Possible complications after surgery. Postoperative complications. Postoperative period and its complications — Surgical diseases

There are complications during the operation and after the operation of tooth extraction, general and local.

For common complications include: fainting, collapse, shock.

Fainting- short-term loss of consciousness as a result of impaired cerebral circulation, leading to anemia of the brain.

Etiology: fear of surgery, type of instrumentation and the entire environment of the dental office, lack of sleep, hunger, intoxication, infectious diseases, pain during tooth extraction.

Clinic: sudden blanching of the face, general weakness, dizziness, tinnitus, darkening of the eyes, nausea, then loss of consciousness, the patient is covered with cold sticky sweat, the pupils dilate and roll up, the pulse becomes accelerated and weak. After a few seconds (minutes), the patient comes to his senses.

Treatment: aims to eliminate anemia of the brain and ensure normal blood circulation in it. It is necessary to stop the operation, sharply tilt the patient's head forward so that the head is below the knees or fold back the back of the chair and give the patient a horizontal position, open the window, unfasten everything that can restrict breathing, put a cotton ball with ammonia on the nose and s / c is injected 1-2 ml of 10% caffeine solution, 10-20% camphor oil solution., 1 ml of 10% solution of cardiasol, cordiamine, 1 ml of lobelin. After removing the patient from fainting, you can continue the operation of tooth extraction.

Prevention: elimination of all the above causes.

Collapse- develops as a result of acute cardiovascular insufficiency.

Etiology - prolonged and traumatic removal, accompanied by large blood loss and pain. Predisposing factors are the same as with fainting: overwork, hypothermia, intoxication, infectious diseases, exhaustion, psycho-emotional overstrain.

Clinic: the skin is cyanotic and pale, dry, consciousness is preserved, dizziness, nausea, retching, tinnitus, blurred vision. The vascular tone decreases, blood pressure drops, the pulse is filiform and sharply accelerated. Breathing is shallow and rapid. In the future, loss of consciousness may occur and go into a coma.

Treatment: elimination of blood loss and pain factor, increase in blood pressure, vascular tone by transfusion of blood, plasma, blood-substituting fluids, 40% glucose solution, saline, heating pads to the legs, s / c - cardiac agents (camphor, caffeine, cordiamine , ephedrine).

Prevention - careful attitude to periodontal tissues, effective anesthesia and elimination of predisposing factors.

Shock- a sharp, acute depression of the central nervous system (central nervous system).

Etiology: psycho-emotional overstrain, fear, large blood loss, and most importantly, the pain factor.

Clinic - there are 2 phases: erectile and torpid.

In the erectile phase, the patient is aroused. In the torpid phase - the phase of CNS depression, inhibition. Consciousness is preserved, according to N.I. Pirogov, the patient resembles a “living corpse” - he looks at one point, is indifferent and indifferent to everything around him, his face turns pale, acquires a grayish-ashy hue. The eyes are sunken and motionless, the pupils are dilated, the mucous membrane of the eyelids, the oral cavity is sharply pale. A / D falls, the pulse of weak filling and tension, body temperature decreases.

Treatment: administer cardiac, promedol, morphine, overlay the patient with heating pads, inject 50 ml of 40% glucose solution intravenously, transfuse blood, blood substitute fluids, Ringer's solution, immediately send to the hospital by ambulance.

Local complications during tooth extraction surgery are more common than common.

Fractures of the crown or root of the tooth.

Etiology: the wrong choice of instrument for removing the crown or root of the tooth, the wrong technique for removing the tooth or root, a carious defect of the tooth, the presence of anatomical prerequisites for a fracture (strongly curved and thin roots in the presence of powerful and sclerosed partitions), teeth treated with resorcinol-formalin liquid.

Treatment: The tooth or root must be removed by any known means.

Fracture of the antagonist tooth.

Etiology - rapid extraction of the extracted tooth and the direction of the forceps up or down, insufficient closing of the forceps cheeks and slipping of the forceps during tooth extraction.

Treatment: depending on the trauma of the tooth, the antagonist tooth is filled, an inlay is placed, covered with a crown, and root residues are removed.

Dislocation or removal of an adjacent tooth.

Etiology: this complication occurs when the doctor, using an elevator, leans on an adjacent tooth. The removal of an adjacent healthy tooth also occurs as a result of slipping of the cheeks of the teeth from the causative tooth to the adjacent one, as a result of hypercementosis. Such a complication occurs if the width of the cheeks is wider than the tooth being removed itself.

Treatment: carry out trepanation of teeth and replantation.

Fracture of the alveolar process.

Etiology: forceps are advanced deeply and with significant use of force, either partial or complete fracture of the alveolar process occurs.

Clinic: there is bleeding and mobility of the alveolar process along with the teeth.

With a partial fracture, the fragment is removed, sharp edges are smoothed and sutures are applied. With a complete fracture, a smooth splint is applied, i.e. splinted.

Fracture of the tubercle of the upper jaw.

Etiology: with deep advancement of the forceps or elevator, with excessively rough and vigorous removal of the wisdom tooth.

Clinic: with a rupture of the mucous membrane of the maxillary sinus, with damage to the vascular anastomoses in the region of the tubercle, significant bleeding, pain, and mobility of the alveolar process along with the last two molars occur.

Treatment: they stop the bleeding with a tight tamponade and it stops after 15-30 minutes, then the tubercle of the upper jaw with a wisdom tooth or with the last two molars is removed and sutures are applied, anti-inflammatory therapy.

Fracture of the body of the mandible is a rare complication, but it does occur.

Etiology: rough, traumatic removal of a wisdom tooth, less often a second molar. Predisposing factors - the presence of a pathological process in the area of the angle of the lower jaw (inflammatory process, benign or malignant neoplasms, odontogenic cysts, atrophy of bone tissue in the elderly).

Clinic: mobility of fragments of the jaw, bleeding, pain, malocclusion.

Treatment: splinting.

Dislocation of the lower jaw.

It occurs more often in the elderly.

Etiology: excessive opening of the mouth, when lowering the lower jaw down during tooth extraction, in cases of prolonged gouging or sawing of the roots of the teeth.

Clinic: it happens only anterior and unilateral or bilateral, in patients the mouth is half open, saliva is determined from the mouth, the lower jaw is motionless.

Treatment: reduction of the lower jaw according to Hippocrates and immobilization of the lower jaw with a sling bandage.

Prevention: fixation of the chin of the lower jaw during tooth extraction.

Opening or perforation of the maxillary sinus.

