Surgery. Indications, contraindications for carrying out. Indications and contraindications for surgical treatment of abdominal hernias. Assessment of risk factors for complications in hernia repair Contraindications to surgery

With the help of different types of anesthesia, surgeons can perform long and complex surgical interventions in which the patient does not feel any pain. Before carrying out any operation, it is necessary to conduct a complete examination of the patient in order to identify contraindications to anesthesia.

The main contraindications for general anesthesia

General anesthesia can be of three types: parenteral (intravenous), mask or endotracheal and combined. During general anesthesia, the patient is in a state of deep medical sleep and does not feel pain. For those patients who cannot be given this type of anesthesia, the anesthesiologist selects another anesthesia or the attending physician tries to cure them with conservative methods.

The anesthesiologist decides on the type of anesthesia for the patient

Below is a list of diseases in which general anesthesia is strictly prohibited:

1. Diseases of the cardiovascular system such as:

• acute and chronic heart failure;
• unstable angina, or exertional angina;
• acute coronary syndrome or myocardial infarction in history;
• congenital or acquired defects of the mitral and aortic valves;
• atrioventricular block;
• flickering arrhythmia.

1. Diseases of the kidneys and liver - are a ban for parenteral and combined general anesthesia, among them:

• acute and chronic liver or kidney failure;
• viral and toxic hepatitis in the acute stage;
• cirrhosis of the liver;
• acute pyelonephritis;
• glomerulonephritis.

1. Foci of infection in the body. If possible, the operation should be postponed until the infection is completely cured. It can be abscesses, cellulitis, erysipelas on the skin.
2. Respiratory system diseases such as atelectasis, pneumonia, obstructive bronchitis, emphysema, and respiratory failure. Also a contraindication is a cough with ARVI, due to laryngitis or tracheitis.
3. Terminal states, sepsis.

Diseases of the cardiovascular system are a contraindication to anesthesia

There is also a group of contraindications for children under one year old. It includes such diseases:

• rickets;
• spasmophilia;
• vaccination within two weeks prior to surgery;
• purulent diseases of the skin;
• childhood viral diseases (rubella, chickenpox, measles, mumps);
• elevated body temperature without an established cause.

Contraindications for spinal and epidural anesthesia

Spinal and epidural anesthesia is a type of regional anesthesia. In spinal anesthesia, the doctor injects the anesthetic directly into the spinal canal, at a level between the 2nd and 3rd lumbar vertebrae. At the same time, it blocks sensory and motor functions below the injection level. During epidural anesthesia, the anesthetic is injected into the epidural space, that is, not reaching the structures of the spinal canal. In this case, the area of ​​​​the body that is innervated by the nerve roots passing at the injection site is anesthetized.

In spinal and epidural anesthesia, the drug is injected into the spinal canal

Contraindications to these methods of regional anesthesia:

• Infectious diseases of the skin at the site of the proposed injection.
• Allergy to local anesthetics.

If the patient has a history of episodes of Quincke's edema or anaphylactic shock that occurred after the use of a local anesthetic, this type of anesthesia is categorically contraindicated! Moderate or severe scoliosis. With this pathology, it is technically difficult to perform this procedure and identify the injection site.

• Patient refusal. During surgical interventions using epidural or spinal anesthesia, the patient is conscious. He does not fall asleep during the operation. And there are times when people are afraid of such surgical interventions.
• Decreased arterial blood pressure. With hypotension, it is dangerous to carry out these types of anesthesia, since there is a risk of collapse.
• Violation of blood clotting. With hypocoagulation, this type of anesthesia can lead to the development of internal bleeding.
• Atrial fibrillation and atrioventricular blockade of the third degree.

Contraindications for local anesthesia

During local anesthesia, the anesthetic is injected locally into the area of ​​the planned operation. This type of anesthesia is most often used in anesthesiology. It is also used in surgery, when opening abscesses and felons, sometimes in gynecological and abdominal operations, when there are strict contraindications to other methods of anesthesia.

Local anesthesia is used on the part of the body that will be operated on

Local anesthesia should not be used in such cases:

1. With allergic reactions to local anesthetics. Before conducting local anesthesia, it is better to do an allergy test. In this way, the doctor can save the life of the patient and protect himself.
2. In acute renal failure, since these drugs are excreted by this organ.
3. When planning a long operation. The average time of action of a local anesthetic is 30-40 minutes. With repeated administration of the drug, there is a risk of overdose.

