C-section. Indications and contraindications for elective and emergency surgery. Contraindications for surgery Absolute contraindications for surgery

Contraindications for surgical treatment.

According to vital and absolute indications, operations should be performed in all cases, with the exception of the preagonal and agonal state of the patient, who is in the terminal stage of a long-term current disease, leading inevitably to death (for example, oncopathology, liver cirrhosis, etc.). Such patients, according to the decision of the council, undergo conservative syndromic therapy.

With relative indications, the risk of surgery and the planned effect of it should be individually weighed against the background of concomitant pathology and the age of the patient. If the risk of surgery exceeds the desired result, it is necessary to refrain from surgery (for example, removal of a benign formation that does not compress vital organs in a patient with severe allergy.

126. Preparation of organs and systems of patients at the stage of preoperative preparation.

There are two types of preoperative preparation: general somatic skye and special .

General somatic training is carried out for patients with common surgical diseases that have little effect on the state of the body.

Skin should be examined in every patient. Rash, purulent-inflammatory rash exclude the possibility of performing a planned operation. Plays an important role sanitation of the oral cavity . Carious teeth can cause diseases that are severely reflected in the postoperative patient. Sanitation of the oral cavity, regular brushing of teeth are very useful for preventing postoperative parotitis, gingivitis, glossitis.

Body temperature before a planned operation should be normal. Its increase finds its explanation in the very nature of the disease (purulent disease, cancer in the stage of decay, etc.). In all patients hospitalized in a planned manner, the cause of the temperature increase should be found. Until it is detected and measures are taken to normalize it, the planned operation should be postponed.

The cardiovascular system should be studied especially carefully. If blood circulation is compensated, then there is no need to improve it. The average level of arterial pressure is 120/80 mm. rt. Art., may vary between 130-140 / 90-100 mm. rt. Art., which does not necessitate special treatment. Hypotension, if it represents the norm for this subject, also does not require treatment. If there is a suspicion of an organic disease (arterial hypertension, circulatory failure and cardiac arrhythmias and conduction disturbances), the patient should be consulted with a cardiologist and the issue of surgery is decided after special studies.

For prevention thrombosis and embolism determine the protombin index and, if necessary, prescribe anticoagulants (heparin, phenylin, clexane, fraxiparin). In patients with varicose veins, thrombophlebitis, elastic bandaging of the legs is performed before surgery.

Training gastrointestinal tract patients before surgery on other areas of the body is uncomplicated. Eating should be limited only on the evening before the operation and in the morning before the operation. Prolonged fasting, the use of laxatives and repeated washing of the gastrointestinal tract should be performed according to strict indications, as they cause acidosis, reduce intestinal tone and contribute to stagnation of blood in the vessels of the mesentery.

Before scheduled operations, it is necessary to determine the status respiratory system , according to indications, eliminate inflammation of the accessory cavities of the nose, acute and chronic bronchitis, pneumonia. Pain and the forced state of the patient after surgery contribute to a decrease in respiratory volume. Therefore, the patient must learn the elements of breathing exercises included in complex of physiotherapy exercises of the preoperative period.

Special preoperative preparation at planned patients can be long and voluminous, in emergency cases short-term and quickly effective.

In patients with hypovolemia, impaired water and electrolyte balance, acid-base state, infusion therapy is immediately started, including the transfusion of polyglucin, albumin, protein, sodium bicarbonate solution in acidosis. To reduce metabolic acidosis, a concentrated glucose solution with insulin is administered. At the same time, cardiovascular agents are used.

In acute blood loss and stopped bleeding, blood, polyglucin, albumin, and plasma are transfused. With continued bleeding, transfusion is started into several veins and the patient is immediately taken to the operating room, where an operation is performed to stop the bleeding under the cover of infusion therapy, which is continued after the operation.

Preparation of organs and systems of homeostasis should be comprehensive and include the following activities:

improvement of vascular activity, correction of microcirculation disorders with the help of cardiovascular agents, drugs that improve microcirculation (reopoliglyukin);

fight against respiratory failure (oxygen therapy, normalization of blood circulation, in extreme cases - controlled ventilation of the lungs);

detoxification therapy - the introduction of liquid, blood-substituting solutions of detoxification action, forced diuresis, the use of special methods of detoxification - plasmaphoresis, oxygen therapy;

correction of disturbances in the hemostasis system.

In emergency cases, the duration of preoperative preparation should not exceed 2 hours.

Psychological preparation.

The upcoming surgical operation causes more or less significant mental trauma in mentally healthy people. Patients often at this stage have a feeling of fear and uncertainty in connection with the expected operation, negative experiences arise, numerous questions arise. All this reduces the reactivity of the body, contributes to sleep disturbance, appetite.

Significant role in psychological preparation of patients, hospitalized in a planned manner, is given medical and protective regime, the main elements of which are:

impeccable sanitary and hygienic conditions of the premises where the patient is located;

clear, reasonable and strictly observed internal regulations;

discipline, subordination in the relationship of medical staff and in the relationship of the patient to the staff;

cultural, caring attitude of the staff to the patient;

full provision of patients with medicines, apparatusswarm and household items.

Urinary retention (inability to empty the bladder after at least one catheterization attempt);
- repeated massive hematuria due to BPH;
- renal failure due to BPH;
- bladder stones due to BPH;
- repeated urinary tract infections due to BPH;
- large bladder diverticula due to BPH.

Radical surgery for BPH performed by transurethral or open access should be performed routinely after a complete clinical examination.

Many patients try to delay the operation by any means, enthusiastically meeting each new remedy for the conservative treatment of BPH. Often they neglect the relative indications for surgery and wait for absolute indications, one of which, the most common, is acute urinary retention. For this reason, almost every third patient with BPH begins treatment with a suprapubic urinary fistula for acute or chronic urinary retention. The presence of infravesical obstruction is an indication for surgical treatment.

The "gold standard" in the treatment of BPH worldwide is transurethral resection of the prostate. The use of epidural anesthesia has dramatically reduced the number of contraindications for surgical treatment. TUR is performed in patients whose prostate volume reaches up to 60 cubic meters. see. With a larger volume, which is measured by ultrasound with a rectal sensor, an open operation is indicated - adenomectomy.

At one time, the literature held the idea of ​​the viciousness and inadmissibility of cystostomy, although now we can say with confidence that in a number of patients this operation is absolutely indicated. It is necessary for the removal of patients from the state of intoxication and for the sanitation of the urinary tract, as well as for the preoperative preparation of the patient (heart, lungs, etc.). The effect of cystostomy exceeds all the inconveniences associated with the temporary presence of suprapubic drainage.

When a patient presents with acute urinary retention and the diagnosis of BPH is established (after a rectal examination), we recommend that the surgeon on duty decide on the possibility of a radical operation in the near future. If there are no contraindications for TUR or adenomectomy, the patient should be referred for radical surgery as soon as possible. We do not recommend catheterization of the bladder for more than two days, as infection of the urethra and bladder occurs, which significantly complicates the postoperative period. If there are contraindications for performing a radical operation (the state of the cardiovascular system, lungs, signs of renal failure, urinary tract infection), cystostomy, possibly puncture, should be performed and appropriate preoperative preparation should be performed.

