How to prepare for general anesthesia. Preparing the patient for general anesthesia. Complications of early menopause

For any operation should be thoroughly prepared. Is it true that it is better to go to the surgeons with an empty stomach? What to do before the intervention for people with heart disease? These questions are always of interest to patients. How to prepare for the operation was told by the chief anesthesiologist of the Ministry of Health of Ukraine, head of the department of anesthesiology and intensive care National medical university named after A. A. Bogomolets, doctor medical sciences, Professor Felix Glumcher. An interview with him was published by the weekly Facts. Events and people.

The gallbladder, clogged with stones, surgeons recommend removing. Felix Semenovich, tell me, can hypertension become an obstacle to the operation?

Not at all. Before surgical intervention one always talks to the anesthesiologist. The doctor will definitely find out what drugs the patient is taking. Some of them, such as aspirin, may have to be abandoned: they can increase bleeding and change the effect of anesthetics. And here is the reception antihypertensive drugs it is not necessary to stop - cancellation can cause a pressure surge.

Many people feel insecure before surgery. Is it possible to drink a little cognac for courage?

In no case! Alcohol should not be consumed even a week before surgery. Alcohol damages the liver, impairing its ability to neutralize and eliminate toxic substances. The heart works worse, pressure jumps, arrhythmia occurs. Blood clotting may change, and then blood clots form, clogging the vessels, or, conversely, bleeding opens. It has been observed that older people sometimes develop bronchitis or pneumonia after surgery. In smokers, such complications develop more often and they are more severe.

I would also advise you to quit smoking: the substances contained in tobacco negatively affect the functioning of all organs.

Is it true that you should go to an operation with an empty stomach, and it would be better if a person goes hungry two days before it?

No. The patient needs to eat normally in order to have the strength to survive the operation and recover faster after it. Low-fat meat, chicken, fish, cottage cheese, kefir and others are useful dairy products. From food saturated with animal fats (lard, sausages), it is better to refrain: it is poorly absorbed. Should not be consumed Exotic fruits and dishes that a person has not eaten before: if an allergy occurs, the operation can be canceled.

You should also eat well after surgery. It used to be thought that it restores strength better chicken bouillon. But, according to the latest data, preference should be given to fish broth. If after the operation the patient cannot eat on his own, they put a probe into the stomach or intestines, or even inject special solutions into the blood through a vein. For severe postoperative patients developed special formulations, which, say, when introduced into the intestine, are absorbed with little or no waste.

How do you recommend preparing for surgery for a person who has diabetes and ischemic heart disease?

Continue treatment and administer insulin at such doses that the blood glucose level is within the normal range. Do not stop taking drugs prescribed against coronary disease hearts. It is often recommended before surgery additional medicines, normalizing vascular tone to reduce the risk of pressure surges. These and other drugs will be prescribed by the anesthetist and surgeon who will perform the operation.

You need to refuse solid food eight hours, and liquid food two hours before the start of the operation.

In the old days, surgeons "turned off" the patient with a hammer, which was beaten on the crown of the head. There was a time that alcohol was given for pain relief. What methods are used today?

Most often, general anesthesia is used - the so-called anesthesia. Special substances are injected into a vein or by inhalation into the trachea. This is how they act if you have to operate in the chest or abdominal cavities, with other complex interventions when it is required to carry out complete anesthesia and relax the muscles. If you need to “turn off” a part of the body, they can apply regional anesthesia(epidural, spinal and other types). Sometimes a local anesthetic is enough.

In general, it used to be considered normal that the patient suffers from pain for some time after the operation. Today they have a different opinion. The fact is that when a person has something for a long time, the body secretes stress hormones that cause spasm blood vessels. As a result, tissues experience a lack of oxygen, nutrients, and the patient's wounds heal worse. The digestive organs, the cardiovascular system also suffer, the functions of the heart and brain are disturbed. If conventional analgesics or injections do not help, the patient may be given medication in the epidural space (the area near the spine). When a person does not experience pain, the body recovers faster.