Etiology:

Insignificant distance between the bottom of the maxillary sinus and the roots of the teeth or the absence of bone tissue, the roots of the teeth are in contact with the mucous membrane;

Pathological process in the area of the root apex;

Pathological process in the maxillary sinus;

Incorrect technical performance of the tooth extraction operation with an elevator, deep application of forceps;

Traumatic, rough removal of the tops of the roots.

Clinic. Patients have bleeding from the hole of the tooth, corresponding to half of the nose, along with air bubbles. With inflammation of the maxillary sinus, purulent discharge from the hole and perforation is noted.

To diagnose perforation of the bottom of the maxillary sinus, the patient is asked to inflate his cheeks, first holding his nose with two fingers, while air passes from the oral cavity through the alveolus, the perforation into the nasal cavity and cheeks subside, the symptom of puffed up cheeks is called. The perforation is also detected when probing the alveoli with either an eye probe or an injection needle - a message from the alveolus to the maxillary sinus is detected.

loose plugging of the hole, not reaching the bottom of the maxillary sinus and strengthened in the form of a wire frame or for adjacent teeth or sutured to the mucous membrane, fixed with a fast-hardening plastic cap;

radical treatment - a mucoperiosteal flap is formed and sutures are applied, if possible, without the formation of a flap, sutures are applied to the edges of the gums;

with purulent discharge from the hole and perforation from the maxillary sinus with its acute inflammation, anti-inflammatory treatment is prescribed, antiseptic washing of the hole, further leading the hole under the iodoform turunda;

with chronic inflammation of the maxillary sinus, the patient is sent to the hospital for radical maxillary sinusectomy.

Pushing the root into the maxillary sinus.

Etiology - rough, traumatic removal of the root tips with elevators or deep advancement of bayonet forceps with narrow cheeks.

Clinic - there is bleeding, pain, when the maxillary sinus is infected, swelling increases, infiltration of soft tissues, and the temperature rises. Diagnosis - X-ray examination.

Treatment - patients are sent to the hospital, in the absence of inflammation in the maxillary sinus - they revise the sinus and remove the root, the wound is sutured. In acute inflammation of the maxillary sinus - anti-inflammatory therapy, to stop the inflammatory process - surgery on the maxillary sinus with root removal, in chronic inflammation - radical maxillary sinusectomy.

Pushing teeth and roots into soft tissues.

Etiology - a sharp careless movement in the process of removing the lower wisdom teeth with an elevator or when gouging them.

Diagnosis - noticing the absence of a tooth or root, it is necessary to conduct an x-ray of the lower jaw in two directions.

Treatment depends on local conditions and the qualifications of the doctor, if possible, then continue the removal of the tooth or root from the soft tissues or refer to the hospital.

Damage to the surrounding soft tissues of the jaw.

Etiology - the gums are not exfoliated with a trowel, when working with a direct elevator - injury to the tongue, sublingual region.

Treatment. If the doctor noticed that during the removal the mucous membrane of the gums stretches, then the mucous membrane is cut off with a scalpel, and if there is a tissue rupture, then sutures are applied, as well as when the tongue and sublingual region are injured.

Swallowing an extracted tooth or root.

This complication often occurs asymptomatically and they come out naturally.

Ingestion of a tooth or root into the respiratory tract.

Asphyxia sets in. It is necessary to ensure an urgent consultation with an ENT doctor and transportation (if necessary) of the patient to a hospital in order to do a tracheobronchoscopy and remove the indicated foreign body, in case of asphyxia - the imposition of a tracheostomy.

Sudden profuse bleeding from a wound.

Etiology - during removal, an opening (accidental) of a vascular neoplasm.

Clinic - after tooth extraction, significant bleeding suddenly opens under pressure.

Treatment - urgently press the wound with a finger, then carry out a tight tamponade with iodoform turunda and send it to the hospital.

Common complications after tooth extraction surgery.

These include rare complications:

myocardial infarction;

hemorrhage in the brain;

subcutaneous emphysema in the cheeks, neck, chest;

hysterical fits;

thrombosis of the cavernous sinuses.

Treatment is carried out by specialist doctors in stationary conditions.

Local complications after tooth extraction.

Hole bleeding distinguish between primary and secondary, early and late.

Etiology: general and local etiological factors.

Common ones include: hypertension, hemorrhagic diathesis, blood disease (Werlhof's disease, hemophilia); menstruation in women.

For local reasons include: ruptures and crushing of soft tissues, breaking off part of the alveolus or interradicular septum, the presence of granulation tissue or granuloma in the hole (up to 70-90%), infection of the hole and the collapse of a blood clot.

Treatment - for common causes, patients should be in a hospital and under the supervision of dentists and hematologists, or a general therapist and conduct general anti-hemorrhagic therapy.

Local ways to stop bleeding.

Most of the bleeding from the holes after the extraction of teeth can be stopped - by tamponade of the hole with iodoform turunda. Blood clots are removed from the hole, the bleeding hole is dried with 3% hydrogen peroxide and tight tamponade is carried out for 3-4 days, cold.

In the presence of granulation tissue or granulomas in the well, curettage is performed, put a ball with a hemostatic sponge, fibrin film on the well.

When bleeding from the damaged gums, tongue, sublingual region, the wound is sutured.

When bleeding from the bone septum (interdental or interradicular), the bleeding area is compressed by squeezing the bone with bayonet-shaped forceps.

Bleeding from the hole can be stopped by filling it with catgut, with bleeding from soft tissues, it can be cauterized with potassium permanganate crystals, trichloroacetic iron.

A radical way to stop bleeding, as well as with ineffective treatment by the above methods, is suturing the hole.

Extraction of teeth in patients with hemophilia should be carried out only in stationary conditions - in the hematology department under the supervision of a dental surgeon or in the dental department - under the supervision of a hematologist. They are not recommended to suture the hole, but to carry out tamponade with hemostatic drugs of local hemostatic action and prescribe blood transfusions, aminocaproic acid, vikasol to patients.

Alveolitis- acute inflammation of the hole, accompanied by alveolar pain.

Etiology - rough, traumatic extraction of a tooth or roots, pushing dental deposits into the hole, leaving granulation tissue or granuloma, tooth fragments or bone tissue in the hole, prolonged bleeding from the hole, the absence of a blood clot in the hole, violation of postoperative care by patients and poor cavity care mouth; infection in the hole, when the tooth is removed due to acute or exacerbated chronic periodontitis with a decrease in the reactivity of the body.

Clinic. Patients complain 2-4 days after tooth extraction on initially aching pains of a non-permanent nature, with its intensification when eating. The temperature is either normal or subfebrile (37.1-37.3 0 C), the general condition is not disturbed.