Surgery remains the best and only choice for patients who developed serious complications of BPH. However, the analysis of long-term results after surgery shows that up to 25% of patients are not satisfied with the treatment, since they still have many symptoms of the disease manifestation. Almost every fourth patient after TUR notes frequent urination, 15.5% do not retain urine, and residual urine is determined in 6.2% of patients (Savchenko N. E. et al., 1998). A noticeable decrease in symptoms after surgical treatment is observed mainly in patients with severe forms of the disease and severe obstructive symptoms. In this regard, at the 2nd meeting of the International Conciliation Committee on the Problem of BPH (Paris, 1993), the following absolute indications for surgical treatment were defined: urinary retention (inability to empty the bladder after at least one catheterization attempt), repeated massive hematuria due to BPH, renal failure due to BPH, bladder stones due to BPH, recurrent urinary tract infections due to BPH, large bladder diverticula due to BPH.

In other cases, conservative therapy may be indicated, one of the types of which is drug treatment. It should be noted here that in the asymptomatic course of benign prostatic hyperplasia, the method of "careful waiting" is fully justified, subject to an annual follow-up examination.

Any surgical intervention is accompanied by the use of anesthesia. The introduction of potent drugs into the body, especially with deep anesthesia, often entails not the most pleasant manifestations for the body. However, there are situations when their use has contraindications. This means that general anesthesia is performed only for emergency medical reasons or when the risk to the life of the patient is justified by the risk of using anesthetics.

Absolute contraindications

This list is conditional. In some cases, as mentioned above, deep anesthesia is used even if they are available. We list the main contraindications to anesthesia:

• The patient has a disease such as bronchial asthma in a severe or progressive form. This condition is directly related to the risk of laryngeal intubation during deep anesthesia. This manipulation can cause closure of the glottis or the occurrence of bronchospasm, dangerous for human life. That is why a rather dangerous combination.
• Pneumonia. After surgery in this case, pulmonary edema may develop.
• Serious diseases of the cardiovascular system. These include myocardial infarction, transferred earlier than six months, acute heart failure, as well as uncompensated heart failure. The latter is often accompanied by severe sweating, swelling and severe shortness of breath. Atrial fibrillation, in which the heart rate reaches one hundred beats per minute, also refers to unacceptable conditions.
• Epilepsy, schizophrenia and some other psychiatric and neurological diseases. Contraindications for such diagnoses are associated with an unforeseen reaction of the body of a sick person to the use of anesthetics.
• Temporary, but absolute contraindications, in which the operation is usually not performed under anesthesia, is the state of alcohol or drug intoxication. The point here is that anesthetics will not work, so this procedure is impossible. Surgical intervention in a patient who is in a state of alcoholic or drug intoxication can be performed only after a complete detoxification of the body. Often in this case, the help of a narcologist is needed. General anesthesia is used for patients who are in a state of alcoholic or drug intoxication only for emergency medical reasons. However, in this case, large doses of anesthetics and narcotic analgesics are introduced into the body, which can subsequently lead to an unpredictable effect.

In what cases it is impossible to use mask anesthesia?

It is worth noting that there are contraindications to the use of long-term. First of all, they include the presence of tuberculosis in a patient. It is also prohibited in case of diabetes mellitus and impaired renal function, including with unstable work of the adrenal glands.

In any case, it is up to the anesthesiologist to decide which anesthesia is best for you. It takes into account all diseases and possible contraindications. Carefully approach the choice of specialists and be healthy!

I created this project to tell you about anesthesia and anesthesia in simple language. If you received an answer to your question and the site was useful to you, I will be glad to support it, it will help to further develop the project and compensate for the costs of its maintenance.

Related questions

Olga 10.09.2019 05:50

Good afternoon! Mom (73 years old) was diagnosed with a giant cystoma of the right ovary. A CT scan was done, all organs were examined, there were no metastases. In the extract, the doctor writes: cystoma? disease of the right ovary (implying oncology)?, i.e., the diagnosis is not known. Due to the fact that the cystoma squeezed all the organs, there are malfunctions in the work of the heart. An operation was planned to remove the cystoma, but after consultation with the anesthesiologist, it was postponed. The anesthesiologist said that the risk is high due to severe tachycardia. Previously, my mother did not complain about her heart. I received a referral for blood donation for a tumor marker (I had donated blood earlier, there was an excess), we will wait for the choice of an alternative treatment. It is difficult for her to move around, she eats little due to the fact that food simply does not fit in a squeezed stomach, in other words, she loses her strength. Should I insist on surgical intervention?

Inna 05/17/2019 09:50

Good afternoon. Tell me, with vertebroplasty, local anesthesia is done, I have 4 mature gastric erosions on FGDS, I have been treated for 3 weeks, soon again on FGDS. If they don't heal, will the operation be denied? After all, I am still undergoing treatment, and during the operation, drugs for the stomach can be taken. Can there be bleeding from local anesthesia?

Yana 05.02.2019 11:57

Hello! A 3-year-old child has congenital dropsy of the testicles, will soon have an operation under general anesthesia, the child often complains about his knee and we did an ultrasound of the knee joint, in conclusion they wrote that moderate synovitis of the right knee joint with a slight effusion into the cavity, and we also adenoids of the 2nd degree. Can we go to the operation under general anesthesia or should we postpone it for now? And what could be the consequences?

Alexander Grigorievich 21.01.2019 16:57

Hello! I am 68 years old. Diagnosis: Chronic polypous rhinosinusitis. The operation was performed using video endoscopic technologies. There is a concomitant diagnosis: Arterial hypertension 3 st 1 st risk 4. Question. How relevant is the use of general anesthesia in this case? Thank you.

Svetlana 05.10.2018 20:03

The gynecologist prescribed the operation, my grandmother has a strong prolapse of the uterus! + The doctor found that the bladder turned over as it were. Grandmother has epilepsy (drinks benzanal) from about 23 years old, bladder stones, hypertension, the pressure in the evening and at night rises very high, it used to be over 200, they were taken away in an ambulance, 2 times over the summer. I'm very worried about my grandmother. What tests need to be done to check the body's reaction to anesthesia? Is it worth doing an operation at that age?

ANATOLY GRIGORYEVICH 24.07.2018 19:05

HELLO, DOCTOR!!! I was 69 years old and was diagnosed with a benign adenolymphoma of the right parotid salivary gland, while they advised me to do an operation under general anesthesia, because of the facial nerve, so as not to damage it, but I have concomitant sores, moderate chronic renal failure, dislocation of the left heart, right ventricular cavity, aortic atherosclerosis, enlargement of the aorta 51cm. signs of ischemic heart disease cardiosclerosis hypertension stage 2. Is general anastasia contraindicated for me, I'm afraid to completely plant the kidneys and heart. What do you doctor recommend? What type of anesthesia is best for my sore? THANKS(((((((

Olga 07/07/2018 15:20

Hello, please tell me if it is possible to perform an operation to remove a 40mm aneurysm on a shunt delivered in 2013. On the leg 37 cm long? Dad is 75 years old, flickering arteremia, pressure sometimes jumps, they found oncology on the lung about 60 mm. The doctor says general anesthesia is impossible, is it possible locally?

