Indications and contraindications for surgical treatment of abdominal hernias. Assessment of risk factors for complications in hernia repair. Open Medical Library Urologist no contraindications to surgical treatment

Operation indications determine its urgency and can be vital (vital), absolute and relative:

$ Vital indications for surgery – diseases or injuries in which the slightest delay threatens the life of the patient. Such operations are performed on an emergency basis, that is, after a minimum examination and preparation of the patient (no more than 2-4 hours from the moment of admission). Vital indications for surgery occur in the following pathological conditions:

¾ Asphyxia;

¾ Continued bleeding: with damage to the internal organ (liver, spleen, kidney, fallopian tube with the development of pregnancy in it, etc.), heart, large vessels, with stomach and duodenal ulcers, etc .;

¾ Acute diseases of the abdominal organs of an inflammatory nature (acute appendicitis, strangulated hernia, acute intestinal obstruction, perforation of a stomach or intestinal ulcer, thromboembolism, etc.), fraught with the risk of developing peritonitis or gangrene of an organ during thromboembolism;

¾ Purulent - inflammatory diseases (abscess, phlegmon, purulent mastitis, acute osteomyelitis, etc.) that can lead to the development of sepsis.

$ Absolute indications for surgery - diseases in which time is needed to clarify the diagnosis and more thorough preparation of the patient, but a long delay in the operation can lead to a condition that threatens the life of the patient. These operations are performed urgently after a few hours or days (usually within 24-72 hours of the preoperative period. A long delay in surgery in such patients can lead to tumor metastases, general emaciation, liver failure and other complications. Such diseases include:

¾ Malignant tumors;

¾ Pyloric stenosis;

¾ Obstructive jaundice, etc.;

$ Relative indications for surgery - diseases that do not pose a threat to the life of the patient. These operations are performed in a planned manner after a thorough examination and preparation at a time convenient for the patient and the surgeon:

¾ Varicose veins of the superficial veins of the lower extremities;

¾ Benign tumors, etc.

Revealing contraindications presents significant difficulties, since any operation and anesthesia pose a potential danger to the patient, and there are no clear clinical, laboratory and special criteria that assess the severity of the patient's condition, the upcoming operation and the patient's response to anesthesia.

Surgical intervention has to be postponed for some time in cases where it is more dangerous than the disease itself or there is a risk of postoperative complications. Most contraindications are temporary and relative.

Absolute contraindications for surgery:

¾ Terminal state of the patient;

Relative contraindications to surgery (any concomitant disease):

¾ Cardiac, respiratory and vascular insufficiency;

¾ shock;

¾ Myocardial infarction;

¾ Stroke;

¾ Thromboembolic disease;

¾ Renal - liver failure;

¾ Severe metabolic disorders (decompensation of diabetes mellitus);

¾ Pre-comatose state; coma;

¾ Severe anemia;

¾ Severe anemia;

¾ Advanced forms of malignant tumors (stage IV), etc.

In the presence of vital and absolute indications, relative contraindications cannot prevent an emergency or urgent operation after appropriate preoperative preparation. Planned operations are preferably carried out after appropriate preoperative preparation. It is desirable to carry out planned surgical interventions after the elimination of all contraindications.

The factors that determine the operational risk include the age of the patient, the state and function of the myocardium, liver, lungs, kidneys, pancreas, the degree of obesity, etc.

Established diagnosis, indications and contraindications allow the surgeon to resolve issues of urgency and scope of surgical intervention, method of anesthesia, preoperative preparation of the patient.

Question 3: Preparation of patients for planned operations.

Planned operations - when the outcome of treatment is practically independent of the time of execution. Before such interventions, the patient undergoes a complete examination, the operation is performed on the most favorable background in the absence of contraindications from other organs and systems, and in the presence of concomitant diseases - after reaching the stage of remission as a result of appropriate preoperative preparation. Example: radical surgery for non-strangulated hernia, varicose veins, cholelithiasis, uncomplicated gastric ulcer, etc.