So, you are going to have surgery. You have already come to terms with the thought of this difficult test and now you want to prepare as best as possible for it. And rightly so, because the right approach to the operation, as well as the subsequent compliance with the rules and regulations of the postoperative regime, plays a very important role in the recovery of the patient and maintaining his health. In fact, preparation for elective surgery begins long before planned hospitalization sick.

If you have a planned operation...

It includes not only a whole list of important activities aimed at improving health, preparing personal hygiene products, necessary clothing and items to fill free time. You also need to take care of developing a certain psychological attitude that allows you to calmly, correctly, soberly and balancedly relate to the upcoming medical manipulations.

To your health

Before planned operation need to make the most possible health of your body. If there are any chronic ailments care should be taken to achieve their stable remission. Your therapist will help you with this.

Stop smoking approximately one and a half months before the proposed intervention. So you can significantly reduce the likelihood of developing some respiratory complications after coming out of anesthesia. If you still can't quit smoking, don't try to grab a cigarette even on the day of your surgery.

If you have overweight body, do everything possible to get rid of at least a couple extra pounds. This will avoid many different complications and problems after surgery.

If you have loose teeth or crowns, take the time to visit your dentist and get the appropriate treatment. During the operation there is a significant risk of losing such teeth during installation by the anesthesiologist special equipment to ensure patency respiratory tract.

In addition, you should prepare all the medicines you need in advance and take them with you to the hospital.

Remove all jewelery and jewelry from yourself. If you cannot do this for some reason, wrap them with duct tape before the operation. This will help avoid damage to them, and also prevent them from accidentally injuring your skin.

Remember that the clothes that you take to the hospital can get very dirty, so give preference to those things that you do not mind throwing away. Most medical institutions the patient before the operation is recommended to change into a special hospital gown.

Fasting mode

Unless you have received any special advice from your surgeon or anesthesiologist, remember that on the day before surgery you are allowed to drink and eat normally until midnight. However, in the morning, on the day of the operation, you can not consume anything. Your stomach should not contain any the slightest amount water and food, as otherwise the safety of anesthesia may be significantly reduced, creating real threat life and health.

For children age group slightly different rules apply. So until the age of six months, the last meal should be taken no later than four to six hours before anesthesia. For children aged six to thirty-six months, this period is at least six hours. Drinking is not recommended for at least two to three hours before surgery. All of these instructions remain in effect unless otherwise advised by the anesthesiologist.

Hygiene measures

In the evening, on the day before the operation, take a shower or a bath, unless you have been told to do so by your doctor. Similar procedure will cleanse your body of small invisible impurities, which will significantly reduce the risk of infection during surgical intervention.

In the morning, be sure to brush your tooth or at least rinse your mouth thoroughly.

Before the operation

Extract from oral cavity foreign objects present: piercings, dentures, sweets and chewing gum. All of these items can cause breathing problems after you are put under anesthesia.
In addition, you should remove hearing aid and contact lenses.

Nails should be kept short and free of nail polish. The applied varnish will prevent you from assessing your condition by the color of the nail plate, and may also prevent you from working normally. special device, which reads information about the rhythm of breathing and is attached to one of the fingers.

Taking medication

If you need to take some other medications the morning before your surgery and your anesthesiologist has no problem, try to swallow the tablets without water. If this is not possible, the amount of liquid should be minimal, in addition, it is recommended to shift the intake of drugs to the maximum possible early morning time.

To especially dangerous drugs before the operation, Viagra is attributed, since in combination with anesthesia it causes hard fall blood pressure leading to damage to the kidneys, brain and heart. Do not take Viagra at least a day before surgery.

As mentioned above, proper preparation to the operation also includes mental attitude. Trust your doctor, trust that the intervention will be easy and successful, and it will actually be so.

(General principles for preparing patients for surgical treatment at the Center)

Any intervention in the human body is perceived as severe stress. Preparation for surgery is one of the stages of treatment, the nature of which largely determines the restoration of lost body functions and the improvement of the patient's quality of life. Preparation includes a complex of therapeutic and diagnostic measures, taking into account clinical and individual features patient and the nature of the subsequent surgical intervention.