Roman 05/28/2018 22:13

Hello. I'm 39 years old. Scheduled ear surgery (chronic suppurative otitis media, cholesteatoma) was scheduled. Removed one kidney and spleen (hit by a car in childhood), there was a brain contusion. There are problems with the heart (arrhythmia, tachycardia) - therefore, for many years I have been taking Concor 2.5 mg every day. Plus, they found the hepatitis C virus (how long I have had it is unknown), ECG - sinus rhythm, 86 beats, interatrial blockade; on the only kidney, the parenchyma is 1.9 cm and in the middle segment there is a hyperechoic formation of 0.8 cm, plus, it seems. liver problems (heterogeneous structure). Is it safe to have surgery? Formally, all the doctors in the local regiment (cardiologist, internist, urologist, neurologist) gave the go-ahead, but a lot of sores were revealed. Thanks in advance for your reply.

Oleg 05/17/2018 02:14

Hello. Please tell me, a 43-year-old patient will have a planned laparoscopic cholecystectomy. Of the comorbidities, there is stage 1 hypertension, narrowing of the bifurcation of the carotid artery by 60% on one side with a history of ischemic attacks. How dangerous is general anesthesia in this case and is it possible to use regional anesthesia in this patient. Thank you.

Elena 03.05.2018 18:40

Hello, tell me please, breast plastic surgery is planned, sinus rhythm on ecg with a heart rate of 78 beats. in min. Diffuse disorders of myocardial repolarization, is this a contraindication to anesthesia? Thank you.

Karlygash 04/08/2018 16:21

Hello, my aunt, 46 years old, they found stones in her kidney, they said she needed to have an operation, but in one clinic they refused to do the operation, they said that a weak heart is now going to go to another city, I have a question if she has a very weak heart, is it possible to have an operation and they will be under anesthesia do or how? Will she be all right?

Marina 03/25/2018 22:36

Hello. I would like to know. For my 4-year-old child, we want to treat all the teeth at once under general anesthesia for a day. But we recently discovered a pelvis in our right kidney, it is slightly enlarged. Can we have such anesthesia ?!

Svetlana 13.03.2018 13:28

Hello! I have instability of 5-6-7 cervical vertebrae, and a hernia of the cervical region, at the moment the pains have aggravated, headaches are added to them, and circulatory disorders. Is it possible to perform an operation under general anesthesia in this state (duration of the operation 1 hour)?

Natalya 27.02.2018 11:50

Is it possible to have an operation to remove a hernia with a heart block!? (If not, what are the consequences) (and if so, will this affect the deterioration of the heart)

Larisa 03.02.2018 07:18

Hello! I have a planned operation to remove the gallbladder, but there are heart diseases such as extrasystole and paroxysmal tachycardia. I take sotahexal 80, magnesium. During treatment with sotahexal, paroxysmal tachycardia did not occur. Is general anesthesia possible for these problems? And is it possible to take sotahexal on the day of the operation, before the operation?

Sergey. 29.10.2017 21:25

Hello. I want to extract some teeth under general anesthesia. I am taking Cordarone because I have atrial fibrillation. Does it make sense to apply with this request to the dental center? Or will it be denied anyway? Thank you.

Elena 10/26/2017 15:03

Hello! A relative (74 years old) was diagnosed with stomach cancer (initial stage). but he has COPD, the oncologist gave a conclusion that surgery and chemotherapy cannot be done (it will not withstand anesthesia), is he right?

Marina 20.10.2017 10:42

Hello! Tell me, please, my mother made a conclusion on ultrasound of the kidneys: US-signs of cystic transformation of the right kidney. Pronounced diffusion changes in the parenchyma and sinus of the left kidney. ICD. Pyelitis on the left. Left kidney cyst. Cysts of the right ovary, endometrium, uterine fibroids. Can we reschedule spinal surgery? And how dangerous is it?

Ekaterina 10/19/2017 22:49

Hello, my daughter is 3 months old. On ultrasound of the brain, expansion of the stomachs of the brain was revealed. Livosrderzhaschaya system expanded D>S Depth of the anterior horns: right -7.8 mm, left 6.5 mm (N to 5 mm) And another open oval window. We are going to have a cosmetic surgery under general anesthesia (removal of capillary malformation) Is it possible to perform anesthesia with such a diagnosis

Natalya 10/13/2017 11:14

Hello, please tell me, we are going to have an operation to remove adenoids under general anesthesia, but sinusoidal arrhythmia (105 beats) was written on the ECG, the cardiologist did not give permission, he said that the child has bradycardia. Is this a contraindication?

Oksana 11.10.2017 22:35

Hello. Please reply urgently. My friend has stage 3 lung cancer and metastasis in T7 with a pathological fracture of the vertebral body and compression of the spinal cord. At the moment, the legs have failed (sensitivity is preserved), the bladder does not work and constipation for 8 days, the enema does not help. They put him in the hospital to install metal rods instead of a vertebra, and during the examination in the hospital they found an erosion of the stomach and the operation is postponed. The question is, is gastric erosion a contraindication to neurosurgery in such a situation? The condition worsens every hour. Symptoms of intoxication from constipation began. Or doctors fear the development of pulmonary embolism? How to insist on neurosurgical surgery

Ivan 05.10.2017 11:17

Hello. I have a spring allergy to flowering (April-May), I need to have an operation to remove the intervertebral hernia. Is it possible with such an allergy? Thank you.

Dmitry 09/25/2017 20:02

Good day Dear doctor, I have an umbilical hernia that needs to be sutured, right today We wanted to do surgery, but the doctor came and said that I could go crazy in plain language before he came in the evening I talked with the girl an anesthetist told her the whole truth that I am very much afraid that I have panic attacks when my heart is pounding, my heart is pounding for 10 minutes I go to wash my face and go to bed, said that from the age of 14 I smoke black marijuana every day now I am 19 or any other drugs I have not used told her that I have a very impressive character, so to speak, when we were sitting, I cried after 30 minutes I calmed down and was almost ready for surgery, told me that I had a diseased gallbladder (biliary dyskenasia and chronic cholecystitis, a gastroenterologist also diagnosed liver steatosis at the moment I have slightly yellowish eyes and the skin told her that I had gastroudenitis, she suggested spinal anesthesia, an injection in the back after which I won’t move my legs for 6 hours (but I have a hernia along the white line of the abdomen above the navel) in general, today I was discharged from the hospital and they said that anesthesia is dangerous for me and, simply speaking, I can go crazy because I’m so emotionally excited I’m afraid so I’m shaking all over + I waited until this day for several days and was very afraid, in general, they discharged me from the hospital and said come, we’ll do everything for you in 3 months.