On external examination, no changes. On palpation in the submandibular, submental areas, slightly enlarged and painful lymph nodes are determined. Mouth opening is somewhat limited if mandibular molars are the cause. The mucous membrane around the hole is slightly hyperemic and edematous, the hole is filled with a partially disintegrating blood clot or is completely absent. The hole is filled with food debris, saliva, the bone tissue of the hole is exposed. On palpation of the gums, pain is noted.

After some time, patients are disturbed by acute persistent pains that have a tearing, pulsating character, radiate to the ear, temple, eyes, depriving the patient of sleep and appetite. The general condition worsens, general weakness, malaise, the temperature rises to 37.5-38.0 0 С.

On external examination, there is swelling of the soft tissues at the level of the extracted tooth; on palpation, the regional lymph nodes are enlarged and painful. In the presence of alveolitis in the region of the lower molars, patients have a restriction of mouth opening, painful swallowing.

Bad breath from the mouth, which is associated with the putrefaction of the blood clot in the hole. Hole walls are bare, covered with dirty gray decay; the mucous membrane around the hole is hyperemic, edematous, painful on palpation.

Treatment of alveolitis consists of the following points:

under conduction anesthesia, an antiseptic treatment of the hole of the extracted tooth is performed (hydrogen peroxide, furacillin, ethacridine-lactate, potassium permanganate);

a curettage spoon is used to carefully remove the disintegrated clot, fragments of bone tissue, and a tooth;

the well is again antiseptically treated, after which it is introduced loosely into the well:

a) iodoform turunda;

b) a strip with an emulsion of streptocide on glycerin and anesthesin;

c) turunda with chloral hydrate (6.0), camphor (3.0) and novocaine (1:5);

d) turunda with proteolytic enzymes (trypsin, chymotrypsin);

e) turunda with 1% solution of amorphous ribonuclease;

f) biomycin powder with anesthesin;

g) novocaine, penicillin - novocaine blockades are carried out along the transitional fold;

h) "alveostasis" (sponge).

After the removal of a tooth or root, it is necessary to carry out the toilet of the hole. In order to remove granulation or infected dead tissue detached from the root of the periradicular granuloma and bone fragments, the well should be washed with warm saline. Aspirate the wash liquid from the well with a pipette and isolate the well. Remove one (or several at the discretion of the doctor) sponge from the jar with tweezers and carefully place it in the hole. A dry swab can be applied over the alvostasis sponge. For difficult-to-heal holes, sutures may be placed over the sponge, since the sponge has the ability to completely dissolve.

Treatment of patients can also be carried out in an open way, without introducing turundas into the well with antiseptics, after gentle curettage, patients are prescribed intensive rinsing of the well with soda solution (1 tsp per glass of warm water) or a solution consisting of 3% hydrogen peroxide solution with furacillin, after pain relief, rinsing with furacillin, oak bark, a weak solution of potassium permanganate, sage, chamomile is prescribed.

Patients with alveolitis are prescribed anti-inflammatory therapy,

analgesics and physiotherapy: UHF, solux, fluctuation, microwave therapy, ultraviolet radiation, laser therapy.

Sharp edges of the alveolus or neuritis of the alveolar nerves.

Etiology: traumatic, rough tooth extraction, removal of several teeth.

Treatment is an alveolotomy operation, the sharp edges of the hole are removed.

QUALITY CONTROL,

MARKETING SUPPORT AND MANAGEMENT SUPPORT IN DENTAL PRACTICE

Importance of quality management in dental practice. Organization of the Quality Management System.

The state of health of the population, the organization of medical care, are one of the main indicators of the culture of society, the criteria for its economic development.

An important condition for raising the cultural level of the development of society is the strengthening of the requirements for the quality of medical care provided to the population, including in the field of dental practice. In this regard, the very definition of the concept of quality is significant. It can be defined as a result that meets and exceeds requirements.

Former director of the Health Insurance Review Organization, Missouri, Thomas K. Zinck defines the essence of quality as follows: "Doing the right thing, in the right way, for the right reason, at the right time, for the right price, with the right result."

It should be recognized as appropriate to take into account at a clinical appointment and bring to the attention of patients the established warranty periods and service periods for the types of work carried out in the provision of therapeutic and orthopedic dental care. There are guidelines for dentists covering issues related to warranty obligations for clinical dental procedures.

The service life of certain types of orthopedic structures can be extended, provided that innovative technologies are used in clinical and laboratory practice.

In view of the use of the latest achievements of science, the improvement of the material and technical base, it becomes possible to manufacture fundamentally new modern orthopedic structures. In this regard, some types of prostheses can reasonably be considered outdated, physiological for patients to an incomplete degree. Therefore, the use of such structures for the purpose of orthopedic treatment of dentition defects through their manufacture and fixation (overlay) should be considered irrational.

According to the sociologist, Master of Arts Cornelia Hahn and the head of one of the leading dental clinics in Europe, MD, Friedhelm Bürger (Germany) in the field of health, this is the degree of correspondence between the achieved treatment goal and what can be achieved in reality.

In the healthcare system, quality is measured in terms of:

structural quality;

procedural quality;

Efficient quality.

If we subdivide the value of quality into degrees, then we can determine its four steps:

"Poor quality", determined in cases where the services provided do not meet the requirements and desires of patients who seek help from a particular dental clinic.

Main quality, is determined in accordance with the requirements of patients and the services provided to them.

Achievement quality, is determined by justifying the requirements and desires of patients.

The quality of delight, is determined in cases where the services provided exceed the expectations of patients.

At the present level of development of society and medicine, in particular, the problem of quality management is outlined and becomes important.

The very concept of "quality management" comes originally from the industrial sector and then was transferred to the service sector.

Ensuring quality management implies the development and organization of new areas in the field of providing medical care to the population.

Quality management is defined as the sum of all the efforts of medical practice to improve the desired quality.

It should be noted that such an organizational form as quality management contributes to the economic survival of a dental medical institution.

There is a model of the European Organization for Quality Management (EFQM). This model is focused on meeting the needs of the client, the needs of the staff, and a positive perception of civic responsibility. Proper organization of processes and resources, as well as adequate staff orientation contribute to the achievement of outstanding clinical and economic performance.

In addition, one of the most interesting areas that correspond to the quality management organization is the Total Quality Management (TQM) model, which covers the entire enterprise, practice, organization. This model is based on an idea that follows the Japanese philosophy of quality, focusing on patients and continuous quality improvement in all areas. At the same time, each employee of a medical institution is required to focus on quality, initiative and responsibility for their activities.

Reasons why a quality management system should be developed and implemented in dental practice:

There are a number of aspects, in addition to medical duty and legal obligations, according to which it is necessary to introduce a Quality Management system into the practice of dentistry.