Why you need to prepare for surgery
To minimize risk, you need:

• exclude infection from entering the body, including the prevention of chronic diseases and dental treatment as potential sources, the skin should not show signs of infection or irritation,
• ensure a good state of immunity, which may require taking additional drugs reinforcing it,
• prepare the body for future rehabilitation with the help of physical activity,
• reduce the potential load, which requires the normalization of weight and correct execution exercises.

Note! It is important! The optimal body mass index (BMI) is less than 35 kg/m2. BMI can be calculated using the following formula:

Depending on the patient's condition and the degree of his activity in fulfilling the doctor's recommendations, preparation for the operation can take from several days to 5-6 months.

Surgical interventions in our Center are carried out in a planned manner, so there is always the opportunity to prepare in time for surgical operation.

How to prepare for surgery

• change necessary analyzes, conducting research and consulting specialist doctors who will help prepare for the intervention,
• determination of individual factors affecting the course of the operation: allergy to drugs, individual intolerance to some medicines etc.,

After all, the excellent condition of the patient and his emotional mood guarantee the success of the whole case.

Social Support Planning

Although soon after the operation the patient begins to move around with the help of a walker or crutches, within a few weeks he will need help with household chores: bathing, cooking, washing, shopping. If the patient lives alone, then help in this can be provided Social worker or medical staff at the place of residence.

Home planning

The following are activities that need to be carried out at home to facilitate the recovery period:

• install carefully fixed handrails in the shower or bath,
• install carefully fixed handrails on all stairs,
• purchase a stable chair with a firm seat that keeps the knees below the line hip joints, with a firm back and two armrests,
• raised toilet seat
• a stable bench or a special chair for bathing in the shower,
• choose a washcloth for bathing long handle and a comfortable shower head,
• buy a special cane-handle for dressing and undressing, devices for dressing socks and stockings, a shoe horn with a long handle, which allow you to perform familiar actions without excessive bending in the joint,
• dense seats for chairs, armchairs, sofas (in the car), which ensures the position of the knees below the line of the hip joints,
• place items of regular use at arm level,
• remove all slippery rugs and electrical cords from the home that are in the way of the patient's usual routes.

Actions of the doctor and the patient a month before the operation

Approximately 2-4 weeks before the operation, undergo laboratory and instrumental studies, get advice from specialist doctors. Their purpose is to determine the factors that will require correction before surgery. In particular, they are appointed:

1. Laboratory research:

General blood test with platelet count (shelf life 10 days),

Coagulogram (shelf life 10 days),

Biochemical blood test (transaminases, bilirubin, sugar, total protein, urea, creatinine) (shelf life 1 month),

Analysis for blood type and Rh factor,

Blood test for markers of hepatitis B (HbSAg) and hepatitis C (HCV) (shelf life 3 months),

Blood test for syphilis (shelf life 1 month),

Blood test for HIV infection (validity 3 months) (for non-residents certified by the seal of the institution),

Urinalysis (shelf life 10 days), - analysis for specific infections(PCR) (according to indications) (shelf life 30 days);

The results of a three-time puncture of the joint with seeding for microflora and sensitivity to antibiotics (in the presence of a metal structure in the surgical area) (shelf life - 30 days);

Analysis of feces for worm eggs (shelf life 10 days).

2. Fluorographic examination(shelf life 12 months) .

3. Electrocardiogram (ECG) with interpretation and conclusion (shelf life 14 days).

4. Daily monitoring ECG, echocardiography, cardiologist consultation for people with heart disease vascular system and over 65 years old.

5. USDG of veins lower extremities and consultation with an angiosurgeon(in case of deviation from the norm of the results of UZDG) (shelf life 30 days).

6.Ultrasound of the brachiocephalic arteries and consultation with a neurologist for people who have undergone stroke.

7. Fibrogastroduodenoscopy(shelf life 30 days) (in case of changes, it is necessary to undergo treatment; the presence of erosions or ulcers is a contraindication for surgical intervention).

8. X-rays.

9. Conclusion of medical specialists(shelf life 1 month):

Therapist

Gynecologist (for women),

Urologist (for men),

Dentist (about sanitation of the oral cavity),

Profile specialists (in the presence of concomitant diseases).