Before carrying out any surgical intervention, it is necessary to conduct a complete laboratory and instrumental examination of the patient to identify possible contraindications to anesthesia. If there are contraindications, the doctor, together with the anesthesiologist, chooses another method of anesthesia or tries to cure the patient with conservative methods.

MILITARY-MEDICAL ACADEMY

Department of Military Traumatology and Orthopedics

"APPROVE"

Head of Department

Military traumatology and orthopedics

Professor Major General of the Medical Service

V. SHAPOVALOV

"___" ____________ 2003

Senior Lecturer, Department of Military Traumatology and Orthopedics
Candidate of Medical Sciences
colonel of medical service N. LESKOV

LECTURE #

in military traumatology and orthopedics

On the topic: "Plasty of bone cavities and tissue defects

With osteomyelitis"

for clinical residents, students of I and VI faculties

Discussed and approved at the meeting of the department

"_____" ____________ 2003

Protocol No._____

LITERATURE

a) Used in preparing the text of the lecture:

1. Akzhigitov G.N., Galeev M.A. etc. Osteomyelitis. M, 1986.

2. Ariev T.Ya., Nikitin G.D. Muscular plasty of bone cavities. M, 1955.

3. Bryusov P.G., Shapovalov V.M., Artemiev A.A., Dulaev A.K., Gololobov V.G. Combat injuries to limbs. M, 1996, p. 89-100.

4. Vovchenko V.I. Treatment of the wounded with gunshot fractures of the femur and tibia, complicated by defects. Dis. cand. honey. Sciences, St.Petersburg, 1995, 246 p.

5. Gaidukov V.M. Modern methods of treatment of false joints. Abstract doc. dis. L, 1988, 30 p.

6. Grinev M.V. Osteomyelitis. L., 1977, 152 p.

7. Diagnosis and treatment of wounds. Ed. SOUTH. Shaposhnikova, M., 1984.

8. Kaplan A.V., Makhson N.E., Melnikova V.M. Purulent traumatology of bones and joints, M., 1985.

9. Kurbangaleev S.M. Purulent infection in surgery. M.: Medicine. M., 1985.

10. Treatment of open bone fractures and their consequences. Mater. conf. dedicated to the 100th birthday of N.N. Pirogov. M., 1985.

11. Melnikova V.M. Chemotherapy of wound infection in traumatology and orthopedics. M., 1975.

12. Moussa M. Plasty of osteomyelitic cavities with some biological and synthetic materials. Dis. cand. honey. Sciences. L, 1977.

13. Nikitin G.D. Chronic osteomyelitis. L., 1982.

14. Nikitin G.D., Rak A.V., Linnik S.A. and other Surgical treatment of osteomyelitis. St. Petersburg, 2000.

15. Nikitin G.D., Rak A.V., Linnik S.A. Bone and muscle-bone plastics in the treatment of chronic osteomyelitis and purulent false joints. St. Petersburg, 2002.

16. Popkirov S. Purulent-septic surgery. Sofia, 1977.

17. Experience of Soviet medicine in the Great Patriotic War 1941-1954. M., 1951, vol. 2, pp. 276-488.

18. Wounds and wound infection. Ed. M.I. Kuzina and B.M. Kostyuchenko. M.. 1990.

19. Struchkov V.I., Gostishchev V.K., Struchkov Yu.V. Guide to purulent surgery. M.: Medicine, 1984.

20. Tkachenko S.S. Military traumatology and orthopedics. Textbook. M., 1977.

21. Tkachenko S.S. Transosseous osteosynthesis. Uch. allowance. Leningrad: VmedA im. S.M. Kirova, 1983.

22. Chronic osteomyelitis. Sat. scientific works of Len. sanitary and hygienic honey. institute. Ed. prof. G.D. Nikitina. L., 1982, v. 143.

2, 3, 4, 6, 13, 14, 15, 20.

VISUAL AIDS

1. Multimedia presentation

TECHNICAL TRAINING TOOLS

1.Computer, software and multimedia software.

Introduction

The problem of osteomyelitis at the present time cannot be considered finally solved. The reasons for this are largely determined by the special properties of bone tissue - its rigidity, a tendency to necrosis when exposed, circulatory disorders and infection (formation of bone sequesters), cellular structure (formation of closed purulent foci, which in themselves are a source of infection), a state of unstable balance in the "macroorganism-microbes" system, changes in the body's immunoreactivity.