When using the quality management system in dental practice, an increase in the degree of patient satisfaction is achieved, confidence in the clinic and medical staff is aroused, which in turn contributes to the long-term existence of a dental medical institution.

Patients, health care institutions and insurance companies expect the dentist to maintain the quality of the ongoing consultative and treatment-diagnostic process. The Quality Management System contributes to this.

The Quality Management System is the basis for optimizing the organizational process in a dental facility, reduces the number of errors and costs, which in turn creates an improvement in patient provision.

The Quality Management System contributes to the reduction of economic risk and potential claims for damages.

The Quality Management System can be a factor of rational competition.

To organize a quality management system in the dental

practice, it is necessary to determine the structure and organization of work. The tasks, the solution of which is necessary for the organization of the Quality Management System, are: taking care of the constant professional development of dentists and medical staff of a dental institution, studying and using innovative technologies with the involvement of the latest equipment and consumables. Undoubtedly, one of the main points in the organization of the system is the development and implementation of preventive measures in order to prevent errors and quality problems. Attention should also be paid to the appropriate training of clinic administrators, in view of the fact that the correct construction of their communication with patients ultimately affects the quality of the ongoing consultative and treatment-diagnostic process.

What activities should be carried out by the head of the dental structure to organize a quality management system?

After understanding the purpose and objectives of the organization of the Quality Management system in a dental institution, the following should be carried out:

It is necessary to make a decision on the introduction of a quality management system and develop a calendar plan of activities.

It is necessary to search for information on the subject of Quality Management.

The practice of responsible persons in a certified institution is an undoubted advantage.

It is necessary to organize a quality circle in a dental institution, with the regulation of the timing of meetings.

It is necessary to hold regular meetings, highlighting the benefits of the activities carried out and their suitability for the intended purpose.

It is necessary to appoint an employee responsible for this type of activity, that is, for Quality Management.

It is necessary to specify in writing a quality policy that does not arouse objections from staff and patients.

The competences and areas of activity of the personnel should be defined, with the preparation of instructions and a graphical representation in the scheme of the structure of the organization.

Collection, analysis and distribution of all available forms.

Drawing up your own Quality Management handbook, in which it is necessary to document and describe the Quality Management system.

Keeping patients informed.

Carrying out inspection and evaluation of the quality of services provided by the dental institution.

An important aspect is bringing to the consciousness of the clinic staff the expediency of organizing a quality management system. In addition, it is necessary to ensure the interest of the staff in the rational operation of this system, with appropriate seminars on the rules of its work and organization.

One of the components of any rational model of Quality Management is to help colleagues in the team in clinical practice. Using the right management guidelines, the head of the dental institution ensures the motivation of the staff, which implies long-term cooperation in the team. To ensure this, the leader needs to clearly define the leadership style.

Summarizing the main nuances of leadership, three main styles, according to German scientists, can be distinguished.

The collaborative style called "Coaching" is considered by many dental leaders to be the most successful. This style provides for the coordination with the staff of the intended goals and the gradation of measures of responsibility, depending on the individual qualities and competence of the employees.

The third style is completely opposite to the second - the style of non-intervention. There is no leadership as such. Employees of the team are left to themselves, disoriented, have no connection with the leader, do not have the opportunity to collegially discuss the goal and tasks with him.

In order to develop motivation among the staff of a dental institution at any level, it is necessary to create conditions under which each employee will feel like a partner doing a common thing.

The implementation of the Quality Management System in practical dentistry should be primarily dealt with by the structures responsible for the organization of dental care and its management support.

Marketing and management in dental practice.

To increase the profitability of municipal and private dental institutions, it is necessary to improve the quality of the treatment provided, which leads to a reduction in the terms of the treatment itself, and, thereby, a decrease in the number of visits to the dentist by the patient, which provides a certain economic effect.

In the conditions of a market economy and insurance medicine, the requirements of patients for the quality of treatment of dental diseases, including the quality of measures related to the replacement of defects in the dentition, have sharply increased.

Necessary for improving the qualification level of dentists is the appropriate specialized training on thematic cycles.

It should be noted the rationality of conducting specialized cycles for dentists of related areas: dentists-therapists, dental surgeons, orthopedic dentists, pediatric dentists. Due to the fact that diseases of the dental profile quite often affect several dental disciplines at the same time, such an approach to improving the qualification level of specialists should be considered appropriate.

The ability of a dentist to competently understand various clinical situations allows you to raise the rating of a dental institution. The possibility of self-assessment of the clinical situation, diagnosis and treatment of diseases that are concomitant for a dentist of a certain discipline create significant prerequisites for increasing the economic effect of the activities of a particular unit of a medical institution of a dental profile.

The professional development of management in dentistry is of great importance in the current economic situation.

In this regard, a separate link should be allocated in the structure of dental institutions that provides management support for the functioning of the organization. This type of activity should include ensuring the professional development of dentists, their participation in scientific and practical conferences, seminars and exhibitions at various levels, communication with scientific and educational organizations in order to acquire the latest technologies and developments, facilitating the implementation of innovative technologies in clinical practice. practice, studying the results of statistical analysis of dental morbidity in the region and studying the trend towards changes in its indicators, cooperation with manufacturers of dental equipment and materials, as well as with dealers for their implementation.

Undoubtedly, a positive and significant activity is the creation of Training Centers on the basis of dental clinics.

Management support is determined by cooperation with the management departments of scientific and educational institutions, specialized medical institutions, manufacturers of dental equipment and materials, as well as companies selling them, organizers of conferences and exhibitions.

It can be argued that the development of management in the conditions of the medical dental unit contributes to the achievement of a higher quality of dental care provided to the population, creates conditions for increasing the professional growth of dentists, and increases the profitability and competitiveness of clinical dental institutions.

To ensure the effective operation of the management department of a dental institution, it is necessary to create a sufficient information base containing the results of research, including statistical data, reflecting the various characteristics of diseases of the dental profile in the region.

In addition to the quality of the treatment and prevention process, the quality of disease prevention is undoubtedly of great importance in protecting public health.

At present, the prevention of dental diseases is impossible without planning, managing the development of health, and strict quality control of the measures taken. The result of the introduction of the prevention system depends on a number of organizational factors, a rationally constructed management mechanism in the institution.

Postoperative complications develop in at least 10% of all operations. There are several reasons for this.

First, the situation that necessitated surgery does not disappear at the time of the operation. The patient will have a long restoration of the normal functioning of the body.