If deviations from the norm are detected, the doctor will prescribe the appropriate treatment. For the remaining period, you can eliminate the reasons that will be contraindications for the operation.

Patient activities one week before surgery

1. Three days before hospitalization, follow a sparing diet: broth, boiled meat, fish, chicken, cheese, milk. Observe the water and drinking regimen (fluid intake of at least 1.5 liters per day) If available chronic constipation for 2-3 days, take laxatives (senade, dufalac, bisacodyl, etc.) or combine with cleansing enemas.

2. On the eve of hospitalization, take a bath or shower, make foot bath, short cut toenails and hands, nails should be without varnish coatings.

4. If you are taking anticoagulants and antiplatelet agents:

7 days before surgery - stop taking clopidogrel and acetylsalicylic acid(aspirin at a dose of not more than 100 mg / day can be continued),

5 days before surgery - stop taking warfarin,

3 days before the operation - those who stopped taking warfarin are prescribed enoxaparin sodium in a prophylactic dose (0.4 ml 1 time per day subcutaneously),

1 day before surgery - stop taking (if taken before) non-steroidal anti-inflammatory drugs.

Basic cardiotropic, antihypertensive, antiarrhythmic therapy should not be canceled!!!

Hospitalization is possible in the presence of all the above examination results, in the absence of pronounced changes in analyzes and the absence of contraindications from medical specialists, with a body mass index of not more than 40.

Over the years of operation of our Center, more than 48,000 operations have been performed on residents of 70 regions Russian Federation, including about 4000 operations in childhood.

In the structure of surgical interventions, joint replacements account for 71.5%, reconstructive plastic surgery - 20%, spinal surgery - 8.5%. (of which 1/10 part is the correction of scoliotic deformity of the spine).

All patients admitted for hospitalization are subject to a joint examination by an orthopedic traumatologist and a therapist at the stage of the admission department. Assigned if necessary additional research, consultations of narrow specialists, in difficult cases, medical consultations are held.

An integrated approach and a thorough examination at the level of the admission department allows you to timely identify pathological changes in the body, requiring correction and postponing the date of surgery for more late deadline or reject it.

According to the Federal State Budgetary Institution “FTsTOE” of the Ministry of Health of Russia (Cheboksary), refusals on the day of hospitalization average 20%.

Root Cause Analysis

• severe obesity (body mass index over 40 kg/m2) - 11.5%,
• diseases of the skin and subcutaneous fat, incl. fungal infection, bedsores II-III st., erysipelas - 29%,
• pathology of the cardiovascular system ( decompensation of CHF, uncorrected blood pressure and arrhythmias and conduction of the heart, as well as such emergency conditions, how acute infarction myocardial infarction, unstable progressive angina pectoris, arrhythmia according to the type of newly diagnosed atrial fibrillation) - 18.3%,
• pathology venous system(acute phlebothrombosis) - 4.9%, (detected mainly in patients with a fracture of the femoral neck at terms preoperative period- from 5 to 30 days, with inadequate antithrombotic therapy or its absence),
• sharp ulcerative lesions gastrointestinal tract - 3,2%,
• high activity rheumatoid arthritis 9,7%,
• intra-articular injection of glucocorticoids 2 months before hospitalization - 1.2%,
• severe anemia - 2.1%,
• sharp and chronic diseases in the acute stage - 15.4%,
• lack of indications for surgical treatment was found in 1.9% of patients,
• patient's refusal to surgical treatment - 2,8%.

Good and timely preparation will reduce anxiety, mentally tune in to surgery and quickly begin recovery. motor activity. It depends only on the desire of the person how quickly the day of the operation comes. After all, violating the recommendations of the doctor, you can delay the operation.

You will need

• – complete preoperative examination of the body;
• – consultation with an anesthesiologist;
• - preparation for anesthesia

Instruction

Preliminary preparation for the operation and the anesthesia procedure consists in a comprehensive examination of the state of the body. it whole complex laboratory tests and instrumental research. Accompanying illnesses it is necessary, if not cured, then transferred to the stage of compensation.

Even before consulting with an anesthesiologist, think over a conversation with him. Remember if you had surgery under anesthesia before and how you endured it; whether there is an allergy to anything; which ones do you accept. This information is necessary for the anesthesiologist to select and dose drugs, which are selected strictly individually.

