Preparation of the patient for planned and emergency operations. Preparation of the patient for planned and emergency operations Features of the surgical method of treatment

A surgical operation (intervention) is a bloody or bloodless therapeutic or diagnostic measure carried out by means of physical impact on organs and tissues.

By the nature of the surgical intervention:

1. Healing

Radical. The goal is to completely eliminate the cause of the pathological process (gastrectomy for gastric cancer, cholecystectomy for cholecystitis). A radical operation is not necessarily a sweeping operation. There are a large number of reconstructive and restorative (plastic) radical operations, for example, plastic surgery of the esophagus with cicatricial stricture.

Palliative. The goal is to partially eliminate the cause of the pathological process, thereby facilitating its course. They are performed when a radical operation is not possible (for example, the Hartmann operation with the removal of the visible part of the tumor, the creation of a pocket and the imposition of a single-barrel colostomy). In the name of the operation, an explanatory term is sometimes introduced that characterizes its purpose. Palliative surgery does not always mean the impossibility and futility of curing the patient (for example, with tetralogy of Fallot ("blue" heart disease) after palliative surgery in infancy, there is the possibility of radical surgical correction later).

Symptomatic. The goal is to alleviate the patient's condition. They are performed when a radical or palliative operation is impossible for some reason. An explanatory term is introduced into the name of the operation, characterizing its purpose (nutritional gastrostomy in incurable patients with esophageal cancer; draining cholecystotomy in case of a general serious condition and an attack of cholecystitis, sanitary mastectomy in case of decaying breast cancer). Symptomatic surgery does not always mean the impossibility and futility of curing the patient; often symptomatic surgery is performed as a stage or as an addition to radical treatment.

2.Diagnostic

Diagnostic operations include: biopsy, puncture, laparocentesis, thoracocentesis, thoracoscopy, arthroscopy; as well as diagnostic laparotomy, thoracotomy, etc. Diagnostic operations pose a certain danger to the patient, therefore, they should be applied at the final stage of diagnosis, when all the possibilities of non-invasive diagnostic methods have been exhausted

By urgency:

Emergency. Produced immediately after diagnosis. The goal is to save the patient's life. According to emergency indications, conicotomy should be performed for acute obstruction of the upper respiratory tract; puncture of the pericardial sac in acute cardiac tamponade.

Urgent. Produced in the first hours of admission to the hospital. So, when making a diagnosis of "acute appendicitis", the patient should be operated on in the first 2 hours of hospitalization.

Planned operations. They are performed after full preoperative preparation at a time that is convenient for organizational reasons. This does not mean, however, that a planned operation can be delayed for an arbitrarily long time. The vicious practice of queuing for planned surgical treatment that still exists in some polyclinic institutions leads to an unreasonable delay in the indicated operations and a decrease in their effectiveness.

The concept of "surgical operation" is a Greek expression adapted to the Russian language, which literally means "I do it with my hand." Many years have passed since the time of ancient Greece, and today a surgical operation means various effects on living tissues, during which the function of the whole organism is corrected. During the operation, the tissues are separated, moved and reconnected.

Background

The first mention of surgical interventions dates back to the 6th century BC. e. Since the dawn of time, people have stopped bleeding, tending wounds, and cutting off shattered or gangrene-affected limbs. Medical historians know that long before our era, the then healers knew how to perform craniotomy, immobilize broken bones, and even ... remove the gallbladder.

In all textbooks on the history of medicine there is an ancient statement that in the arsenal of a doctor there is a knife, an herb and a word. From ancient times to the present day, the knife - now its analogues, of course - is in the first place. An operation is the most radical method of treatment that allows a person to get rid of the disease forever. Hippocrates, Galen and Celsus developed surgery more than others.

The best Russian surgeon was Nikolai Ivanovich Pirogov, whose tomb is tremblingly kept in Vinnitsa. The relatives of those whom he treated and saved from death still take care of his former estate free of charge. Once upon a time, a great surgeon helped his neighbors without payment - and they still remember him. Pirogov removed the gallbladder in 40 seconds, his hands can be seen in the tomb - with long and thin fingers.