1.General activities: general measures include improving the patient's condition by identifying and eliminating as much as possible violations of the function of the main organs and systems. During the period of preoperative preparation, the functions of organs and systems are carefully studied and they are prepared for surgical intervention. The nurse with full responsibility and understanding should relate to preoperative preparation. She is directly involved in the examination of the patient and the implementation of therapeutic and preventive measures. Basic and mandatory research before any planned operation:

J Measurement of blood pressure and pulse;

J Measurement of body temperature;

J Measuring the frequency of respiratory acts;

J Measurement of height and weight of the patient;

J Carrying out a clinical analysis of blood and urine; determination of sugar in the blood;

J Determination of blood group and Rh factor;

J Examination of feces for eggs of worms;

J Statement of the Wasserman reaction (=RW);

J In the elderly - an electrocardiographic study;

J According to indications - a blood test for HIV; others

a) preparation of the psyche and physical condition: creating an environment around the patient that inspires confidence in the successful outcome of the operation. All medical personnel should eliminate the moments that cause irritation as much as possible and create conditions that provide complete rest for the nervous system and the patient. For the correct preparation of the patient's psyche for the operation, it is of great importance that the nurses follow the rules of deontology. Before the operation in the evening, the patient is given a cleansing enema, the patient takes a hygienic bath or shower and changes underwear and bed linen. The morale of patients entering for surgery is significantly different from the state of patients who receive only conservative treatment, since the operation is a great physical and mental trauma. One "waiting" for the operation instills fear and anxiety, seriously undermines the strength of the patient. Starting from the emergency department and ending with the operating room, the patient looks and listens to everything around him, is always in a state of tension, usually turns to the junior and middle medical staff, looking for their support.

The protection of the patient's nervous system and psyche from irritating and traumatic factors largely determines the course of the postoperative period.

The nervous system is especially traumatized by pain and sleep disturbance, the fight against which (prescribing painkillers, sleeping pills, tranquilizers, sedatives and other drugs is very important during the preoperative preparation.

For the correct preparation of the patient's psyche for surgery, it is of great importance that the nursing staff follow the following rules of surgical deontology:

¾ When a patient enters the emergency department, it is necessary to provide him with the opportunity to calmly communicate with his relatives accompanying him;

¾ The diagnosis of the disease should be communicated to the patient only by a doctor who, in each individual case, decides in what form and when he can do this;

¾ It is necessary to address the patient by name and patronymic or last name, but do not call him impersonally “sick”;

¾ The patient before the operation is especially sensitive to the look, gesture, mood, carelessly spoken word, captures all the shades of the nurse's intonation. Particularly careful should be conversations during a planned round and rounds conducted for pedagogical purposes. At this moment, the patient is not only an object for research and teaching, but also a subject who catches every word of the bystanders and the teacher. It is very important that these words and gestures contain benevolence, sympathy, sincerity, tact, endurance, patience, warmth. The indifferent attitude of the nurse, the negotiations of the staff about personal, irrelevant things in the presence of the patient, the inattentive attitude to requests and complaints give the patient reason to doubt all further measures, alarm him. The talk of the medical staff about the poor outcome of the operation, death, etc. has a negative effect. A nurse who performs appointments or provides any assistance in the presence of patients in the ward must do it skillfully, calmly and confidently so as not to cause them anxiety and nervousness;

¾ Medical history and diagnostic data should be stored in such a way that they cannot become available to the patient; the nurse must be the keeper of medical (medical) secrets in the broadest sense of the word;

¾ In order to distract the patient from thoughts about his illness and the upcoming operation, the nurse should visit him as often as possible and, if possible, involve him in conversations far from medicine;

¾ Medical staff should ensure that in the hospital environment surrounding the patient there are no factors that irritate and frighten him: excessive noise, frightening medical posters, signs, syringes with traces of blood, bloody gauze, cotton wool, sheets, fabrics, tissue, organ or parts of it, etc.;

¾ The nurse must strictly monitor the strict observance of the nosocomial regimen (afternoon rest, sleep, bedtime, etc.);

¾ Medical staff should pay special attention to their appearance, given that untidiness, sloppy appearance causes the patient to doubt the accuracy and success of the operation;