A day before the operation, women with a manicure should remove the varnish from their nails. You need to remove makeup from your face and do not use cosmetics, perfumes.

On the eve of the operation last time you can eat not late in the evening, and preferably solid, not liquid food. At night, it is necessary to cleanse the intestines by taking a laxative or making an enema. Laxative anal suppositories "Bisacodyl" are effective.

On the day of the operation, you can’t eat or drink anything, you have to be patient. But, if you are very thirsty, you can drink water at least four hours before leaving for the operating unit. A quarter glass, no more.

Before the operation, the patient usually takes off all his clothes, he is given sterile shoe covers and a gown. First you need to remove watches, beads and other jewelry. Mobile phone turn off and pass on to loved ones. If you wear dentures, be sure to remove them too.

The most difficult thing is the restrictions on drinking and eating. They are practically the same as. Babies can be breastfed up to four hours before surgery, artificial babies up to six hours. Water should not be given to all children four hours before anesthesia.

Intestines little patient should also be emptied, especially if the operation is to be done on it. For three days, the child should not be given meat dishes and foods that are high in fiber.

With the consent of the surgeon, it is desirable that the mother is next to the child until he falls asleep from anesthesia. If after the operation he is transported not to the intensive care unit, but to the ward, you should be on duty near him, especially the first day after the operation.

note

Anesthesia should not cause strong side effects(vomiting, “lapses” in memory, etc.). Sometimes there are mild disorders of attention, thinking, but they soon pass. The usual occurrences are mild nausea, dry throat, dizziness, general weakness.

Two or three days before the operation, you can not take alcohol, drugs.

Obese people and smokers tolerate anesthesia worse, so it is recommended to lose weight before surgery. excess weight and at least temporarily not to smoke.

Interruption of medications prescribed for permanent use (for example, diabetics, hypertensive patients) is not required either before or after anesthesia.

Useful advice

Anesthesia is general and local. General - this is anesthesia, i.e. anesthesia with loss of consciousness. Therefore, to say “under general anesthesia” is incorrect, since “ local anesthesia" can not be. The second type is local anesthesia, i.e. local, partial, in which consciousness is completely preserved. When possible, the operation local anesthesia it is better to choose it instead of anesthesia.

If you have had surgery before and the standard doses did not work for you, be sure to tell the anesthesiologist about it!

Usually drugs for anesthesia are administered in two ways: intravenously and inhalation, through a breathing mask. Inhalation anesthesia preferable, as it provides a state of sleep with a lower dose of the drug. The stronger the dosage of anesthesia, the more likely complications. But do not believe the tales that anesthesia "takes away five years of life" or "undermines the heart."

Sources:

• Website DoktorSafonova.ru/Interview with an anesthesiologist
• Malysh-nash.ru website / How to prepare a child for anesthesia
• Video: How anesthesia works

This article is for patients. It will tell you how to prepare for surgery on the organs. abdominal cavity(, stomach, intestines, pancreas, gynecological surgery etc.).

How to prepare for surgery?

Regardless of the diagnosis and volume of surgery, all patients undergo some preparation for surgery on the abdominal organs. As a rule, the doctor tells the patient how to prepare for the surgery in each case. We will analyze the general aspects of preparing for surgery, based on the international recommendations of WHO and.

Analyzes (laboratory diagnostics).

The patient must have fresh laboratory tests:

• Clinical blood test with counting leukocyte formula(analysis is valid for 7 days);
• Biochemical blood test (ALT, AST, total protein, albumin, creatinine, urea, total bilirubin, direct bilirubin + additional indicators biochemical indicators blood as prescribed by a doctor) (analysis is valid for 7 days);
• Blood group with the determination of the Rh factor (the analysis is valid for 6 months);
• Blood test for hepatitis B and C (test is valid for 6 months);
• Wasserman's reaction (analysis is valid for 6 months);
• HIV test (test is valid for 6 months);
• Urinalysis with sediment microscopy (analysis is valid for 7 days).

As a rule, the doctor prescribes these tests not long before the operation. If necessary, can be assigned additional tests(depending on the patient's condition).

instrumental examinations.