Pain relief or anesthesia

Any operation is first of all a pain. Living tissue reacts to pain with spasm and worsening of blood circulation, therefore, removing pain is the first task in surgical intervention. We have received historical information about what our ancestors used for pain relief: decoctions of plants containing narcotic substances, alcohol, marijuana, cold and compression of blood vessels.

A breakthrough in surgery occurred in the middle of the 19th century, when nitrous oxide, diethyl ether, and then chloroform were discovered. Since that time, it began to be used. A little later, surgeons drew attention to cocaine in the sense that this substance anesthetizes tissues locally. The use of cocaine can be considered the beginning of local - conduction and infiltration - anesthesia.

The discovery of muscle relaxants or substances capable of immobilizing muscles dates back to the middle of the last century. Since that time, anesthesiology has become a separate medical science and specialty, inextricably linked with surgery.

Modern surgery is a complex of techniques from various branches of medicine. It can be said that this is a synthesis of knowledge accumulated by medicine.

Surgery: types of operations

There are classifications of operations according to the nature of the intervention, urgency and stages.

The nature of the operation can be radical, symptomatic or palliative.

Radical surgery is the complete elimination of the pathological process. A classic example is the removal of an inflamed appendix in acute appendicitis.

Symptomatic is the elimination of the most painful signs of the disease. For example, with cancer of the rectum, independent defecation is impossible, and the surgeon displays a healthy part of the rectum on the anterior abdominal wall. Depending on the general condition of the patient, the tumor is removed at the same time or later. This type is adjoined by palliative ones, which also eliminate various complications.

Urgent and elective surgery

Sometimes a patient needs urgent surgery. Types of emergency operations are performed as quickly as possible, they are required to save lives. This is a tracheotomy or conicotomy to restore airway patency, cavities with life-threatening hemothorax, and others.

Urgent surgery can be postponed for a maximum of 48 hours. An example is renal colic, stones in the ureter. If, against the background of conservative treatment, the patient fails to “give birth” to the stone, then it is necessary to remove it surgically.

A planned operation is performed when there are no other ways to improve the state of health, and there is no direct threat to life either. For example, such a surgical operation is the removal of an enlarged vein in chronic venous insufficiency. Also planned is the removal of cysts and benign tumors.

Surgery: types of operations, stages of surgery

In addition to the above, by type, the operation can be single- or multi-stage. Reconstruction of organs after burns or injuries, transplantation of a skin flap to eliminate a tissue defect can take place in several stages.

Any operation is performed in 3 stages: surgical access, surgical admission and exit. Access is the opening of a painful focus, dissection of tissues for an approach. Reception is the actual removal or movement of tissues, and the exit is the stitching of all tissues in layers.

The operation on each organ has its own characteristics. Thus, a surgical operation on the brain most often requires a trepanation of the skull, because in order to access the substance of the brain, it is first necessary to open the bone plate.

At the stage of operative exit, vessels, nerves, parts of hollow organs, muscles, fascia and skin are connected. All together constitutes a postoperative wound that requires careful care until healing.

How to reduce injury to the body?

This question worries surgeons of all times. There are operations that are comparable in their trauma to the disease itself. The fact is that not every organism is able to quickly and well cope with the damage received during surgery. In places of incisions, hernias, suppurations, dense non-absorbable scars are formed that disrupt the functions of the organ. In addition, the sutures may diverge or bleeding from injured vessels may open.

All these complications force surgeons to reduce the size of the incision to the minimum possible.

This is how a special section of surgery appeared - microinvasive, when a small incision is made on the skin and muscles, into which endoscopic equipment is inserted.

Endoscopic surgery

This is a special surgical operation. Types and stages in it are different. With this intervention, accurate diagnosis of the disease is extremely important.

The surgeon enters through a small incision or puncture, he sees the organs and tissues located under the skin through a video camera placed on the endoscope. Manipulators or small instruments are also placed there: forceps, loops and clamps, with the help of which diseased areas of tissues or entire organs are removed.

They began to be massively used from the second half of the last century.