Eugene 20.09.2017 14:44

Good afternoon! MRI of the brain revealed a saccular aneurysm of the anterior communicating artery 2 mm. A laparoscopy is due. Are there any contraindications to anesthesia?

Ekaterina 16.09.2017 17:35

Hello, a child of 6 years old suffers from asthma for 2 years, basic therapy with Seretide 2 times a day 25/125. and violation of intraventricular conduction, the appearance of a slowdown in intraventricular conduction was noted.

Polina 12.09.2017 06:35

Hello! My brother was found to have a lung bulla. He also has inflamed adenoids. They had to do an operation to remove them, but when they found a bulla, they said that it was a contraindication. Is it really true? How then to remove adenoids? Can't use anesthesia? We also wanted to take him to stem therapy, because. he has ROP of the central nervous system, but anesthesia (mask) is also needed there. The coordinator of the clinic said that, even with the use of gentle anesthesia, it is not known how the body will react. What can be done in this situation? Thanks in advance!

Alla 10.09.2017 15:58

Hello, my child, 4 years old, 2 days before the operation (phimosis), the stool was upset, tell me, in this case, the operation will be postponed?

Petimat 09.09.2017 23:13

Hello. I wanted to know if we have an adenotomy operation in five days. The boy is 8 years old, but his nose was stuffy yesterday, the snot is slightly transparent, there is no temperature, his throat is slightly red. There is no cough, but at night he coughed a couple of times. Do we have any contraindications for the operation. It's just that if we are denied an operation, I will no longer wait for recovery. I'll wait until the summer then, since September gets colder, we get sick all the time. Not like 10 days of days, we get sick again. Thanks in advance.

Elena 09/05/2017 14:12

Hello. I need to do a laparoscopy in 15 days. I have VVD, I waited for support for a long time and was nervous, it got to the point that I wake up at night because it’s stuffy and I start to lose consciousness when I go out into the fresh air. The genecologist also prescribed lutein hormone 200 for ten days for me to adjust my body to the date of the operation. If I could do the operation, I would like to know your opinion, I will ask my anesthesiologist, but it is interesting to know your opinion.

Dmitry 08/17/2017 05:43

Hello! I would like to know if it is possible for me to do anesthesia if the diagnosis is "Impaired intraventricular conduction, accessory chord in the left ventricle"?

Elena 08/07/2017 11:27

Good afternoon! A 7-year-old child is diagnosed with bronchial asthma (mild form) of an allergic nature (to dust mites). We constantly take Singular and courses of flexotide. Did the neurologist send you for an MRI of the brain with anesthesia through a mask? Is such anesthesia dangerous for a child with asthma? What is the best way to prepare for anesthesia? Thank you.

Marina 03.08.2017 06:35

Hello, tell me, please, what kind of anesthesia is possible for my child. I have a 9 year old daughter. A diagnosis of papillomatosis of the larynx was made. She did not allow herself to be examined in a mirror without anesthesia. We were told that they would do an examination under anesthesia. She was diagnosed with OOP. By school, the condition improved, they said that it was overgrown. The child is very nervous. Thank you very much for the information.

Daria 07/01/2017 05:40

Hello. Child 2y 10m. An operation to remove the adenoids under general anesthesia is expected. ECG revealed boadycardia. Pulse rate 80 beats/min. The cardiologist said that the operation would have to be postponed, because. with such a pulse, they simply won’t take us to it. Is it so?

Alexandra 06/27/2017 16:42

Hello. The child is 6 months old. An operation is due for vesicoureteral reflux of the 2nd degree. The child has increased intracranial pressure (moderate) and an enlarged thymus (Stage 3). Is it possible to use anesthesia?

Waag 26.06.2017 17:59

Good afternoon. My father is due to undergo surgery to remove a cervical hernia, and he has a heart aneurysm. Is there a risk of surgery under prolonged anesthesia. Thank you.

Alexandra 06/25/2017 08:21

One of these days, a 6-year-old son will have an operation to remove adenoids under general anesthesia. Passed an EKG, the conclusion: sinus rhythm. with heart rate = 87 beats / min., s type ECG. Impaired intraventricular conduction. Can they refuse anesthesia with such a result.

Eugene 16.06.2017 10:48

Hello! The child is 1 year and 8 months old and will undergo surgery under mask anesthesia. on the ECG sinus rhythm with a heart rate of 89-109, with periods of bradycardia. There is no way to get advice from a pediatric cardiologist. The pediatrician doubts. Tell me please, is it dangerous to go for an operation with such ECG data. We'll survive. Thanks in advance.

Irina 06/09/2017 11:26

Good afternoon, my mother was discharged on May 31, 2017 from Bol. diagnosis: Cerebrovascular disease: cerebral infarction dated May 11, 2017. Ischemic heart disease: post-infarction cardiosclerosis. Persistent form of atrial fibrillation. Background disease: Hypertension stage 3, stage III, CVC risk 4. Complication: NK 2A (Strazhenko-Vasilenko) On June 7, 2017, she was taken to the hospital with suspected intestinal hemorrhage. On the next day, the coloproctologist said that there was no more blood in the stool and most likely the mucous membrane was damaged due to constipation (Mom is lying down, the right side is paralyzed). Since you need to constantly take anticoagulant therapy, the doctor nevertheless advised to perform a colonoscopy under anesthesia. What is the risk? Is it worth it to conduct this examination under anesthesia, given the above?

Elena 05/30/2017 00:34

Hello! A child aged 17 months needs to undergo FGS under general anesthesia. ECG examination diagnosed AV blockade of the 1st degree. Can it be done? How does general anesthesia affect the brain of an actively growing child? Thanks in advance.

Natalia 04/24/2017 08:37

Hello, I have a planned operation (lipoma) under local anesthesia, my throat hurts, I drink Ingoverine, should I cancel the operation or not?

Arthur 11.04.2017 09:26

An operation is scheduled to remove the inguinal hernia. I am 56 years old, atrial fibrillation in a permanent form. Two years ago, during coronary angiography, there was ventricular fibrillation. Now I'm afraid to go for surgery under general anesthesia. Help advice, thanks.

Oksana 04/08/2017 12:28

They did an ovarian laparoscopy, the anesthesiologist said that there were problems with me: a hard-to-remove and narrow glottis. What does it mean?

Anastasia 04.04.2017 13:50

Hello. Do we have such a question? We go to the hospital for a CT scan under anesthesia. We have had staphylococcus aureus since birth, and later they discovered that we also had adenoids. The bottom line is that we have eternal problems with snot. anesthesia, if before that we blow our nose well?