Secondly, surgery itself is a non-physiological effect that disrupts many cyclic processes in the body. Here and the introduction of a narcotic substance that loads the liver and kidneys, and a change in the heart and respiratory rhythm, blood loss, pain. Emergency and long-term operations are natural factors in the occurrence of complications. Normally, on the 3-4th day, the body copes with unexpected circumstances, and the patient's well-being improves.

Treatment of postoperative complications requires a qualified approach on the part of doctors and medical personnel.

Local complications

In the area of the surgical wound, the following troubles may occur:

bleeding due to a bleeding disorder, slippage of the suture material from the vessel, or insufficient restoration of hemostasis during the operation. To eliminate bleeding, stitches are applied, re-ligation is done, cold is placed on the wound, or hemostatic drugs are administered;
hematoma due to a bleeding vessel. The hematoma is opened, removed by puncture. At small sizes, it resolves with UV radiation or the application of a compress;
infiltrate - swelling of tissues within 10 cm from the edges of the seam due to infection of the wound or the formation of necrosis in the subcutaneous fat. Depending on the cause, surgical treatment is used for its resorption;
suppuration is an infiltrate with severe inflammation. To eliminate it, remove the sutures, open the edges of the wound, wash and install drainage;
eventration - prolapse of internal organs to the outside due to suppuration, fragile suturing of the edges of the wound, an increase in intra-abdominal pressure during coughing or flatulence, or reduced regeneration (healing) of tissues. It is necessary to reduce the organs with asepsis, strict bed rest and wearing a tight bandage.
Ligature fistula - occurs when it forms around the suture material. It needs to be excised along with the suture material.

General complications

As a result of surgical intervention in the body, systemic disorders occur, which are considered as postoperative complications:

pain sensations. They are removed with analgesics, antispasmodics and desensitizing agents in various combinations;
disorders of the nervous system. If the patient suffers from insomnia, then he is prescribed sleeping pills and sedatives;
postoperative and more often appear in smokers. In such cases, antibiotics and symptomatic therapy are prescribed;
acute heart failure is considered the most dangerous complication requiring measures to save the patient;
acute embolism and thrombosis in cardiovascular pathologies, increased blood clotting,. To prevent such complications, it is necessary to place the operated limbs above the level of the body, to tighten the feet and lower legs with elastic bandages, to prescribe therapy with anticoagulants and disaggregants;
complications of the gastrointestinal tract in the form of sialoadenitis (inflammation of the salivary glands) or more serious consequences of the operation - paresis (lack of tone and peristalsis) of the stomach and intestines;
from the side of the bladder, difficulty is often observed and. Catheterization may help;
Bedsores are formed when the patient is in one position for a long time in a supine position. To prevent them, good patient care is needed. When bedsores appear, they are treated with antiseptic solutions and wound healing agents.

Treatment of complications after surgery is a very important point in the rehabilitation program of a surgical patient. This is given due attention from the outside in the clinic "Sanmedekspert". As a result, the number of postoperative complications is minimized.

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Ministry of Education, Youth and Sports of Ukraine

National University of Physical Education and Sports of Ukraine

abstract

On the topic: « Causes of complications after surgery»

Prepared

Orlov Anton

Group 5.06

Introduction

1. Complications after surgery

2. Five classes of postoperative complications

Bibliography

Introduction

After surgery for endometriosis, as after any other surgical interventions, there can be various complications. Most of them pass quickly and are easily treated. The tips we provide below are general information. If you notice any unusual symptoms, deterioration of health, then tell your doctor about it. Also, be sure to tell your doctor if you have any bleeding, fever, swelling, or discharge from the postoperative wound.

1. Complicationsle surgery

Constipation is a fairly common complication of abdominal operations, especially if they are performed on the intestines. If this complication occurs, your doctor may prescribe laxatives for you. What can help prevent constipation after surgery? First, eat more fiber foods. the fact is that dietary fiber irritates the intestinal wall and stimulates intestinal motility (that is, the work of the intestine). Secondly, drink more water, up to seven glasses a day is recommended. Third, take small walks daily. Early activation promotes better breathing, and the diaphragm - the main respiratory muscle - has a “massaging” effect on the intestines.

Diarrhea is also a fairly common complication that occurs after abdominal operations, especially if they are performed on the intestines. If you have severe diarrhea or it is accompanied by fever, you should tell your doctor. Your doctor may prescribe medicine for diarrhea. In addition, diarrhea can be a manifestation of an infection in the intestines. In this case, antibiotics are usually prescribed. But in no case do not start taking any medications on your own without consulting your doctor. At home, you can prevent diarrhea with ginger tea or chamomile tea, and limit your intake of dairy products, carbonated drinks, and caffeine.

Shoulder pain. During laparoscopy, carbon dioxide is injected into the abdominal cavity. Gradually it dissolves. However, after the operation, the gas rises to the diaphragm, on the lower surface of which the nerves are located. Irritation of these nerves with gas leads to unpleasant pain sensations that radiate to the shoulders. In this case, pain can be relieved by thermal procedures: heating pads can be placed in front and behind the shoulder. In addition, your doctor may prescribe pain medication for you. In order for carbon dioxide to be absorbed faster, mint or ginger tea, as well as carrot juice, are recommended.

Bladder irritation. Usually, during and after surgery, a catheter is inserted into the patient's bladder - a flexible plastic tube through which urine flows. This is to control urination during and after surgery. In addition, very often in the postoperative period, urinary retention may occur. This is a reflex phenomenon. Over time, it passes. However, the catheter itself can irritate the mucous membrane of the urethra, causing inflammation - urethritis. It is manifested by moderate pain and burning in the urethra during urination. To prevent this complication, it is recommended to drink plenty of fluids in the postoperative period, as well as personal hygiene. If you feel pain and cramps when urinating, as well as a change in the color of urine (urine becomes dark or pinkish), urination has become frequent, you should consult a doctor. These signs may indicate an infection in the bladder - cystitis. Antibiotics are usually prescribed for cystitis. Your doctor may prescribe painkillers to relieve pain. In addition, a plentiful warm drink is recommended, preferably rosehip decoctions. It is even better to drink cranberry juice, as cranberries have natural antiseptics that suppress the infection.

Thrombophlebitis and phlebitis. Phlebitis is an inflammation of the wall of a vein. Thrombophlebitis is a condition in which inflammation of a vein is accompanied by the formation of a blood clot on its wall - a thrombus. usually after surgery, phlebitis / thrombophlebitis can occur due to a long stay in the vein of an intravenous catheter. The situation is aggravated by the introduction of certain drugs into the vein that irritate the vein wall. Phlebitis / thrombophlebitis is manifested by redness, swelling and pain along the inflamed vein. If there is a thrombus along the vein, you can feel a small seal. If you experience these symptoms, you should immediately inform your doctor. With the development of phlebitis, heat compresses, painkillers and anti-inflammatory drugs are usually prescribed. In addition to compresses, anti-inflammatory ointments (for example, diclofenac) can be used. With the development of thrombophlebitis, heparin ointment is usually used. Heparin, when applied locally, is absorbed into the affected vein. However, heparin itself does not resolve the thrombus. It only warns its further development. The thrombus dissolves itself in the course of treatment.