The long course (for years and tens of years) of all forms of chronic osteomyelitis, the occurrence of exacerbations after periods of calm, severe complications (amyloidosis, nephrolithiasis, allergization of the body, deformities, contractures and ankylosis of the joints in the vicious position of the limb) - all this gave rise to a recent In the past, osteomyelitis was considered an incurable disease. The development of the pathology and treatment system for acute and chronic osteomyelitis by domestic authors made it possible to refute this statement. The successful use of antibiotics in the post-war period, the introduction of radical plastic surgery into practice made it possible to obtain a stable recovery in 80-90% of operated patients.

At present, due to the evolution of purulent infection and the change in the resistance of the human body to it, there is an increase in the number of unsuccessful outcomes of osteomyelitis treatment, an increase in the number of late relapses of the disease, and a manifestation of infection generalization. Osteomyelitis, like other purulent diseases and complications, is becoming a social and sanitary problem.

Open fractures and their adverse consequences over the past decades have attracted increasing attention of surgeons, traumatologists, immunologists, microbiologists and doctors of other specialties. This is primarily due to the aggravation of the nature of injuries due to an increase in the number of multiple and combined injuries, as well as a high percentage of suppurative processes in patients with open bone fractures. Despite the significant progress in medicine, the frequency of suppuration in open fractures reaches 45%, and osteomyelitis - from 12 to 33% (Goryachev A.N., 1985).

A significant increase in operational activity in the treatment of injuries, their consequences and orthopedic diseases, the expansion of indications for internal osteosynthesis, an increase in the proportion of elderly patients among those operated on, the presence of immunodeficiency of various genesis in patients, lead to an increase in the number of suppurations and osteomyelitis.

This lecture will discuss the issues of surgical treatment of osteomyelitis, depending on the phase of the wound process and the size of the secondary bone defect formed as a result of surgical treatment: direct and cross muscle, free and non-free bone grafting.

Many domestic and foreign scientists dealt with the issues of diagnosis and treatment of purulent osteomyelitis. Of particular importance were the works of the Finnish surgeon M. Schulten, who in 1897 was the first to use muscle grafting for the treatment of bone cavities in chronic purulent osteomyelitis, and the Bulgarian surgeon S. Popkirov, who in 1958 showed the effectiveness of surgical treatment of bone cavities in osteomyelitis using bone autoplasty.

The principles of osteomyelitis treatment were developed as early as 1925 by T.P. Krasnobaev. They include: impact on the body in order to reduce intoxication, normalize homeostasis; drug effect on pathogens; surgical treatment of the focus of the disease.

Surgical treatment of osteomyelitis is of decisive importance, all methods of general and local effects on the body aimed at optimizing the wound process are only of additional importance, all of them are not effective enough without rational surgical tactics.

With an exacerbation of the osteomyelitic process, opening and drainage of the purulent focus is shown, necr - sequestrectomy. Reconstructive and plastic surgeries are performed after the subsidence of acute inflammation. During surgery, radical sequestrectomy is performed, resulting in the formation of a secondary bone cavity or bone defect throughout.

Elimination of the defect and stabilization of the bone are necessary conditions for the treatment of osteomyelitis.

Surgical treatments for a bone defect in chronic osteomyelitis can be divided into two main groups: conservative and radical in relation to the formed secondary cavity.

Conservative methods include isolated local antibiotic treatment for all forms of osteomyelitis, the use of trepanation and bone processing (flattening of foci, the use of fillings, most of which have only historical significance).

With a small cavity (up to 3 cm), it can be treated under a blood clot (Schede method), large cavities require replacement. For this, in some cases, seals are used.

Fillings in medicine mean organic and inorganic substances introduced into cavities with solid walls to cure caries and chronic osteomyelitis. A distinctive feature of all types of fillings is the absence of its biological connections with the body, primarily vascular and nervous. That is why it is wrong to call plastic surgery for chronic osteomyelitis "biological filling".

There are three types of seals: designed for rejection or removal in the future; designed for resorption and biopolymer materials.

There are over 50 types of fillings. The most serious research on the use of fillings was conducted by M. Moussa (1977), who used biopolymer compositions containing antibiotics in the treatment of chronic osteomyelitis. Currently, the drug "Kollapan" is used to replace bone cavities.