Tanya 04/02/2017 23:51

Good afternoon! An operation is planned to remove the placental polyp. I have tachycardia up to 90 beats per minute. Should I be worried that it will take me a long time to get off anesthesia? Is it contraindicated for me? I'm drinking rose hips now in order to regulate my pulse, does it really help? Thank you!

Oksana 19.03.2017 09:38

Hello, I am going to have a colpoperineorrhaphy surgery under local anesthesia. I am currently suffering from acute bronchitis. Operation in a week. Is it possible to carry out the operation under such conditions

Irina Nikolayevna 28.02.2017 13:25

I am contacting you again because I did not find an answer. I need to do a colonoscopy and I would like to do it under anesthesia. Is it possible to do this if I take lyrica (pregalbin) zoloft and spitomin I will also add sirdalud. I have neuropathy against the background of stenosis of the lumbosacral spine. Age 67 years. Sincerely, Irina Nikolaevna.

27.02.2017 14:26

Olga, all the concomitant diseases you listed are not a contraindication to anesthesia. Spinal anesthesia is also possible. Everything is at the discretion of your anesthesiologist.

Vyacheslav 26.02.2017 06:35

Hello, my father is 67 years old, he has coronary artery disease, he suffered a myocardial infarction 3 years ago, now he is suffering from an inguinal hernia. Is it possible for him to use anesthesia, if possible, what kind in this situation?

Abdurakhman 19.02.2017 22:39

Hello, I have parkinson's syndrome and I didn't successfully fall and broke my femoral neck and now I'm going to have an operation to replace the femoral neck, please tell me if anesthesia is contraindicated or not

Olga 18.02.2017 23:45

Hello, what kind of anesthesia is done during the operation to remove the hygroma of the tendon of the long muscle of the abductor thumb of the wrist joint? Are there any risks? The child is 13 years old.

Olga 11.02.2017 00:09

Hello! Please tell me, I have been pregnant for 2 years now with a 3rd child, I will have a cop. Is he scary at all? Thanks!!!

Natalya 02.02.2017 17:57

Hello, the operation is to remove the tumor of the posterior part of the mediastinum, the child is 1 year 1 month old. The child has a runny nose, teeth are climbing. Is this a reason not to have surgery at the moment?

Olga 01/20/2017 18:56

Thank you. But is it advisable to put at risk for the sake of some kind of cardiogram? Why in simple cases (not requiring sutures, not touching muscles, nerves, blood vessels) not to hold the child, fix it with straps (I did this, though for a long time) and get by with local anesthesia? Sorry for the intrusiveness, this question is very worrisome.

Olga 19.01.2017 20:43

Hello. A 3.9-year-old child wants to remove a lipoma (5 mm) on the leg under general anesthesia. Wen on the surface of the skin, under a layer of skin about 1 mm thick, the contents are perfectly visible to the naked eye, the size of a sunflower seed .. You don’t even have to put stitches. Why do doctors go for general anesthesia for NO reason other than their own convenience? Why do not they measure the amount of work and do not offer other methods (for example, resorption by injection of the drug)? Please help, is this a violation of the rights of the patient?

Andrey 19.01.2017 00:38

Good afternoon! The wife is due to give birth, and she has a polyvalent allergy (up to anaphylactic shock). Tell me, what drugs for anesthesia are used during childbirth, and is it possible to do allergy tests on them in advance. If yes, where? I would also be grateful for any advice in such cases.

Sima 12/17/2016 18:23

Hello, my son is 29 years old. He has diangosis - PMD, and he needs to remove his gallbladder. The doctor refused to do the operation because he should not be given anesthesia. Tell me what to do? Thanks for the information.

Maria 11/26/2016 21:10

Hello. The patient was scheduled for CABG (coronary bypass grafting) in a planned manner. During a preliminary examination of narrow specialists, the ophthalmologist diagnosed Suspicion of glaucoma. And he signed that there are no contraindications to the operation. But the patient in cardiac surgery was refused to take the operation, since Glaucoma is in question, they said that the patient needs to find out exactly whether or not glaucoma exists. Since Glaucoma is a contraindication to CABG. Is it so?

Tatyana 11/15/2016 09:28

Thanks a lot!

Tatyana 09.11.2016 10:12

Good afternoon! The patient is 53 years old. The main diagnosis of CIHM stage 2 (atherosclerotic, hypertensive). Postponed ischemic stroke in BZSMA on the right (cystic transformation in the occipital lobe on CT). Transient ischemic attack in BLSMA a year ago. Hypertensive heart. Atheromatosis of the aortic valve. Risk 4. Nephropathy mixed. BP S2. CHF 1. FC1 Diabetes mellitus 2. Obesity 1 st. Surgical treatment was recommended for atherosclerosis of the neck vessels of the extracranial bracheocephalic vessels. Occlusion of both ICAs. Stenosis of the proximal segment of the left vertebral artery up to 60%, refused surgery. X-rays later established COPD. Diffuse pneumosclerosis, emphysema. Can we now count on the operation or is this a contraindication?

Ulyana 01.11.2016 12:39

Good afternoon! My son is 5.5 years old, the result of the ECG is a local violation of intraventricular conduction, is it possible to do adenotomy under anesthesia?

Alina 01.11.2016 00:34

Hello. My child is 6 years old, was diagnosed with cicatricial phimosis, and surgical treatment was recommended. I'm also concerned about general anesthesia. The fact is that the child suffers from asthma and has MAS. Anomaly of the chordal apparatus. During examination by a cardiologist, bradycardia was registered on the ECG. ECHOCG shows MAC. ECG with exercise, according to the cardiologist, is normal. This bradycardia is associated with VSD. Surgery is due in 2 weeks, we are very worried. Can we have general anesthesia?

Marina 10/15/2016 09:02

frequent extrasystole 4 degrees, bigenimia. trigenimia. jogging, biliary tachycardia, coronary heart disease. What is the risk?

Eugene 08.10.2016 11:28

Hello! I want to do a chin plastic surgery + SMAS lift. A year ago, there were problems with the heart due to nerves, the ECG showed a scar on the back wall of the heart. In the conclusion it is written: "According to Echo-KG, there are signs of atherosclerotic lesions of the aorta, aortic vertae cusps and mitral valves. signs of diastomic dysfunction.Signs of an aneurysm with / from the interatrial septum.Right type". Is anesthesia contraindicated for me? I had a heart problem in October 2015. (one year ago), date of the above conclusion: 29.10.2015. Sometimes, once every few days, the heart can stab quite a bit (2-3 "shots"), there are no serious complaints about the heart now. I do not treat the heart. Well, what are the consequences of anesthesia if it is contraindicated for me, and I hide the above from the plastic surgeon?

Aldyn 30.09.2016 12:49

Hello, my grandmother is 70 years old, the cavity of her uterus is filled with purulent-hemorrhagic contents, curettage of the uterus is indicated, but due to the presence of chronic bronchitis, it was refused (they said anesthesia might not pull). Is it true? Thanks for the answer.