¾ When talking with the patient before the operation, the operation should not be presented to him as something easy, at the same time he should not be frightened by the riskiness and the possibility of an unfavorable outcome. It is necessary to mobilize the strength and faith of the patient in a favorable outcome of the intervention, eliminate the fears associated with perverted ideas about the upcoming pain sensations during and after the operation, report postoperative pain. When explaining, the nurse must adhere to the same interpretation that the doctor gave, otherwise the patient ceases to believe the medical staff;

¾ The nurse must timely and conscientiously fulfill the doctor's prescriptions (taking tests, obtaining research results, medication prescriptions, preparing the patient, etc.), it is unacceptable to send the patient from the operating table to the ward due to his unpreparedness due to the fault of the medical staff; the nurse must remember that nursing at night is of particular importance, since there are almost no external stimuli at night. The patient is left alone with his illness, and, naturally, all his senses are sharpened. Therefore, care for him at this time of day should be no less thorough than during the day.

2.Specific events: these include activities aimed at preparing those organs on which the operation is to be performed. That is, a number of studies are being carried out related to the operation on this organ. For example, during heart surgery, heart sounding is performed, during lung surgery - bronchoscopy, during stomach operations - analysis of gastric juice and fluoroscopy, fibrogastroscopy. On the eve of the evening in the morning, the contents of the stomach are removed. With congestion in the stomach (pyloric stenosis), it is washed. At the same time, a cleansing enema is given. The patient's diet on the day before the operation: a regular breakfast, a light lunch, and sweet tea for dinner.

Before surgery for biliary tract it is necessary to examine the gallbladder, pancreas and bile ducts using special methods (ultrasound) and study the laboratory parameters of the functions of these organs and the exchange of bile pigments.

At obstructive (mechanical) jaundice the flow of bile into the intestine stops, the absorption of fat-soluble substances, which include vitamin K, is disrupted. Its deficiency leads to a deficiency of clotting factors, which can cause severe bleeding. Therefore, before surgery, a patient with obstructive jaundice is given vitamin K ( vikasol 1% - 1 ml), a solution of calcium chloride, transfuse blood, its components and preparations.

Before the operation on the large intestine for the prevention of endogenous infection, it is very important to thoroughly cleanse the intestines, but at the same time, the patient, often emaciated and dehydrated by the underlying disease, should not starve. He receives a special diet containing high-calorie food, devoid of toxins and gas-forming substances. Since an operation with an opening of the large intestine is supposed, to prevent infection, patients begin to take antibacterial drugs during the preparation period ( colimycin, polymyxin, chloramphenicol and etc.). Fasting and the appointment of laxatives are resorted to only according to indications: constipation, flatulence, lack of a normal stool. On the evening before the operation and in the morning, the patient is given a cleansing enema.

For operations in the area rectum and anus(for hemorrhoids, anal fissures, paraproctitis, etc.) it is also necessary to thoroughly clean the intestines, since in the postoperative period the stool is artificially retained in the intestines for 4-7 days.

To survey departments large intestine resort to radiopaque (barium passage, irrigoscopy) and endoscopic (sigmoidoscopy, colonoscopy) studies.

Patients with very large, long-term hernias of the anterior abdominal wall. During the operation, the internal organs located in the hernial sac are set into the abdominal cavity, this is accompanied by an increase in intra-abdominal pressure, displacement and high standing of the diaphragm, which makes it difficult for cardiac activity and respiratory excursions of the lungs. To prevent complications in the postoperative period, the patient is placed on a bed with a raised leg end, and after the contents of the hernial sac have been reduced, a tightening bandage or sandbag is applied to the area of ​​the hernial orifice. The body is "accustomed" to the new conditions of the high standing of the diaphragm, to the increased load on the heart.

Special training on limbs comes down to cleansing the skin from contamination with baths with a warm and weak antiseptic solution (0.5% ammonia solution, 2-4% sodium bicarbonate solution, etc.).

Other diseases and operations require appropriate special studies and preoperative preparation, often in a specialized surgical department.

¾ Preparation of the cardiovascular system:

On admission - examination;

Carrying out a general blood test

Biochemical analysis of blood and, if possible, normalization of indicators

Measurement of heart rate and blood pressure

Removing an ECG

Taking into account blood loss - preparation of blood, its preparations

Instrumental and laboratory research methods (ultrasound of the heart).