Bloodless surgery

This is a way to preserve the patient's own blood during surgery. This method is most often used in cardiac surgery. During heart surgery, the patient's own blood is collected in an extracorporeal circuit, which maintains blood circulation throughout the body. After the end of the operation, the blood returns to its natural course.

Such a surgical operation is a very complicated process. Types of operations, its stages are determined by the specific state of the body. This approach avoids blood loss and the need to use donor blood. Such an intervention became possible at the intersection of surgery with transfusiology - the science of transfusion of donor blood.

Foreign blood is not only salvation, but also foreign antibodies, viruses and other foreign components. Even the most careful preparation of donated blood does not always allow avoiding negative consequences.

Vascular surgery

This branch of modern surgery has helped save many lives. Its principle is simple - the restoration of blood circulation in problematic vessels. With atherosclerosis, heart attacks or injuries, there are obstacles in the way of blood flow. This is fraught with oxygen starvation and, as a result, the death of cells and tissues consisting of them.

There are two ways to restore blood flow: by installing a stent or a shunt.

A stent is a metal frame that pushes the walls of the vessel apart and prevents its spasm. The stent is placed when the vessel walls are well preserved. The stent is more often installed in relatively young patients.

If the walls of the vessels are affected by an atherosclerotic process or chronic inflammation, then it is no longer possible to push them apart. In this case, a bypass or shunt is created for the blood. To do this, they take part of the femoral vein and let blood through it, bypassing the unsuitable area.

Bypass for beauty

This is the most famous surgical operation, photos of people who underwent it flash on the pages of newspapers and magazines. It is used to treat obesity and type 2 diabetes. Both of these conditions are associated with chronic overeating. During the operation, a small ventricle is formed from the area of ​​the stomach adjacent to the esophagus, which can hold no more than 50 ml of food. It is joined by the small intestine. The duodenum and the intestine following it continue to participate in the digestion of food, since this site joins below.

The patient after such an operation can eat little and loses up to 80% of the previous weight. Requires a special diet enriched with protein and vitamins. For some, such an operation is really life-changing, but there are patients who manage to stretch the artificially formed ventricle almost to its previous size.

Surgical miracles

Modern technologies make it possible to perform real miracles. In the news now and then flashed reports of unusual interventions that ended in success. So, quite recently, Spanish surgeons from Malaga performed a brain operation on a patient, during which the patient played the saxophone.

French specialists have been performing facial tissue transplants since 2005. Following them, maxillofacial surgeons of all countries began to transplant skin and muscles on the face from other parts of the body, restoring the appearance lost after injuries and accidents.

Perform surgical interventions even ... in the womb. Cases are described when the fetus was removed from the uterine cavity, the tumor was removed, and the fetus returned back. A full-term healthy baby born at term is the best reward for a surgeon.

Science or art?

It is difficult to unambiguously answer this question. A surgical operation is a combination of knowledge, experience and personal qualities of a surgeon. One is afraid to take risks, the other does everything possible and impossible from the baggage that he currently has.

The last time the Nobel Prize in Surgery was awarded in 1912 to the Frenchman Alexis Carrel for his work on the vascular suture, and since then, for more than 100 years, surgical achievements have not received the interest of the Nobel Committee. However, every 5 years, technologies appear in surgery that radically improve its results. Thus, rapidly developing laser surgery allows removing intervertebral hernias through tiny incisions, "evaporating" prostate adenoma, and "soldering" thyroid cysts. The absolute sterility of lasers and their ability to weld blood vessels give the surgeon the ability to treat many diseases.

A real surgeon today is called not by the number of awards and prizes, but by the number of lives saved and healthy patients.

Surgery- this is the exposure of a pathological focus by dissecting tissues in order to treat or diagnose a disease. Operation the most responsible and dangerous stage in the treatment of the patient and therefore must be performed according to strictly justified indications. If the patient can be cured without surgery, it should not be offered.

There are the following indications for surgery: absolute, conditionally absolute, relative.

Absolute readings arise in cases where the disease threatens the life of the patient, and surgery is the only method of treatment that can eliminate this threat in most cases. In emergency surgery, the term "life-saving surgery" is used, which corresponds to absolute indications.