Before extensive surgery, the doctor prescribes:

• X-ray of organs chest or fluorography;
• Electrocardiography (ECG);
• Ultrasound examination (ultrasound) of the abdominal cavity and pelvic organs;
• ECHO-KG (according to indications);
• Function external respiration(according to indications);
• Holter monitoring (by indications)
• Computed tomography (CT) (according to indications);
• Magnetic resonance therapy (MRI) (according to indications);

If the disease requires more extensive diagnosis and additional surveys before the operation, the doctor informs the patient about it.

Conversation with a doctor.

The attending physician always conducts a conversation with the patient before the operation. He will talk about the surgical intervention, why it needs to be carried out, talk about possible risks and complications of the procedure. Try to prepare your questions in advance so that the doctor can answer them during the conversation. Also, on the eve of the operation, the anesthesiologist conducts a conversation with the patient about the upcoming operation and about the anesthesia.

Diet before surgery

As a general rule, follow special treatment nutrition is not required unless it has been previously prescribed by a doctor. However, according to international ERAS recommendations, it has been proven that if a patient is malnourished and his body mass index (height-weight ratio, height-to-weight ratio) is less than 18.5 points, then enhanced protein-carbohydrate nutrition within 7 days before surgery. For severely malnourished patients, enhanced nutrition is indicated 14 days before the expected date of surgery.

Hunger before surgery.

Taking medication before surgery.

If the patient is receiving regular therapy for their disease(s), it is worth discussing with the doctor which medications should be taken or not taken prior to surgery. As a rule, drugs that affect blood viscosity are canceled 7 days before the planned surgical intervention. However, without the consent of the doctor, it is not worth canceling the prescribed therapy on your own.

Bowel preparation before surgery.

There are two types of bowel preparation:

• Mechanical (enema);
• Oral (taking macrogol preparations - a laxative drug with osmotic properties used to cleanse the intestines).

The doctor informs the patient about the need for mechanical or oral bowel cleansing before the operation. The procedure for mechanical preparation of the intestine is performed by a nurse the day before the operation and on the day of the operation before being taken to the operating room.

Removal of hair from the body.

Hair is the source of infection. They are one of the sources of postoperative infectious complications. Therefore, removing body hair before surgery is a must. Hair, if present, is removed from the neck, chest, abdomen, inguinal region, and the upper third of the thigh. There are two options - shaving or machine haircut.

According to the latter, a machine haircut is preferable, since shaving operating field causes micro cuts in the skin, which can lead to infection. It is also recommended to shave your face. If intubation is performed during the operation (placement of a breathing tube in the trachea for machine breathing), it will be convenient for the anesthesiologist to fix the breathing tube to a shaved face.

Hygienic shower.

The patient is obliged to take a hygienic shower (thorough washing skin with soap) in the evening before surgery and in the morning before going to the operating room) to reduce the risk of infectious complications.

Foot bandage before surgery.

In some cases, bandaging of the legs is required before surgery to prevent thrombosis of the veins of the lower extremities. This is reported by the doctor on the eve of the operation. You can use an elastic 5-meter bandage, or individual compression underwear (stockings) of the 1st degree of compression.

Bandaging of the feet nurse. The patient should be in the supine position. The procedure is carried out immediately after a night's sleep in the supine position, or after the patient is lying with his legs up for 5-10 minutes. Compression underwear put on immediately after a night's sleep in a lying position, or after the patient is lying with his legs up for 5-10 minutes.

Delivery to the operating room.

The patient is brought into the operating room naked. There should not be any items of clothing on the body, as well as jewelry, piercings, etc. If the patient has a manicure or pedicure, it must be removed (in some cases, anesthesiologists look at the color of the nail plate to assess tissue oxygen saturation).

Compression bandage after surgery.

About the need to wear postoperative bandage for the prevention of postoperative ventral hernias, the doctor reports additionally.

Total.

I described in as much detail as possible how to prepare for a surgical operation on the abdominal organs. Depending on the disease and on the proposed surgical treatment, there may be an additional necessary information which the doctor conveys to his patients before surgical treatment.