Regardless of the material, all fillings, all compositions are allogeneic biological tissues, which, when introduced into the bone cavity, become foreign bodies. This violates the basic principles of surgical treatment of wounds - the removal, and not the introduction of foreign bodies into it (Grinev M.V., 1977). Therefore, the percentage of positive treatment results in general for various authors who used fillings does not exceed 70-75%.

Modern research indicates the fundamental unacceptability of most types of fillings when used in surgical practice.

The most acceptable at present is the replacement of the cavity with a blood-supplying muscle or bone tissue.

An initially existing bone defect, which is widened by necrosequestrectomy and radical cleaning, remains a major treatment problem. It cannot be performed on its own, it exists for many months and years, turning into a bed of a chronic purulent process that supports fistulas and additionally damages and destroys bone tissue. Such a wound is not capable of self-healing (Ivanov V.A., 1963). The task becomes even more difficult when a bone defect causes instability or when its continuity is broken.

Indications and contraindications for surgical treatment

The existence of a fistula supported by the bone cavity is overwhelmingly an absolute indication for surgical treatment. Surgery is also required for non-fistulous forms of osteomyelitis, including Brodie's abscess, which is usually almost asymptomatic, and more superficial soft tissue and bone defects called osteomyelitis ulcers. In most cases, it is very difficult to establish what is the main reason preventing the healing of an ulcer or fistula - sequesters, granulations, scars, foreign bodies or a cavity, therefore, the most correct and mandatory is the removal of all pathological tissues that form a purulent focus in the form of a cavity or surface defect fabrics. Patients who underwent repeated surgical interventions did not receive treatment only because the final stage of the operation was not carried out - the elimination of the resulting secondary cavity or bone defect. In 46.7% of cases, the cavity itself is the main cause of a non-healing fistula or ulcer, in 2% of cases, on its own or after surgery on the focus of osteomyelitis, the fistula is supported by rejected bone sequesters (Nikitin G.D. et al., 2000).

Thus, the indications for surgical treatment of osteomyelitis are:

1. The presence of non-healing fistulas or ulcers that correspond to the x-ray picture of osteomyelitis;

2. A form of osteomyelitis occurring with periodic exacerbations;

3. Fistulous forms of osteomyelitis, confirmed by X-ray;

4. Rare forms of chronic osteomyelitis, complicating tuberculosis, syphilis, tumors of the skeletal system.

Contraindications to surgical treatment are identical to those before any other operation. The most serious obstacle to plastic surgery is acute inflammation in or near the focus of osteomyelitis. In these cases, opening and drainage of the abscess, expansion of the fistulous tract, sometimes trepanation of the bone, removal of sequesters and antibiotic therapy should be applied beforehand. Temporary contraindications may occur with extensive bone lesions in relatively recent cases of hematogenous osteomyelitis, where topical diagnosis of osteomyelitis is difficult, since the boundaries of the lesion have not been determined, or a pathological fracture is possible due to weakening of the bone. In these cases, it is advisable to postpone the operation for 2-3 months, so that during this period the acute inflammatory process subsides, the bone becomes stronger and the focus is demarcated.

Contraindications to surgery may also arise in cases where there are technical difficulties for its implementation: a significant size of the bone cavity with a corresponding lack of soft tissues in the affected area and the inability to obtain them on the other limb. This makes it necessary to resort to transplantation of free musculocutaneous flaps using microvascular technology.

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

The following terms are used:

Tomia- dissection, incision, opening;

ectomy- excision;

extirpation- isolating, husking;

resection- partial excision;

amputation- removal of the peripheral part of the organ;

stomia- creation of an artificial fistula;

centes- puncture.

This is where the following names come from:

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

Indications and contraindications for operations

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

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

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

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

Indications may be:

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

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

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

They are divided into:

Contraindications due to the serious condition of the animal:

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

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

Contraindications due to economic and organizational factors:

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

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

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

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

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

Any surgical operation has a relative degree of risk.

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

Grade 2 - moderate.

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

Grade 3 - severe.

A sick animal was found to have local lesions of vital organs (myocardial infarction, acute respiratory failure, diabetes).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

14. improvement of vascular activity, correction of micro
circulation with the help of cardiovascular agents, drugs, improve
microcirculation (reopoliglyukin);

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

16. detoxification therapy - fluid administration, blood replacement
solutions of detoxification action, forced diuresis, with
change of special methods of detoxification - plasmophoresis, oxygen therapy;

17. correction of disorders in the hemostasis system.