¾ Respiratory system preparation:

· To give up smoking

Elimination of inflammatory diseases of the upper respiratory tract.

Carrying out breath tests

Teaching the patient how to breathe and cough properly, which is important for the prevention of pneumonia in the postoperative period

· Chest x-ray or X-ray.

¾ Gastrointestinal preparation

Sanitation of the oral cavity

Gastric lavage

Suction of the contents of the stomach

Meals before surgery

¾ Preparation of the genitourinary system:

Normalization of kidney function;

· Carry out studies of the kidneys: urine tests, determination of residual nitrogen (creatinine, urea, etc.), ultrasound, urography, etc. If pathology is detected in the kidneys or in the bladder, appropriate therapy is carried out;

· For women, before the operation, a gynecological examination is mandatory, and if necessary, treatment. Planned operations during menstruation are not carried out, since these days there is increased bleeding.

¾ Immunity and metabolic processes:

Improving the immunobiological resources of the patient's body;

Normalization of protein metabolism;

· Normalization of water-electrolyte and acid-base balance.

¾ Skin covers:

Identification of skin diseases that can cause severe complications in the postoperative period, up to sepsis (furunculosis, pyoderma, infected abrasions, scratches, etc.). Preparation of the skin requires the elimination of these diseases. On the eve of the operation, the patient takes a hygienic bath, shower, changes underwear;

· The operating field is prepared immediately before the operation (1-2 hours in advance), since cuts and scratches that may occur during shaving may become inflamed over a longer period of time.

On the eve of the operation the patient is examined by an anesthesiologist, who determines the composition and timing of premedication, the latter is usually carried out 30-40 minutes before the operation, after the patient has urinated, removed dentures (if any), as well as other personal belongings.

The patient, covered with a sheet, is taken on a gurney head first to the operating unit, in the vestibule of which he is transferred to the gurney of the operating room. In the preoperative room, a clean cap is put on the patient's head, and clean shoe covers are put on his feet. Before bringing the patient to the operating room, the nurse should check whether the bloody underwear, dressings, and instruments from the previous operation have been removed there.

The medical history, x-rays of the patient are delivered simultaneously with the patient.

In each 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 assigned 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 cancer of the esophagus 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 surgery 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).

At the same time, all these reasons are not a contraindication for the use of palliative procedures performed according to vital indications 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 and contraindications for surgery.

Indications for surgery are divided into absolute and relative.

Absolute readings The operation considers diseases and conditions that pose a threat to the life of the patient, which can only be eliminated surgically.

Absolute indications for performing emergency operations are otherwise called ʼʼvitalʼʼ. This group of indications includes asphyxia, bleeding of any etiology, acute diseases of the abdominal organs (acute appendicitis, acute cholecystitis, acute pancreatitis, perforated gastric and duodenal ulcers, acute intestinal obstruction, strangulated hernia), acute

purulent surgical diseases (abscess, phlegmon, osteomyelitis, mastitis, etc.).

In elective surgery, indications for surgery are also absolute. In this case, urgent operations are usually performed, not postponing them for more than 1-2 weeks.

The following diseases are considered absolute indications for a planned operation:

‣‣‣ malignant neoplasms (cancer of the lung, stomach, breast, thyroid, colon, etc.);

‣‣‣ stenosis of the esophagus, the outlet of the stomach;

‣‣‣ obstructive jaundice, etc.

Relative readings The operation includes two groups of diseases:

‣‣‣ Diseases that can be cured only by surgery, but do not directly threaten the life of the patient (varicose saphenous veins of the lower extremities, non-strangulated abdominal hernias, benign tumors, cholelithiasis, etc.).

‣‣‣ Diseases that are quite serious, the treatment of which can in principle be carried out both surgically and conservatively (ischemic heart disease, obliterating diseases of the vessels of the lower extremities, peptic ulcer of the stomach and duodenum, etc.). In this case, the choice is made on the basis of additional data, taking into account the possible effectiveness of a surgical or conservative method in a particular patient. According to relative indications, operations are performed in a planned manner under optimal conditions.

There is a classic division of contraindications into absolute and relative.