Natalya 21.09.2016 11:56

Good afternoon. Anesthesia question. A gynecological operation is coming, the removal of a polyp in the uterus. Operation for the day after tomorrow. I have a broken wrist, my arm has been in a cast for a month now. Will they accept me for surgery or can they refuse to operate? Thanks to.

Daria 16.09.2016 01:09

Hello. Anesthesia question. I am preparing for a gynecological operation, endometrial scraping. Is general anesthesia applicable to me, is it possible to minimize the risks? I have type 1 diabetes on insulin with concomitant diseases, chronic pyelonephritis, cholecystitis, anemia, low blood pressure.

Irina 13.09.2016 14:22

My daughter was scheduled for a laparoscopy operation (removal of a cyst on the left ovary), I have hepatitis B, they said general anesthesia .... I'm very afraid of contraindications and consequences. Interested in your opinion

Valentine 08.09.2016 17:32

Hello. In 2013, I underwent a caesarean section due to breech presentation of the fetus under epidural anesthesia. About 5 minutes after the start of the operation, it became very difficult for me to breathe. There was a feeling that half of my lungs were missing, my head was spinning, it was hard to speak, I was fainting. As the anesthesiologist said: the pressure dropped a lot. After 20 minutes the condition returned to normal. Now I will have to again, by the way, I am very afraid of a repetition of this state, especially lack of air. By the way, after the first CS, the feeling of lack of air disappeared only after 2 months. In the anamnesis, JVP, VSD, mitral valve prolapse is not hemodynamically significant, high myopia. At the first pregnancy there was a syndrome of the lower vena cava, now it is not. Age 28 years. Tell me, what kind of anesthesia is still preferable for me and what is the reason for this condition during the first operation? What is the likelihood of such a reaction happening now? Thank you in advance.

Love 02.09.2016 15:51

Hello! I will have a planned caesarean at 38 weeks, now I am 37 weeks and the migraine has worsened again. I have had a migraine since 2014 in spring and autumn. During pregnancy, I have it not as acute (without aura) as it was before pregnancy. I also have tachycardia, my pulse is from 100 to 110. I'm afraid of general anesthesia. departed last time very hard (fainting and vomiting). What anesthesia can I have?

Elena 08/31/2016 10:45

hello! we are getting ready for the operation, we are going through tests and found sand in the kidneys and changes in the urine (protein) in the child, and there is a pronounced sinus arrhythmia on the ECG!, tell me this is a contraindication to surgery with anesthesia? 4-year-old child: the main diagnosis is merosin-negative muscular dystrophy. anesthesia was said to be inhalation with sevuran (if you spelled the name correctly)

Natalya 28.08.2016 08:24

Hello. Please tell me if it is possible to use general anesthesia in my situation. In 2005, the following operations were performed: (first stage) - operation of right-sided ventriculoperitoneal shunting, and the second stage - operation of right-sided paramedian access, removal of the tumor of the left cerebellopontine angle. Currently, the neurologist's diagnosis: CVD, DE st. complex genesis (hypertensive, atherosclerotic, postoperative), hypertensive-hydrocephalic syndrome, left-sided pyramidal insufficiency, liquorodynamic disorders, moderate vestibulo-atactic, cognitive impairment. Chronic cholecystitis, Polyposis of the gallbladder. Dyslipidemia. Is it possible in my situation to use general anesthesia - gynecological surgery (endometrial hyperplasia), removal of the gallbladder. What consequences are possible after the application of general anesthesia on the brain? Are there any contraindications in my situation for general anesthesia?

Natalya 18.08.2016 17:11

Hello. Please tell me, can oligophrenia be the reason for refusing to perform an operation on the gallbladder? A 63-year-old woman, a disabled child, oligophrenia with mental retardation. There are complications after the treatment in the form of speech disorders, severe stuttering. Fully capable. She passed the examination necessary for planned hospitalization. There are no contraindications to the operation. Cholelithiasis, constant pain. Occasional nausea, vomiting, diarrhea. She was hospitalized several times in an ambulance during an exacerbation. The gastroenterologist recommended surgical treatment.

18.08.2016 16:32

Yulia, it is not clear from the question whether we are talking about a planned vaccination, or about the treatment of a disease. If this is a vaccination, I can’t be 100% sure, but most likely there’s nothing to worry about, but it’s better to transfer it to after the operation. And if we are talking about a disease, then additional consultations of doctors, an assessment of the risk and the need for surgery are needed here.

Anastasia 16.08.2016 20:02

Thanks a lot for your answer!

16.08.2016 14:51

Anastasia, if there is no lactation, there are no contraindications, then, of course, you can do it, but I would advise you to postpone the operation, let the body recover - after all, pregnancy and childbirth are a strong stress for the woman’s body, especially since there was a caesarean section, which means there was anesthesia, or anesthesia. Now immediately again anesthesia. Of course, it happens that we do several operations and anesthesia in a row and everything goes well, but you need to understand that if there is no urgency, then it is better to postpone it so that at least a year and a half has passed. Good luck to you!

Azat 10.08.2016 11:47

Hello, is it possible to do an operation to remove the gallbladder with angle-closure glaucoma, and what kind of anesthesia is provided (antropin is contraindicated)? What kind of anesthesia is used during the operation, local or general?

Olga 03.08.2016 15:28

Good afternoon! On August 11, a reconization of the cervix was prescribed, the diagnosis was grade 2-3 dysplasia, blood sugar was 7.1 mmol, can I have surgery?

Diana 02.08.2016 19:59

Hello! I am allergic to all local anesthetics. Only ultracaine showed 30% (as I understand it is possible, but with tavegil) Please tell me what other options for anesthesia can suit me. There was a need to remove a wisdom tooth. And also, for the future, because during childbirth, for example, anesthesia is used.

NATALIA 07/31/2016 15:40

hello August 12, 7-year-old daughter, removal of adenoids under general anesthesia, is it possible to get vaccinated against tetanus (the time has come) before the operation or is it better to postpone?

Lydia 26.07.2016 16:39

Meniscus resection (arthroscopy): which anesthesia to choose? Good afternoon! I ask for help with the choice of the method of anesthesia for knee arthroscopy (the operation will take at least an hour). The surgeon recommends spinal anesthesia. But what stops me is that because of the neglected spine (osteochondrosis, hernia, etc.), this can be difficult. In addition, I heard negative reviews about this method, including from neurologists. There are opinions that the consequences can manifest themselves even after six months - a year. General anesthesia - everything is fine, but several operations have already been carried out under general anesthesia and I'm afraid there might not be too much. Memory worsened, reaction speed worsened, insomnia torments. In addition, I have arrhythmia, problems with pressure (there were cases when it dropped to 40). Local anesthesia, according to the surgeon, is not an option at all. Remains conduction anesthesia (regional). I would be very grateful if you could give me your opinion on this matter. P.S. I have not talked to the anesthesiologist yet, but I would like to understand what to ask him about.

