.

How is gastroscopy done?

Diagnosis is carried out in a clinic or hospital. The study is carried out in a special FGDS room. When using the traditional method, a specialist performs gastroscopy of the stomach under anesthesia. Local anesthesia acts in the area of the pharyngeal ring. Along with pain relief, medications are injected into the bloodstream to help relax the swallowing muscles. An injection of novocaine or treatment of the throat with a lidocaine spray can be used as an anesthetic. After anesthesia, the patient is asked to clamp a special mouthpiece with his teeth. The endoscope is inserted through this device. In the process, quite intense vomiting may occur. The patient should calm down. It is recommended to breathe deeply and evenly, although the procedure may cause some discomfort. The less resistance the patient provides, the faster the examination will be completed. During the diagnostic process, a specialist examines the inner surface of the stomach. A typical examination without additional manipulations takes about three minutes.

Features of conducting research in a child

Gastroscopy of the stomach can be prescribed not only to adults, but also to children. Due to the fact that the child usually behaves very restlessly, the diagnosis is carried out under general anesthesia. The diameter of the optical tube (endoscope) is selected according to the patient’s age. For children, the size usually does not exceed 6-9 millimeters.

How is diagnostics done using a capsule?

When using an alternative method, the capsule, after penetrating the digestive system, “travels” through it, examining the mucous membrane in detail. During the process, data is recorded on the condition of the walls of the gastrointestinal tract. After viewing the information received from the camera, the doctor uses a special program to establish an accurate diagnosis. It should be said that the disadvantage of this research method is the impossibility of performing a mucosal biopsy.

Gastroscopy of the stomach. Reviews

When diagnosing using the traditional method, many patients experience discomfort and unpleasant sensations when swallowing the tube. As a rule, this occurs due to excessive nervousness and fear of the procedure itself. In a calm state, the process causes minimal inconvenience. Reviews from some patients indicate the presence of unpleasant sensations in the throat for one to two days after the test. In general, the procedure was tolerated satisfactorily. The undoubted advantage of this study is its short duration. Experts note that in some (extremely rare) cases, bleeding may occur after the procedure. This may be due to damage to the wall of the organ being examined. But today doctors use the latest developments in diagnostics. In this regard, any damage to the stomach is practically excluded.

Additional features

Gastroscopy can be used to carry out therapeutic procedures. In particular, during the procedure, the specialist removes polyps - excessive growths that have arisen on the mucous membrane, which in many cases can lead to the development of cancer if not removed. During the examination, it is possible to stop the bleeding by applying medications directly to the site of injury. In the case of additional therapeutic or prophylactic manipulations, the duration of the procedure can be increased to ten to fifteen minutes. It should be noted that the capsule method does not allow for measures other than diagnostic ones.

How much will the research cost?

The cost of the procedure depends on the scope of the study, as well as the method by which gastroscopy of the stomach will be performed. Prices in Moscow, for example, range from one to forty-five thousand rubles. The most expensive is a comprehensive study of the entire digestive tract using the capsule method. A diagnostic rapid test for the presence of Helicobacter pylori is considered the cheapest procedure. In regions the cost may be lower. But it must be said that in large cities the most modern equipment is used and highly qualified specialists work.

Conclusion

Gastroscopy is considered one of the most important procedures included in the complex of diagnostic measures to identify pathologies in the digestive system. Experts recommend being examined regularly. When a gastroenterologist prescribes a procedure, his instructions should not be ignored. It should be noted that in some countries this type of diagnosis is mandatory and is part of a comprehensive examination that is carried out annually. In Japan, for example, people sign up for the procedure at will. According to statistics, in this country only a small percentage of the population suffers from stomach cancer and other pathologies of the gastrointestinal tract. This type of diagnosis is of no small importance when examining children. Gastroscopy allows you to detect diseases at the earliest stages. In addition, when using the traditional research method, it is possible to take biological material for a more detailed study. Thus, the specialist will make an accurate diagnosis and select the optimal treatment for the patient.

Fibrogastroduodenoscopy is a procedure that causes fear in many patients. Fear of pain and discomfort makes you put off visiting a doctor, thereby putting your health at risk. Is it painful to have a gastroscopy? This question interests many. There are several recommendations regarding how to make this procedure easier and how to properly prepare for it.

Gastroscopy – painful or not?

A correctly performed procedure does not cause severe pain. The main thing is trust in the attending physician. An experienced doctor always tries to make everything painless and helps the patient relax. There is no need to be ashamed: increased salivation, belching, and a gag reflex are the norm during FGDS. If necessary, the doctor may prescribe the patient to take certain sedatives before the procedure. This is done in extreme cases, but it does happen.

Correct breathing

“I’m afraid to do a gastroscopy,” doctors hear from their patients every now and then. Is it painful to do FGDS? If you follow the basic recommendations, everything will go as smoothly as possible. To minimize discomfort during endoscopy, do not forget about proper breathing. In modern clinics, each patient undergoes a short instruction, where he is taught how to breathe during gastroscopy.

You need to inhale and exhale only through your nose. Breathing from the throat is painful and can lead to the release of saliva, which enters the respiratory tract and provokes a cough reflex.
You should breathe as smoothly and measuredly as possible. Jerky inhalations and exhalations do not allow the gastroscope to be inserted painlessly and correctly, which can cause a rupture of the esophagus.

Preparation for gastroscopy

Dieting. 2-3 days before the FGDS, you should avoid spicy, fatty and heavy foods. Avoid alcohol completely. Medical staff do not recommend indulgence in chocolate and nuts. These products may linger in a sore stomach, which will interfere with the procedure.

Refusal to eat. Eating should occur no later than 12 hours before the procedure. Before visiting the doctor, you should not eat breakfast or drink large amounts of water. The lighter the dinner, the better. An excellent option is buckwheat or rice porridge with boiled chicken fillet.

Refusal of medications. You do not need to take any medications before the procedure. If the patient does not have the opportunity to stop taking medications, you should consult your doctor on this issue to avoid possible complications.

Normalization of mental state. The overwhelming number of patients are afraid of gastroscopy, what to do in this case? Don't worry and get rid of fear. Negative emotions contribute to tension in the esophageal muscles. This significantly complicates the process of inserting the gastroscope.

There is no ban on smoking before FGDS. But still, an experienced doctor will recommend that his patient give up cigarettes before the planned procedure. This step is explained by the fact that tobacco negatively affects the muscles of the esophagus, causing them to contract involuntarily.

FGDS under anesthesia

In most cases, the procedure is performed under light local anesthetic. The doctor treats the patient’s throat with special anesthetics that block unpleasant sensations. But in some cases it is impossible to do without general anesthesia. It is indicated in cases where it is necessary to carry out therapeutic manipulations associated with pain, namely:

when removing polyps;
with tamponade of damaged vessels;
when removing foreign objects.

Before the upcoming surgical intervention, the patient is given an ECG and blood is drawn. The anesthesiologist talks with the patient, finding out about possible intolerance to certain drugs or components, or about previous infectious diseases. Based on the tests obtained, doctors determine the advisability of using general anesthesia.