Conditionally absolute readings arise in cases where the disease impairs health, reduces the ability to work, and surgery is the only method of treatment that can in most cases restore health and/or performance.

Relative readings arise in cases where the disease impairs health, reduces the ability to work, and surgery is one of the methods of treatment, which in most cases can restore health and / or performance.

By deadline distinguish emergency, urgent, delayed and planned operations.

emergency(urgent) operations performed immediately after admission to the hospital or in the first 2-4 hours after hospitalization. They are produced for external bleeding associated with damage to large vessels; with profuse, repeated gastroduodenal bleeding; injuries of the abdominal cavity with damage to internal organs, peritonitis, acute septic diseases in the purulent-necrotic stage, etc.

Urgent operations perform within 24–48 hours after hospitalization of patients. They are produced for acute cholecystitis, pancreatitis and other acute diseases, when intensive conservative therapy is ineffective.

Delayed(postponed) operations performed in acute surgical pathology after 8-10 days after admission of patients to the hospital in cases where the pathological process is effectively stopped by conservative therapy and therefore it is possible to prepare the patient for the upcoming operation.

Planned operations perform in a planned manner for diseases that at the moment do not directly threaten the life of the patient. They are produced for tumors of various localization, uncomplicated peptic ulcer, hernias, varicose veins, hemorrhoids and other diseases.

Operations are divided into radical, palliative, symptomatic, trial, diagnostic, rehabilitation.

radical operations- Surgical interventions, providing in most cases recovery. They can be single or multiple.

Palliative operations provide prolongation of the patient's life.

Symptomatic operations eliminate the painful symptoms of the disease (pain, impaired passage through the esophagus, stomach, intestines, etc.).

Trial Operations- an attempt at radical surgical treatment of certain diseases (tumors, alveolar echinococcus, thrombosis of the main trunk of the mesenteric artery, pulmonary artery, portal vein, etc.), which was unsuccessful.

Diagnostic operations performed in cases where all other research methods do not allow to clarify the nature of the disease.

Rehabilitation(plastic, reconstructive) surgeries improve the quality of life of patients who, in the course of surgical treatment or due to congenital deformity, have gross anatomical, functional or cosmetic defects.

plastic surgery- these are interventions, the main feature of which is the movement (transplantation, transplantation) of tissues and organs or the implantation of materials replacing them.

Recovery operations- These are interventions that use various methods to restore the integrity of organs and restore their functions in case of congenital or acquired defects.

In recent years, along with traditional methods and techniques, endoscopic, laparoscopic and microsurgical surgical interventions have been increasingly used.

Laparoscopy is very informative as a method. It allows in the shortest possible time, with minimal trauma for the patient, to objectify the alleged diagnosis in difficult situations, including emergency surgery, which means? to reduce the terms of clinical observation and the time spent on resolving the issue of the nature of further treatment.

From a pathophysiological point of view, the operation is a planned multicomponent, sometimes extremely heavy stress. Surgical trauma (stress) is not only the surgical intervention itself (mechanical damage), but also a number of adverse factors that cause disorganization of the functions of tissues, organs and systems. If the surgical injury is higher than the physiological capabilities of the life support systems of the body, then a fatal outcome is possible. Therefore, the main duty of the surgeon and anesthesiologist is to protect the patient's body from the stress factors of the surgical injury, if possible, or to reduce their negative effect.

Preparation for an emergency operation is a very important stage, which will determine the degree of success of the event. Before each surgical intervention, it is necessary to take into account the features of the operation and strictly observe the timing of the actions. And if this is an unscheduled procedure, prompt and high-quality preparation is needed.

- a whole range of measures that need to be taken quickly and urgently. They aim to improve the patient's condition. There are such options for operations:

• planned;
• urgent;
• emergency.

Elective is carried out only in the case when the patient was examined in advance and the decision to perform the operation was made long before that. In addition, the patient conducts special examinations. At the same time, human life is not in danger and there is enough time for preparation.

If the operation is urgent, then the specialists have several days left to organize the procedure.