Larisa 25.07.2016 21:07

Hello! My sister fell ill a month ago, with the help of MRI, a sequestered hernia of the L4-S1 vertebra was revealed. They began to prepare for a neurosurgical operation. The ECG showed that there are changes in the heart. Conducted a study of the heart (ultrasound), which showed the presence of an aneurysmal deformity of the n / c MPP in the cavity of the left atrium with an interruption of the echo signal of 3.7 mm with a small pathological shunt of blood. Rhythm disturbance. The thickness of the PS of the pancreas is 8.2 mm. The conclusion also says that there is a tendency to dilatation of the cavities of both atria. Concentric hypertrophy of the LV myocardium with a decrease in contractile function. Diastolic dysfunction type 1 Thickening and unexpressed calcification of the valves of the MV and the aortic root. Mitral insufficiency 1-1.5 tbsp. Aortic regurgitation 0-1 tbsp. Tricuspid insufficiency 1.5 tbsp. Pulmonary regurgitation 1 tbsp. myocardial hypertrophy. Moderate pulmonary hypertension. R sist. LA 40 mm/Hg. The neurosurgeon is ready for the operation, but the anesthetists categorically refused the operation twice, pointing out the presence of a heart defect, which greatly frightened us. We had a consultation with a cardiac surgeon, who said that cardiac surgery is not indicated in this situation and there are no obstacles to a neurosurgical operation. Help me figure out whether it is really impossible to give anesthesia or anesthesiologists are just insured? Is there a real direct threat to life? The operation usually takes 3-3.5 hours under general anesthesia. I also write that the hospital is the base for training students of a medical university (maybe this is the reason?), located in our city, a high-class neurosurgeon was supposed to operate, previously he worked in one of the federal centers. I will also say that they learned about the existing heart disease only during the examination. For us, this is a "find", because there have never been any complaints about the heart and there are none.

Egor 25.07.2016 19:29

Hello. Father is 57 years old. After surgery on the carotid artery, progressing signs of stroke were recorded for a year. As a result, the right side of the body was taken away. They did an MRI of the brain a year ago and now - a 4 cm tumor has formed in the brain in a year (I think a post-stroke cyst), but the doctors do not make a conclusion and simply call it a formation, a tumor (gliastomy). My father walked a little, but fell on his right leg, having received a subtrochanteric fracture of the femur with displacement. Everything would be fine, they wanted to do an operation and install staples on the thigh, but the hospital refused to operate, referring to the impossibility of anesthesia in such a patient. We went to the Institute of Brain Neurosurgery (Tashkent) for permission, where they confirmed to us that no anesthesia can be done, even during surgery on the leg. My father has been in bed for two months and suffers from a fracture, the bones naturally do not grow together on their own. Please tell me, is it really impossible to do anything? Maybe there is a way to anesthetize only the lower part of the body, for example, during a leg operation? Thank you.

Hello, Doctor! When I was treating my teeth, the doctor gave me some kind of anesthetic, after which I cried. She asked if I was in pain and why I was crying. At that moment, I didn’t feel pain, but I cried on my own, I even smiled when answering. She brought me to my senses with ammonia, after which she said that she realized that it was an "adrenaline swing." She said that it was a reaction to adrenaline, and it seems that she added that I ate something sweet before that, so this is the reaction. She did not consider it necessary to write me a name, since it was not a reaction to the anesthetic, according to her, but she wrote something like "adrianol", I could be wrong. I have to go to the dentist, which without anesthesia will be unbearable, and besides, I am breastfeeding, the baby is 1.2 months old, I am not going to quit yet. I still have a question about the adrenaline swing and how dangerous it can be? Is it worth taking tests for the use of anesthetics, if so, which ones, because the prices bite terribly. By the way, after this incident, I was already given anesthesia after childbirth, when the placenta was removed, the general one, but this is probably a different type of anesthesia. Transferred well.

Nikolay Valentinovich 06/10/2016 16:06

Hello. My wife was diagnosed with stage 4. bladder cancer. A month ago, my wife (64 years old) made an unsuccessful suicide attempt (phenazepam-30tab. + 100g. vodka). She survived, but with serious consequences. For the first 10 days after the poisoning, she only slept, did not eat, only drank water. Then she regained consciousness, began to eat and drink a little, recognized her relatives, spoke poorly, tried to get up and walk herself, although she did not realize where she was and what had happened to her. But mostly she slept, often turning over on one side, then on the other. In a dream, he often slowly raises either his arms or legs, making smooth movements (as in ballet). We thought a week or two would pass and everything would be restored, but every day her condition worsened: she began to talk worse (now she doesn’t speak at all), she doesn’t get up, she walks under herself, she doesn’t respond to our requests, she has to drink and feed in a dream. Now he sleeps 24 hours a day. Eating has become bad, takes food from a spoon into her mouth and sleeps with it, does not chew, does not swallow, does not hear our calls. The oncologist asks us to urgently do an MRI of the brain. But since she can raise her leg or arm at any time, this must be done under anesthesia. The question is whether it is possible for my wife in such a state to undergo anesthesia for an MRI examination, or in our case this is excluded. And if so, do we have any other option for examining the brain without anesthesia or not? Thank you. Nikolai Valentinovich is a pensioner from Moscow.

Elena 04/14/2016 01:15

Hello. Please tell me how important it is to inform the anesthesiologist about the intermittent use of amphetamine for two years if the last use was a year ago, and the use of marijuana within the last year if the last use was a month ago?

In each specific case, the surgeon must assess the likely risk of developing an unfavorable outcome of the proposed surgical intervention, take into account the possibility of prolonging the patient's life or curing it. Excessive enthusiasm for surgical radicalism, without taking into account the patient's comorbidities and the risk of an unfavorable outcome of the operation, can lead to a significant increase in immediate postoperative mortality and disappointment in the expediency and prospects of surgical treatment of esophageal cancer.

A very important role in the treatment of patients with esophageal cancer is given to preoperative preparation, aimed at correcting various homeostasis disorders. Hypovolemia, anemia, hypoproteinemia are most often detected in patients with esophageal cancer, hypokalemia and hyponatremia are less common. Parenteral nutrition, correction of volemic and electrolyte disturbances play a leading role in the correction of this type of disorders.

The second, no less important task of preoperative preparation is the identification and treatment of concomitant diseases. Particular attention should be paid to the cardiovascular, respiratory and excretory systems.

Operability for esophageal cancer usually does not exceed 50%, resectability (the possibility of performing a radical intervention in persons taken for surgery) is 50-70%.

Τᴀᴋᴎᴍ ᴏϬᴩᴀᴈᴏᴍ, during the examination period, the doctor must first of all determine the oncological and functional operability of the patient. Unfortunately, about half of patients seek medical help with obvious signs of inoperability, when radical surgical intervention is not feasible. Another group of patients, according to the examination in the hospital, has to be denied surgery due to the prevalence of the tumor process or severe, uncompensated diseases of the vital organs.