Nausea and vomiting are very common after any operation performed under general anesthesia. In addition, some painkillers also cause these symptoms. It should be noted that gynecological operations are accompanied by nausea and vomiting in the postoperative period more often than other types of surgery. In many cases, the anesthesiologist can prevent nausea in the postoperative period by prescribing antiemetics before the operation itself. In the postoperative period, it is also possible to prevent nausea with the help of drugs (for example, cerucal). Home remedies for nausea prevention - ginger tea. In addition, many patients note that if they lie on their backs, then there is no nausea.

Pain. Almost every patient experiences pain of varying degrees in the postoperative period. You should not suffer and endure postoperative pain, as this can aggravate postoperative stress, lead to greater fatigue, and also worsen the healing process. Usually, after surgery, the doctor always prescribes pain medication. They should be taken as directed by your doctor. You should not wait until the pain appears, painkillers should be taken before they begin. Over time, postoperative wounds heal, and the pain gradually disappears.

fatigue. Many women experience fatigue after laparoscopy. Therefore, you should rest as much as you can. When you return to normal work, try to plan your rest. In addition, a daily multivitamin is recommended to restore strength.

Scar formation. Wounds after laparoscopy are much smaller than after other surgical interventions and they scar much faster. Unfortunately, it is impossible to completely get rid of scarring after an incision, since this is a physiological process. However, if desired, even these small scars can be eliminated by the methods offered by plastic surgery. In addition, today the pharmaceutical industry offers ointments that dissolve scars. However, they can only be used effectively with fresh scars. For the speedy healing of the wound, it is necessary to adhere to a complete diet rich in vitamins, minerals and proteins. Vitamin E is especially important for better healing, which is confirmed by many years of experience in its use. surgical postoperative constipation thrombophlebitis

Infection. Compared to other types of surgery, laparoscopy is much less complicated by infection. The infection can be both in the area of incisions and in the abdominal cavity, which can manifest itself as an infiltrate or abscess, which is much more serious. The main signs of infection of the surgical wound: redness in the wound area, swelling, pain and soreness when touching the wound, as well as discharge from the wound. If the infection develops in the abdominal cavity, then there may be pain in the abdomen, bloating, constipation, urinary retention or, conversely, frequent urination, as well as fever and deterioration in well-being. If you have these symptoms, you should immediately inform your doctor. To prevent infectious complications after abdominal operations, including laparoscopy, a short course of antibiotics is prescribed. You should not take any antibiotics on your own, and even more so, painkillers, before you are examined by a doctor.

Headache. It may seem paradoxical, but pain medications themselves can cause headaches. To eliminate them, you can use non-steroidal anti-inflammatory drugs, or acetaminophen. However, check with your doctor before using them. In addition, you can try lavender massage oil, which also has pain-relieving properties.

Hematomas and seromas. Sometimes fluid can accumulate in the area of the postoperative wound: ichor or serous fluid. This is manifested by swelling in the wound area, sometimes pain. Since the patient herself cannot find out what is hidden behind such complaints, it is necessary to consult a doctor for any changes in the wound area. Usually, hematomas and seromas can resolve on their own. To speed up this process, various thermal procedures are recommended in the wound area: at home, it can be a cloth bag with heated sand or salt. You can use electric heaters. In addition, you can use the services of a physiotherapy room. In the absence of the effect of these measures, a minor surgical intervention may be required: the doctor usually dissolves the suture and, using a small metal probe, releases the fluid accumulated under the skin. After that, the knapsack is washed and rubber drainage is left in it for a couple of days. The wound is covered with a sterile bandage. After a few days, the wound heals on its own.

2. Five classes of postoperative complications

Approximately 18% of patients after undergoing surgery experience one or another complication.

Some surgical complications develop frequently and in their manifestations they are relatively mild and do not pose any threat to health. Other surgical complications are rare, but they pose a certain threat not only to health, but also to the life of the patient.

In order to make it easier to navigate the likelihood of certain complications, as well as their severity, all postoperative complications are traditionally divided into five classes:

	Characteristics of complications	Examples of complications
	Mild complications that do not pose a threat to health, resolve on their own or require simple medications such as painkillers, antipyretics, antiemetics, antidiarrheals.	Cardiac arrhythmia that resolves after potassium administration Collapse of the lung (atelectasis), resolving after physical therapy Transient disturbance of consciousness that resolves on its own without any treatment non-infectious diarrhea Mild wound infection that does not require antibiotics
	Moderate complications requiring the appointment of more serious drugs than those indicated above. The development of these complications in most cases leads to an increase in the length of stay in the hospital.	Heart rhythm disorders Pneumonia Minor stroke followed by full recovery infectious diarrhea urinary tract infection wound infection Deep vein thrombosis
	Severe complications requiring reoperation. The development of these complications increases the duration of hospitalization.	Complications of this type are various disorders associated with the anatomical site of the operation. In most cases, all these cases require repeated surgery in an emergency or urgent manner.
	Life-threatening complications requiring treatment in the intensive care unit (intensive care unit). After this kind of complications, the risk of severe chronic diseases and disability is high.	Heart failure Respiratory failure Major stroke Intestinal obstruction pancreatitis kidney failure Liver failure
	Fatal outcome

conclusions

Despite the fact that the main goal of any surgical intervention is to improve the patient's health, in some cases the operation itself is the cause of the deterioration of the patient's health.

Of course, not only the operation, but also the ongoing anesthesia or the initial serious condition of the patient can be a causal factor in the deterioration of health. In this article, we will consider the complications, the occurrence of which is associated with the conduct of the surgical intervention itself.

Firstly, all surgical complications can be divided into two groups:

common complications

Specific complications

Common complications occur with all types of operations. Specific complications are inherent in only one specific type (type) of operations.

Secondly, complications after operations can be divided according to the frequency of their occurrence. So, the most common general complications of operations are:

fever

atelectasis

wound infection

deep vein thrombosis

And, thirdly, operational complications may differ in terms of their occurrence. In particular, complications can occur both directly during the operation itself, and in a long-term period of time - after a few weeks or even months. Most often, complications after surgery occur in the early stages - in the first 1-3 days after surgery.