An emergency is carried out urgently, so the possibility of carrying out diagnostic measures is excluded.

Each type of surgical intervention consists of certain stages, one of which is the preparation of the patient for the process. The absence or incorrect implementation of this step will lead to a poor result (poor quality result).

The main feature of this operation is the lack of time for the full preparation of the patient. The decision that the patient needs surgery is made very quickly, while doctors do not have the right to delay, as this can even lead to the death of a person.

It is necessary to resort to urgent help in some cases. Among them are the following health problems:

• trauma (for example, a broken limb);
• acute forms of diseases (for example, infringement of a hernia);
• other complications;
• if a foreign object is found in the patient's body.

The preparation process is determined by vital indications for each specific case. The main requirement is the minimum time that will be spent on the operation. Doctors have a maximum of 2 hours that can be spent preparing for an emergency operation. In certain cases, it takes only 1 minute while the patient is taken to the operating room, but these cases are very rare.

Based on the recommendations of the surgeon, the planned preparatory measures may be subject to adjustment. Most often, direct instructions are given by the anesthesiologist. In each case, it is possible to reduce the amount of some manipulations.

Preoperative patient preparation

Preoperative preparation of a patient for emergency surgery may include various activities, the purpose of which is to successfully help a person and stabilize his condition. For this, a special algorithm has been developed, according to which it is necessary to act in most cases.

The first action is data collection (brief anamnesis). It is very important to obtain information about the nature of the disease (injury, etc.). If possible, either the patient himself or his acquaintances should be interviewed. Next, an examination of a person is carried out, which consists of the following stages:

• auscultation;
• percussion;
• palpation.

It is almost mandatory to take a general analysis of blood and urine. For an emergency operation, information about the blood type and Rh factor is required. In certain cases, there may be separate indications. Based on them, a decision is made on the need for further research. We are talking about ultrasound, fluoroscopy, fibrogastroduodenoscopy. The last event is aimed at studying the organs of the digestive system. The need for it arises when a certain pathology of the gastrointestinal tract is detected.

If the case is not very complicated and there is still time, then it is recommended to carry out the following measures:

• conduct a coagulogram, it allows you to get information about blood clotting;
• blood test for total protein;
• determination of blood glucose.

Types of sanitization

Sanitary treatment of the patient is an obligatory element, without which the operation is not started. Since time is limited, all actions are minimized. The first event is the removal of clothes. If there is an open wound on the body, then care must be taken that no items of clothing remain in it. All contamination is removed with sterile items.

Processing measures must not be omitted, as this is dangerous to human health. If pollution remains, then there is a high probability that rotting processes will begin. Due to the fact that time is limited, all procedures are simplified to the maximum extent. Indeed, in some cases, the bill for the patient can go for minutes.

On the skin where the operation will be performed, the hairline should be removed, while the skin should remain dry. If there is an open wound on the site, then the complex of preparatory measures expands. Without fail, a special sterile tissue must be applied to the wound. The skin must be treated using a special agent (medical gasoline). You will also need the help of medical alcohol. When shaving hair, do not touch the wound.

In preparation for the surgical event, the area with the wound is treated with an iodine solution. Moreover, this measure is implemented twice. First time after shaving and treating the area with alcohol. Second time before surgery.

In some cases, doctors may insist on removing additional items from the patient's body, such as piercings. Since such elements can interfere with the normal operation. In certain cases, you will need to use a special apparatus (electrocoagulator). At the same time, metal products placed on the site can serve as a hindrance. Therefore, you should remove the rings, chains. If you leave these products on the body, after the operation, a burn may appear in these areas.

Women should definitely remove makeup on their faces. This is due to the fact that an urgent operation requires an objective assessment of the condition of the skin and a change in color from the doctor. Foundation and other concealers will hide any changes. Therefore, you need to cleanse your face of any cosmetics. In addition, during the operation, physicians must necessarily evaluate the patient's cyanosis (gas exchange). Therefore, it is the color of the skin of the face that is the main indicator of a person's condition.