To absolute contraindications include a state of shock (except for hemorrhagic shock with ongoing bleeding), as well as an acute stage of myocardial infarction or cerebrovascular accident (stroke). It should be noted that at present, if there are vital indications, it is possible to perform operations against the background of myocardial infarction or stroke, as well as in case of shock after stabilization of hemodynamics. For this reason, the allocation of absolute contraindications is currently not of fundamental importance.

Relative contraindications include any concomitant disease. At the same time, their influence on the portability of the operation is different. The greatest danger is the presence of the following diseases and conditions: Cardiovascular system: hypertension, coronary heart disease, heart failure, arrhythmias, varicose veins, thrombosis. Respiratory system: smoking, bronchial asthma, chronic bronchitis, pulmonary emphysema, respiratory failure. Kidneys: chronic pyelonephritis and glomerulonephritis, chronic renal failure, especially with a pronounced decrease in glomerular filtration. Liver: acute and chronic hepatitis, cirrhosis of the liver, liver failure. Blood system: anemia, leukemia, changes in the coagulation system. Obesity. Diabetes.

Indications and contraindications for surgery. - concept and types. Classification and features of the category "Indications and contraindications for surgery." 2017, 2018.

Indications. Allocate vital indications (absolute) and relative. Indicating the indications for the operation, it is necessary to reflect the order of its implementation - emergency, urgent or planned. Emergency: o.appendicitis, o. surgical diseases of the abdominal organs, traumatic injuries, thrombosis and embolism, after resuscitation.

Contraindications. There are absolute and relative contraindications to surgical treatment. The range of absolute contraindications is currently sharply limited, they include only the agonal state of the patient. In the presence of absolute contraindications, the operation is not performed even according to absolute indications. So, in a patient with hemorrhagic shock and internal bleeding, the operation should be started in parallel with anti-shock measures - with continued bleeding, shock cannot be stopped, only hemostasis will allow the patient to be taken out of shock.

196. The degree of operational and anesthetic risk. The choice of anesthesia and preparation for it. Preparing for emergency operations. Legal and legal bases for conducting examinations and surgical interventions.