Bibliography

1. Gelfand B.R., Martynov A.N., Guryanov V.A., Mamontova O.A. Prevention of postoperative nausea and vomiting in abdominal surgery. Consilium medicum, 2001, No. 2, C.11-14.

2. Mizikov V.M. Postoperative nausea and vomiting: epidemiology, causes, consequences, prevention. Almanac MNOAR, 1999, 1, C.53-59.

3. Mokhov E.A., Varyushina T.V., Mizikov V.M. Epidemiology and prevention of postoperative nausea and vomiting syndrome. Almanac MNOAR, 1999, p.49.

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The main complications of the early postoperative period.

I. Complications from the wound:

bleeding,

development of wound infection

divergence of seams (eventeration).

Bleeding- the most formidable complication, sometimes threatening the life of the patient and requiring a second operation. In the postoperative period, to prevent bleeding, an ice pack or a load of sand is placed on the wound. For timely diagnosis, monitor the pulse rate, blood pressure, red blood counts.

Development of a wound infection can proceed in the form of the formation of infiltrates, suppuration of the wound or the development of a more formidable complication - sepsis. Therefore, it is necessary to bandage the patients the next day after the operation. To remove the dressing material, which is always wet with sanious wound discharge, treat the edges of the wound with an antiseptic and put a protective aseptic bandage. After that, the bandage is changed every 3 days when it gets wet. According to the indications, UHF therapy is prescribed for the area of surgical intervention (infiltrates) or antibiotic therapy. It is necessary to monitor the portal functioning of the drains.

Divergence of seams (eventeration) most dangerous after abdominal surgery. It may be associated with technical errors in suturing the wound (the edges of the peritoneum or aponeurosis are closely captured in the suture), as well as with a significant increase in intra-abdominal pressure (with peritonitis, pneumonia with severe cough syndrome) or with the development of infection in the wound. To prevent the divergence of the seams during repeated operations and at a high risk of developing this complication, suturing the wound of the anterior abdominal wall with buttons or tubes is used.

II. The main complications from the nervous system: in the early postoperative period are pain, shock, sleep and mental disorders.

The elimination of pain in the postoperative period is given exceptionally great importance. Painful sensations can reflexively lead to disruption of the cardiovascular system, respiratory organs, gastrointestinal tract, and urinary organs.

The fight against pain is carried out by the appointment of analgesics (promedol, omnopon, morphine). It must be emphasized that the unreasonable long-term use of drugs of this group can lead to the emergence of a painful addiction to them - drug addiction. This is especially true in our time. In the clinic, in addition to analgesics, long-term epidural anesthesia is used. It is especially effective after operations on the abdominal organs; within 5-6 days, it makes it possible to drastically reduce pain in the area of operation and to eliminate a pair of intestines as soon as possible (1% trimecaine solution, 2% lidocaine solution).

Elimination of pain, the fight against intoxication and excessive excitation of the neuropsychic sphere are the prevention of such complications from the nervous system as postoperative sleep and mental disorders. Postoperative psychoses often develop in weakened, malnourished patients (homeless people, drug addicts). It must be emphasized that patients with postoperative psychosis need constant supervision. Treatment is carried out in conjunction with a psychiatrist.

Consider an example: A patient with destructive pancreatitis developed psychosis in the early postoperative period. He jumped out of the emergency room window.

III. Complications from the cardiovascular system can occur primarily, as a result of weakness of cardiac activity, and secondarily, as a result of the development of shock, anemia, severe intoxication.

The development of these complications is usually associated with concomitant diseases, so their prevention is largely determined by the treatment of concomitant pathology. The rational use of cardiac glycosides, glucocorticoids, sometimes vasopressants (dopamine), compensation for blood loss, full blood oxygenation, the fight against intoxication and other measures performed taking into account the individual characteristics of each patient make it possible in most cases to cope with this severe complication of the postoperative period.

An important issue is the prevention of thromboembolic complications, the most common of which is pulmonary embolism- a serious complication, which is one of the frequent causes of deaths in the early postoperative period. The development of thrombosis after surgery is due to slow blood flow (especially in the veins of the lower extremities and small pelvis), increased blood viscosity, impaired water and electrolyte balance, unstable hemodynamics, and activation of the coagulation system due to intraoperative tissue damage. The risk of pulmonary embolism is especially high in elderly obese patients with concomitant pathology of the cardiovascular system, the presence of varicose veins of the lower extremities and a history of thrombophlebitis.

Principles of prevention of thromboembolic complications:

early activation of patients, their active management in the postoperative period;

exposure to a possible source (for example, treatment of thrombophlebitis);

ensuring stable dynamics (control of blood pressure, pulse);

correction of water and electrolyte balance with a tendency to hemodilution;

the use of antiplatelet agents and other agents that improve the rheological properties of blood (rheopolyglucin, trental, neoton);

the use of direct anticoagulants (heparin, fraxiparin, streptokinase) and indirect action (sinkumar, pelentan, aescusin, phenylin, dicoumarin, neodicoumarin);

bandaging of the lower extremities in patients with varicose veins.

IV. Postoperative respiratory complications the most common are tracheobronchitis, pneumonia, atelectasis, pleurisy. But the most formidable complication is development of acute respiratory failure, associated primarily with the effects of anesthesia.

That's why the main measures for the prevention and treatment of respiratory complications are:

early activation of patients,

adequate position in bed with a raised head end

(Fowler position),

breathing exercises,

combating hypoventilation of the lungs and improving the drainage function of the tracheobronchial tree (inhalation with humidified oxygen,

banks, mustard plasters, massage, physiotherapy),

liquefaction of sputum and the use of expectorants,

prescribing antibiotics and sulfa drugs, taking into account sensitivity,

sanitation of the tracheobronchial tree in seriously ill patients (through an endotracheal tube with prolonged mechanical ventilation or through a microtracheostomy with spontaneous breathing)

Analysis of inhalers and oxygen system.

V. Complications from the abdominal cavity in the postoperative period are quite severe and varied. Among them, a special place is occupied by peritonitis, adhesive intestinal obstruction, paresis of the gastrointestinal tract. Attention is drawn to the collection of information in the study of the abdominal cavity: examination of the tongue, examination, palpation, percussion, auscultation of the abdomen; digital examination of the rectum. The special importance in the diagnosis of peritonitis of such symptoms as hiccups, vomiting, dry tongue, tension of the muscles of the anterior abdominal wall, bloating, weakening or absence of peristalsis, the presence of free fluid in the abdominal cavity, the appearance of the Shchetkin-Blumberg symptom is emphasized.