The preparatory process that precedes an emergency operation takes a minimum amount of time. At the same time, any delay can lead to negative processes. Therefore, it is very important that the event in question is carried out by real specialists who cope with the task as efficiently as possible. Fast and well-coordinated work of medical specialists who will carry out the entire range of necessary procedures according to the instructions, regardless of external circumstances, is almost 30% of the success of the operation.

Elective surgery is a planned non-emergency surgical procedure. Elective surgery may be performed either when medically necessary (eg, elective cataract surgery) or as desired (eg, breast augmentation).

The purpose of the planned operation

Elective elective surgery may prolong life or improve the quality of life physically and/or psychologically. Cosmetic and reconstructive procedures - such as a facelift (rhytidectomy), tummy tuck (abdominoplasty), or nose surgery (rhinoplasty) - cannot usually be performed for medical reasons, but they can benefit the patient in terms of improving their self-esteem. Other procedures - such as cataract surgery - improve functional quality of life, even if they are done "on request" or as an elective procedure.

Some elective surgeries, such as angioplasty, are necessary to prolong life. However, unlike emergency surgery (eg, for appendicitis), which must be performed immediately, the required procedure can be scheduled according to the wishes of both the patient and the surgeon.

Planned operation: description

There are hundreds of elective elective surgeries covering all body systems in modern medical practice. Several major categories of general elective procedures include:

Plastic surgery. Cosmetic or reconstructive surgery that improves appearance and (in some cases) physical function.

Refractive surgery. Laser surgery for vision correction.

Gynecological surgery. It is carried out both for medical reasons and for the consideration of the surgeon.

Exploratory or diagnostic surgery. Surgery performed to determine the origin and extent of a medical problem or to biopsy tissue samples.

Cardiovascular surgery. Non-emergency elective surgeries to improve blood flow or heart function: such as angioplasty or pacemaker implantation.

Surgery of the musculoskeletal system. Orthopedic surgical procedures: such as hip replacement and some types of reconstructions.

Diagnosis and preparation for planned surgery

Diagnosis and preparation for elective surgery are carried out taking into account the intended purpose: for example, when confirming the diagnosis or additional surgery when planning the main procedure. Typically included in the scope of the preoperative assessment are: a complete medical history, physical examination, and laboratory tests (eg, urinalysis, X-ray, blood work, electrocardiogram).

The use of drugs before elective surgery depends on the type of procedure. Under general anesthesia, the patient must comply with dietary restrictions. If blood loss is expected during the procedure, a preliminary blood draw may be recommended.

A brief algorithm for preparing for a planned operation

1. An examination by a surgeon who will determine the need for a particular operation. When deciding on a cosmetic surgery during the examination, the doctor explains all the nuances of the planned intervention and the expected result.
2. Additional consultations: in the presence of concomitant diseases that may affect the course of the operation, the patient should be examined by an appropriate specialist. For diseases of the heart - a cardiologist, lungs - a pulmonologist, gastrointestinal tract - a gastroenterologist.

   Instrumental and laboratory research methods. Each patient at the stage of preparation for a planned operation must pass certain tests. This list can be significantly expanded by the attending physician. Minimum list:

• general blood analysis;
• blood for AIDS, syphilis and hepatitis;
• coagulogram;
• chest x-ray or fluorography.

Elective Surgery: Convalescent Care

Recovery time and postoperative care will vary depending on the elective procedure performed. The patient is given full postoperative instructions before returning home after surgery.

Elective Surgery Risks

The risks of elective surgery vary depending on the type of procedure performed. In general, most invasive surgeries carry the risk of infection, bleeding, and vascular problems (thrombosis). Anesthesia can also pose a certain risk for complications such as anaphylactic shock (allergic reaction).

Normal results

The results of scheduled activities depend on the type of procedures performed. In some cases, normal results may be temporary (i.e., subsequent surgeries may be required at a later date). For example, a facelift may eventually require a second procedure.

Alternatives to elective surgery

The alternatives available for a particular operation depend on the purpose of the procedure. For example, many other birth control options may be used. While some other types of operations have no alternatives.

Denial of responsibility: The information provided in this article about elective surgery is intended to inform the reader only. It cannot be a substitute for the advice of a health professional.