RISK ASSESSMENT OF ANESTHESIA AND SURGERY The degree of risk of surgery can be determined based on the patient's condition, the volume and nature of the surgical intervention, adopted by the American Society of Anesthesiologists - ASA. According to the severity of the somatic condition: I (1 point)- patients in whom the disease is localized and does not cause systemic disorders (virtually healthy); II (2 points)- patients with mild or moderate disorders that to a small extent disrupt the vital activity of the body without pronounced shifts in homeostasis; III (3 points)- patients with severe systemic disorders that significantly disrupt the vital activity of the body, but do not lead to disability; IV (4 points)- patients with severe systemic disorders that pose a serious danger to life and lead to disability; V (5 points)- patients whose condition is so severe that they can be expected to die within 24 hours. According to the volume and nature of the surgical intervention: I (1 point)- small operations on the surface of the body and abdominal organs (removal of superficially located and localized tumors, opening of small abscesses, amputation of fingers and toes, ligation and removal of hemorrhoids, uncomplicated appendectomy and herniotomy); 2 (2 points)- operations of moderate severity (removal of superficially located malignant tumors requiring extended intervention; opening of abscesses located in cavities; amputation of segments of the upper and lower extremities; operations on peripheral vessels; complicated appendectomy and herniotomy requiring extended intervention; trial laparotomy and thoracotomy; other similar by complexity and volume of intervention; 3 (3 points)- extensive surgical interventions: radical operations on the abdominal organs (except those listed above); radical operations on the organs of the breast; extended limb amputations - transiliosacral amputation of the lower limb, etc., brain surgery; 4 (4 points)- operations on the heart, large vessels and other complex interventions performed under special conditions - artificial circulation, hypothermia, etc. The gradation of emergency operations is carried out in the same way as planned ones. However, they are designated with the index "E" (emergency). When marked in the medical history, the numerator indicates the risk by the severity of the condition, and the denominator - by the volume and nature of the surgical intervention. Classification of operational and anesthetic risk. MNOAR-89. In 1989, the Moscow Scientific Society of Anesthesiologists and Resuscitators adopted and recommended for use a classification that provides for a quantitative (in points) assessment of operational and anesthetic risk according to three main criteria: - general condition of the patient; - the volume and nature of the surgical operation; - the nature of anesthesia. Assessment of the general condition of the patient. Satisfactory (0.5 points): somatically healthy patients with localized surgical disease or not associated with the underlying surgical disease. Moderate severity (1 point): Patients with mild or moderate systemic disorders associated or not associated with the underlying surgical disease. Severe (2 points): patients with severe systemic disorders that are associated or not associated with surgical disease. Extremely severe (4 points): patients with extremely severe systemic disorders that are associated or not associated with a surgical disease and pose a danger to the life of the patient without surgery or during surgery. Terminal (6 points): patients in a terminal state with severe symptoms of decompensation of the functions of vital organs and systems, in which death can be expected during surgery or in the next few hours without it. Estimation of the volume and nature of the operation. Minor abdominal or minor surgeries on body surfaces (0.5 points). More complex and lengthy operations on the surface of the body, spine, nervous system and operations on internal organs (1 point). Major or lengthy surgeries in various fields of surgery, neurosurgery, urology, traumatology, oncology (1.5 points). Complex and lengthy operations on the heart and large vessels (without the use of IR), as well as extended and reconstructive operations in surgery of various areas (2 points). Complex operations on the heart and great vessels with the use of IR and transplantation of internal organs (2.5 points). Assessment of the nature of anesthesia. Different kinds local potentiated anesthesia (0.5 points). Regional, epidural, spinal, intravenous or inhalation anesthesia with spontaneous breathing or with short-term assisted ventilation of the lungs through the mask of the anesthesia machine (1 point). Usual standard options for general combined anesthesia with tracheal intubation using inhaled, non-inhaled or non-drug anesthesia (1.5 points). Combined endotracheal anesthesia with the use of inhaled non-inhaled anesthetics and their combinations with methods of regional anesthesia, as well as special methods of anesthesia and corrective intensive care (artificial hypothermia, infusion-transfusion therapy, controlled hypotension, circulatory support, pacing, etc.) (2 points). Combined endotracheal anesthesia with the use of inhalation and non-inhalation anesthetics under conditions of IR, HBO, etc. with the complex use of special anesthesia methods, intensive care and resuscitation (2.5 points). Risk degree: I degree(minor) - 1.5 points; II degree(moderate) -2-3 points; III degree(significant) - 3.5-5 points; IV degree(high) - 5.5-8 points; V degree(extremely high) - 8.5-11 points. With emergency anesthesia, a risk increase of 1 point is acceptable.

Preparing for emergency operations

The amount of preparation of the patient for an emergency operation is determined by the urgency of the intervention and the severity of the patient's condition. Minimal preparation is performed in case of bleeding, shock (partial sanitization, shaving of the skin in the area of ​​the surgical field). Patients with peritonitis require preparation aimed at correcting water and electrolyte metabolism. If the operation is supposed to be under anesthesia, the stomach is emptied using a thick tube. With low blood pressure, if it is not caused by bleeding, intravenous administration of blood substitutes of hemodynamic action, glucose, prednisolone (90 mg) should increase blood pressure to a level of 90-100 mm Hg. Art.

Preparing for emergency surgery. In conditions that threaten the life of the patient (wound, life-threatening blood loss, etc.), no preparation is carried out, the patient is urgently taken to the operating room without even taking off his clothes. In such cases, the operation begins simultaneously with anesthesia and resuscitation (resuscitation) without any preparation.

Before other emergency operations, preparations for them are still being carried out, albeit in a significantly reduced volume. After deciding on the need for surgery, preoperative preparation is carried out in parallel with the continuation of the examination of the patient by the surgeon and anesthesiologist. Thus, the preparation of the oral cavity is limited to rinsing or wiping. Preparation of the gastrointestinal tract may include evacuation of gastric contents and even leaving a gastric nasal tube (for example, in intestinal obstruction) for the duration of the operation. An enema is rarely given, only a siphon enema is allowed when trying to conservatively treat intestinal obstruction. In all other acute surgical diseases of the abdominal cavity, an enema is contraindicated.