The most common complication is the development paralytic ileus (intestinal paresis). Intestinal paresis significantly disrupts the processes of digestion, and not only them. An increase in intra-abdominal pressure leads to a high standing of the diaphragm, impaired ventilation of the lungs and heart activity; in addition, there is a redistribution of fluid in the body, the absorption of toxic substances from the intestinal lumen with the development of severe intoxication of the body.

Basics of prevention of intestinal paresisassigned to operations:

respect for fabrics;

minimal infection of the abdominal cavity (use of tampons);

careful hemostasis;

novocaine blockade of the root of the mesentery at the end of the operation.

Principles of prevention and control of paresis after surgery:

early activation of patients wearing a bandage;

rational diet (small convenient portions);

adequate drainage of the stomach;

introduction of a gas outlet tube;

stimulation of motility of the gastrointestinal tract (prozerin 0.05% - 1.0 ml subcutaneously; 40-60 ml of a hypertonic solution in / in slowly drip; cerucal 2.0 ml / m; cleansing or hypertonic enema);

2-sided novocaine pararenal blockade or epidural blockade;

- Early - as a rule, develop in the first 7 days after surgery;

- Late - develop through various periods after discharge from the hospital

From the side of the wound:

1. Bleeding from a wound

2. Suppuration of the wound

3. Eventration

4. Postoperative hernia

5. Ligature fistulas

From the side of the operated organ (anatomical area):

- Failure of the anastomosis sutures (stomach, intestine, bronchus, etc.).

- Bleeding.

– Formation of strictures, cysts, fistulas (internal or external).

- Paresis and paralysis.

- Purulent complications (abscesses, phlegmon, peritonitis, pleural empyema, etc.).

From other organs and systems:

- From the CCC - acute coronary insufficiency, myocardial infarction, thrombosis and thrombophlebitis, pulmonary embolism;

- From the side of the central nervous system - acute cerebrovascular accident (stroke), paresis and paralysis;

- Acute renal and hepatic failure.

- Pneumonia.

Postoperative complications can be represented as a diagram

Care begins immediately after the end of the operation. If the operation was performed under anesthesia, the anesthesiologist gives permission for transportation. With local anesthesia - the patient is moved to a stretcher after the operation, either independently or with the help of staff, after which he is transported to the postoperative ward or to the ward in the surgical department.

sick bed should be prepared by the time he arrives from the operating room: covered with fresh linen, heated with heating pads, there should be no wrinkles on the sheets. The nurse should know in what position the patient should be after the operation. Patients usually lie on their backs. Sometimes, after surgery on the organs of the abdominal and thoracic cavities, patients lie in the Fowler position (semi-sitting position on the back with limbs bent at the knee joints).

Patients operated on under anesthesia are transported to the intensive care unit (intensive care) on the bed of the same unit. Transferring from the operating table to the functional bed is carried out under the supervision of an anesthesiologist. The unconscious patient is carefully lifted from the operating table and transferred to the bed, while avoiding sharp flexion of the spine (dislocation of the vertebrae is possible) and hanging of the limbs (dislocations are possible). It is also necessary to ensure that the bandage from the postoperative wound is not torn off and the drainage tubes are not removed. At the time of transferring the patient to the bed and transportation, there may be signs of impaired breathing and cardiac activity, therefore, the escort of the anesthesiologist and the anesthetist nurse necessarily . Until the patient regains consciousness, he is laid horizontally, his head is turned to the side (prevention of aspiration of gastric contents into the bronchi - the nurse must be able to use an electric suction to help the patient with vomiting). Covered with a warm blanket.

To better provide the body with oxygen, humidified oxygen is supplied through a special device. To reduce bleeding of the operated tissues, an ice pack is placed on the wound area for 2 hours or a load (usually a sealed oilcloth bag with sand). Drainage tubes are attached to the system to collect the contents of the wound or cavity.

In the first 2 hours, the patient is in a horizontal position on his back or with a lowered head end, since in this position the blood supply to the brain is better provided.

During operations under spinal anesthesia, the horizontal position is maintained for 4-6 hours due to the risk of developing orthostatic hypotension.

After the patient regains consciousness, a pillow is placed under his head, and the hips and knees are raised to reduce blood stasis in the calf muscles (prevention of thrombosis).

The optimal position in bed after surgery may vary, depending on the nature and area of surgery. For example, patients who have undergone operations on the abdominal organs, after they regain consciousness, are laid in bed with their heads slightly raised and legs slightly bent at the knees and hip joints.

Prolonged stay of the patient in bed is not desirable, due to the high risk of complications caused by physical inactivity. Therefore, all factors that deprive him of mobility (drainages, long-term intravenous infusions) must be taken into account in time. This is especially true for elderly and senile patients.

There are no clear criteria that determine the timing of the patient's getting out of bed. Most patients are allowed to get up 2-3 days after surgery, but the introduction of modern technologies in medical practice changes a lot. After laparoscopic cholecystectomy, it is allowed to get up in the evening, and many patients are discharged for outpatient treatment the very next day. Getting up early increases confidence in a favorable outcome of the operation, reduces the frequency and severity of postoperative complications, especially respiratory and deep vein thrombosis.

Even before the operation, it is necessary to teach the patient the rules of getting out of bed. In the evening or the next morning, the patient should already sit on the edge of the bed, clear his throat, move his legs, while in bed he should change his position as often as possible, make active movements with his legs. At the beginning, the patient is turned on his side, to the side of the wound, with bent hips and knees, while the knees are on the edge of the bed; the doctor or nurse helps the patient to sit down. Then, after taking a few deep breaths and exhalations, the patient clears his throat, stands on the floor, takes 10-12 steps around the bed, and goes back to bed. If the patient's condition does not worsen, then the patient should be activated in accordance with his own feelings and the doctor's instructions.

Sitting in a bed or chair is not recommended because of the risk of slowing down venous blood flow and the occurrence of thrombosis in the deep veins of the lower extremities, which in turn can cause sudden death due to thrombus separation and pulmonary embolism.

For the timely detection of this complication, it is necessary to measure the circumference of the limb daily, palpate the calf muscles in the projection of the neurovascular bundle. The appearance of signs of deep vein thrombosis (edema, cyanosis of the skin, an increase in the volume of the limb) is an indication for special diagnostic methods (ultrasound dopplerography, phlebography). Especially often, deep vein thrombosis occurs after traumatological and orthopedic operations, as well as in patients with obesity, oncological diseases, and diabetes mellitus. Reducing the risk of thrombosis in the postoperative period is facilitated by the restoration of disturbed water and electrolyte metabolism, the prophylactic use of direct-acting anticoagulants (heparin and its derivatives), early activation of the patient, bandaging the lower extremities with elastic bandages before surgery and in the first 10-12 days after it.