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

Psychological preparation.

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

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

14. impeccable sanitary and hygienic conditions of the premises where
the patient walks;

15. clear, reasonable and strictly enforced rules internally
th schedule;

16. discipline, subordination in the relationship of medical translation
sonala and in the relationship of the patient to the staff;

17. cultural, caring attitude of the staff to the patient;

18. full provision of patients with medicines, apparatus
swarm and household items.

Absolute - shock (a serious condition of the body, close to terminal), except for hemorrhagic with continued bleeding; acute stage of myocardial infarction or cerebrovascular accident (stroke), except for the methods of surgical correction of these conditions, and the presence of absolute indications (perforated duodenal ulcer, acute appendicitis, strangulated hernia)

Relative - the presence of concomitant diseases, primarily the cardiovascular system, respiratory, kidney, liver, blood system, obesity, diabetes mellitus.

Preliminary preparation of the surgical field

One way to prevent contact infection.

Before a planned operation, it is necessary to carry out a complete sanitization. To do this, on the evening before the operation, the patient should take a shower or bathe, put on clean underwear; in addition, bed linen is changed. On the morning of the operation, the nurse shaves off the hairline in the area of ​​the upcoming operation with a dry method. This is necessary, since the presence of hair greatly complicates the treatment of the skin with antiseptics and can contribute to the development of infectious postoperative complications. Shaving should be mandatory on the day of surgery, and not before. When preparing for an emergency operation, they are usually limited to only shaving the hair in the area of ​​the operation.

"Empty Stomach"

With a full stomach after anesthesia, the contents from it can begin to passively flow into the esophagus, pharynx and oral cavity (regurgitation), and from there with breathing enter the larynx, trachea and bronchial tree (aspiration). Aspiration can cause asphyxia - blockage of the airways, which without urgent measures will lead to the death of the patient, or a severe complication - aspiration pneumonia.

Bowel movement

Before a planned operation, patients need to do a cleansing enema so that when the muscles relax on the operating table, involuntary defecation does not occur. There is no need to do an enema before emergency operations - there is no time for this, and this procedure is difficult for patients in critical condition. It is impossible to perform enema during emergency operations for acute diseases of the abdominal organs, since an increase in pressure inside the intestine can lead to a rupture of its wall, the mechanical strength of which can be reduced due to the inflammatory process.

Bladder emptying

For this, the patient urinated on his own before the operation. The need for bladder catheterization is rare, mainly during emergency operations. This is necessary if the patient's condition is severe, he is unconscious, or when performing special types of surgical interventions (surgery on the pelvic organs).

Premedication- the introduction of drugs before surgery. It is necessary to prevent some complications and create the best conditions for anesthesia. Premedication before a planned operation includes the administration of sedatives and hypnotics on the night before the operation and the administration of narcotic analgesics 30-40 minutes before it starts. Before an emergency operation, only a narcotic analgesic and atropine are usually administered.

The degree of risk of the operation

Abroad, the classification of the American Society of Anesthesiologists (ASA) is usually used, according to which the degree of risk is determined as follows.

Planned operation

I degree of risk - practically healthy patients.

II degree of risk - mild diseases without functional impairment.

III degree of risk - severe diseases with dysfunction.

IV degree of risk - serious diseases, in combination with surgery or without it, threatening the life of the patient.

V degree of risk - you can expect the death of the patient within 24 hours after surgery or without it (moribund).

emergency operation

VI degree of risk - patients of the 1st-2nd categories, operated on an emergency basis.

VII degree of risk - patients of the 3rd-5th categories, operated on an emergency basis.

The presented ASA classification is convenient, but is based only on the severity of the patient's initial condition.

The classification of the degree of risk of surgery and anesthesia recommended by the Moscow Society of Anesthesiologists and Resuscitators (1989) seems to be the most complete and clear (Table 9-1). This classification has two advantages. Firstly, it evaluates both the general condition of the patient and the volume, nature of the surgical intervention, as well as the type of anesthesia. Secondly, it provides for an objective scoring system.

There is an opinion among surgeons and anesthesiologists that the correct preoperative preparation can reduce the risk of surgery and anesthesia by one degree. Considering that the probability of developing serious complications (up to death) progressively increases with an increase in the degree of operational risk, this once again emphasizes the importance of qualified preoperative preparation.