The hygienic water procedure is carried out in an abbreviated form - a shower or washing the patient. However, the preparation of the surgical field is carried out in full. If it is necessary to prepare patients who came from production or from the street, whose skin is heavily contaminated, the preparation of the patient's skin begins with mechanical cleaning of the surgical field, which in these cases should be at least 2 times larger than the intended incision. The skin is cleaned with a sterile gauze swab moistened with one of the following liquids: ethyl ether, 0.5% ammonia solution, pure ethyl alcohol. After cleaning the skin, the hair is shaved and the surgical field is further prepared.

In all cases, the nurse should receive clear instructions from the doctor on how much and by what time she must fulfill her duties.

197. Preparation of the patient for surgery. Training goals. Deontological preparation. Medical and physical preparation of the patient. The role of physical training in the prevention of postoperative infectious complications. Preparation of the oral cavity, preparation of the gastrointestinal tract, skin.

Name surgical operation is made up of the name of the organ on which it is performed and the term that denotes the operational technique being performed.

The following terms are used:

Tomia- dissection, incision, opening;

ectomy- excision;

extirpation- isolating, husking;

resection- partial excision;

amputation- removal of the peripheral part of the organ;

stomia- creation of an artificial fistula;

centes- puncture.

This is where the following names come from:

• rumenotomy(rumen - scar, tomia - dissection) - dissection of the scar;
• enterectomy(enteron - gut, ectomia - excision) - excision of the intestine.
• urethrostomy(urethra - urethra, stomia - creation of an artificial fistula) - the creation of an artificial fistula of the urethra.

Indications and contraindications for operations

Each surgical operation preceded by a diagnosis based on clinical, laboratory or radiological examination.

Thereafter operation substantiate with relevant evidence. In all difficult and doubtful cases of determining indications for surgery, it is necessary to resort to a consultation.

« A cleverly performed surgical operation does not give the right to the title of an experienced clinician. Only a doctor with good clinical training can be a good surgeon.».

Indications for surgery- these are cases when surgical operations are necessary or can be performed.

Indications may be:

• absolute(indicatio vitalis) - those cases in which there is no other way to cure the animal (malignant neoplasms, bleeding, suffocation, pneumothorax, tympania of the scar, prolapse of internal organs);
• relative- those cases in which the operation can be omitted without causing significant damage to the health and productivity of the animal, or when the operation is not the only method of treatment (benign tumor, not strangulated hernia).

NB! One should not resort to surgery when the animal can be cured in an easier and safer way, but also not to neglect the operation when it is the only method of treatment.

Contraindications for surgery- these are cases when the operation cannot or is undesirable to perform.

They are divided into:

Contraindications due to the serious condition of the animal:

With exhaustion, old age, exacerbation of the inflammatory process, fever, infectious disease, a large amount of damage, the second half of pregnancy, sexual hunting in females.

An exception is urgent operations (strangulated hernia, phlegmon, malignant tumor). In these cases, the entire risk must be explained to the owner of the animal.

Contraindications due to economic and organizational factors:

• when imposing a quarantine for an infectious disease characteristic of this type of animal (erysipelas, plague, washing horses, anthrax);
• before the transfer and regrouping of animals;
• 2 weeks before and within 2 weeks after preventive vaccination;
• in the absence of appropriate sanitary conditions for the postoperative maintenance of animals.

The exception is urgent cases that require emergency intervention, in which the operation must be performed in compliance with all the rules of one's own protection and prevention of the further spread of the disease.

Mass operations cannot be carried out in farms that do not have the proper conditions for the postoperative maintenance of animals (calves cannot be castrated if they are kept knee-deep in slurry).

Any surgical operation involving a risk to the life of the animal must be performed only with the written consent of the legal owner of the animal or his representative (head of the farm, private owner of the animal).

If we are talking about an animal that is state property, then the doctor, who imagines the whole need for an operation, must insist on its performance, and, if necessary, operate without waiting for consent.

Any surgical operation has a relative degree of risk.

The risk is negligible. The existing disorders do not affect the general condition and do not cause disorders in other organs and tissues. This group also includes planned operations.

Grade 2 - moderate.

This applies to emergency operations that cannot be postponed, and the animal has moderately severe cardiac or respiratory failure.

Grade 3 - severe.

A sick animal had local lesions of vital organs (myocardial infarction, acute respiratory failure, diabetes).