Absolute contraindications to perform radical surgery are:

1) germination of the tumor in the organs of the mediastinum (trachea, bronchi, aorta);

2) metastases to distant lymph nodes that are inaccessible for surgical removal;

3) metastases to distant organs (liver, lungs).

Moreover, all these reasons are not a contraindication for the use of palliative procedures performed for health reasons for complications of the underlying disease (most often with tumor obstruction of the esophagus).

Relative contraindications to perform radical surgery are:

1) severe concomitant diseases of vital internal organs (heart, lungs, liver, kidneys), especially when their functional state is decompensated;

2) advanced age of patients (over 65-70 years old) in itself is not a contraindication to surgery in the absence of pronounced changes in the function of internal organs;

3) the impossibility of qualitative correction of metabolic disorders, representing a high risk of anesthesia, exceeding the severity of the operation.

Indications for surgery for Fallot's tetrad are actually absolute. All patients are subject to surgical treatment, especially in infants and patients with cyanosis, surgical intervention should not be postponed. Cyanosis, the sharpest hypertrophy of the right ventricle of the heart, continuously occurring changes in the anatomy of the right ventricle, its outlet section, in the structure of the lungs - all this necessitates the possible early surgical intervention, primarily in young children. If the defect proceeds with pronounced cyanosis, frequent dyspnea-cyanotic attacks, disturbances in general development, an urgent operation is indicated.

Contraindications to surgery are anoxic cachexia, severe cardiac decompensation, severe concomitant diseases.

Methods of surgical interventions

In the surgical correction of Fallot's tetrad, its radical correction is widely used, as well as palliative operations for certain indications.

The meaning of palliative operations (there are more than 30 types) lies in the creation of intersystem anastomoses to eliminate the deficit of blood flow in the pulmonary circulation.

Palliative operations allow the patient to survive the critical period, eliminate total arterial hypoxemia, increase the cardiac index, and under certain conditions contribute to the growth of the trunk and branches of the pulmonary artery. An increase in pulmonary blood flow increases

of course - diastolic pressure in the left ventricle, thereby contributing to its development before a radical correction of the defect.

Palliative bypass surgery improves the capacitive-elastic properties of the pulmonary arterial bed with an increase in the elasticity of the pulmonary vessels.

Among bypass palliative operations, the most common are:

1. subclavian - pulmonary anastomosis according to Blelock - Taussig (l 945) (Nobel Prize in 1948). It is the classic and most commonly used in the clinic. To apply it, synthetic linear prostheses Gore are used - Tech

2. anastomosis between the ascending aorta and the right branch of the pulmonary artery (Coogy - Waterston, 1962). This is an intrapericardial anastomosis between the posterior wall of the ascending aorta and the anterior wall of the right branch of the pulmonary artery

3. anastomosis between the trunk of the pulmonary artery and the aorta (Potts - Smith - Gibson, 1946)

When performing bypass operations, an important task is to create an adequate size of the anastomosis, since the degree of reduction in arterial hypoxemia is proportional to the amount of pulmonary blood flow. The large size of the anastomosis quickly leads to the development of pulmonary hypertension and. and small ones - to its rapid thrombosis, therefore, the optimal size of the anastomosis is 3-4 mm in diameter.

Operations are performed on a beating heart, access - anterior-lateral left-sided thoracotomy in the 3rd - 4th intercostal space.

Currently, palliative operations are considered as a stage of surgical treatment of patients with severe forms of the defect. They are not only a necessary measure, but also prepare the patient for a radical correction of the defect. However, the positive effect of palliative surgery is not permanent. With an increase in the duration of the existence of intersystemic anastomoses, deterioration in the condition of patients was absolutely reliably noted. This is associated with the development of hypofunction or thrombosis of the anastomosis, with the development of deformation of the branch of the pulmonary artery on the side of the anastomosis, often with the occurrence of pulmonary hypertension, the possible manifestation of bacterial endocarditis, the progression of pulmonary stenosis up to the development of occlusion of the outflow tract from the right ventricle. This leads to an increase in cyanosis, a deepening of polycythemia, and a decrease in arterial blood oxygen saturation. Over time, the question arises of a second palliative operation or a radical intervention, and these manifestations are indications for their implementation.

The use of endovascular surgery (balloon angioplasty, stenting, bougienage of residual stenoses) has become of particular importance in the preparation of patients at all stages of the surgical treatment of the defect, especially in recent years.

at the level of the mouth of the anastomosis, elimination of stenosis of the pulmonary artery valve, embolization of large aorto-pulmonary collateral anastomoses (BALKA).

Radical correction of TF, both initially and after palliative surgery, is a complex but effective surgical intervention. Currently, the emphasis in the surgical treatment of TF has shifted towards radical surgical intervention at an earlier age, including the neonatal period, due to the development and improvement of methods for ensuring the safety of open heart surgery (anesthesiology, EC, cardioplegia, intensive care and resuscitation).

Radical correction of TF consists in elimination of stenosis or reconstruction of the right ventricular outflow tract and closure of the ventricular septal defect. In cases of previously imposed intersystemic anastomosis - its elimination at the very beginning of the operation before connecting the heart-lung machine by isolating and tying or suturing the anastomosis from the lumen of the corresponding pulmonary artery.

A radical operation is performed under conditions of hypothermic cardiopulmonary bypass (28-30 degrees), pharmaco-cold or blood cardioplegia.

Elimination of stenosis of the outflow tract from the right ventricle: in 90 - 95% of cases, there is a need to expand the output section of the right ventricle, and therefore its longitudinal ventriculotomy is indicated. Infundibular stenosis of the right ventricle is revised, hypertrophied muscles are widely excised. Valvular stenosis is eliminated by dissecting the fused leaflets along the commissures. With a sharply changed valve, the elements of the latter are excised. To expand the output section, xenopericardial patches with an implanted monocusp are used, the dimensions of which vary (No. 14 - No. 18) in each case.

Closure of a ventricular septal defect. In TF, perimembranous and less often subaortic VSD is more common, which is closed with a synthetic or xenopericardial patch, fixing it to the edges of the defect both with separate U-shaped sutures on Teflon pads, and with a continuous suture.

How is the adequacy of defect correction assessed? For this purpose, pressure is measured in the inlet and outlet sections of the right ventricle, in the trunk and right pulmonary artery. The adequacy of the correction is assessed by the ratio of systolic pressure in the right and left ventricles. It should be no more than 0.7. High residual pressure in the right ventricle dramatically increases postoperative mortality.

Adequately performed radical correction of the defect allows to normalize intracardiac hemodynamics, increase physical

working capacity and already a year after the operation up to 75% - 80% of the norm for healthy children.

Recent studies indicate that even with good results, latent heart failure is detected in the long term, due to prolonged arterial hypoxemia affecting delicate structures in vital organs (in particular, in cardiomyocytes). From this follows an important practical conclusion that children should be operated on at an early age, in any case up to two years. Unsatisfactory results of the operation are due to incomplete correction of the defect, VSD recanalization, and hypertension in the pulmonary artery system.