Anesthesia. General and special components of anesthesia, preparing the patient for anesthesia, general anesthesia clinic

Much also depends on the actions of the patient himself on the eve of the operation. What do you need to know when elective surgery is ahead? Will tell you about Medicine.

Before entering the department

You will see when you learn that preparations for surgery begin weeks or even months before you are admitted to the hospital wing. Here everything depends on the patient himself, because the doctor will not be able to constantly monitor the patient’s lifestyle and ensure that he follows all his instructions. So, what is required of the patient before entering a medical facility:

Before anesthesia

After a successfully completed operation, the patient still has to recover from anesthesia. Gradually, muscle sensitivity will return to him and he will regain consciousness. To eliminate medications, the body will need time and concentration. Doctors say that patients recover from anesthesia in 4-5 hours. After about another hour they spend half asleep. This reaction is completely normal and should not bother you or your loved ones.

• after anesthesia, you need to spend at least a day in a quiet environment: you cannot run, jump, play active games, work with children, etc.;
• It is prohibited to handle any devices that can harm your health (chainsaw, lawn mower, etc.);
• after anesthesia, you should not drive, because your reaction speed will be noticeably slower, you may fall asleep while sitting in the driver’s seat;
• do not take any medications other than those prescribed by your doctor;
• alcohol (including beer, cider, cocktails, etc.) should be excluded for at least a few days, allow the body to recover and rest from the stress experienced;
• if you were discharged from the hospital after anesthesia (a minor operation was performed), ask a friend or relative to monitor your condition for 24 hours and tell the doctor if you get worse;
• Limit yourself in food and drink for the first 3-4 days; your diet should consist of broths, porridges with water, yoghurts, mousses, toast bread.

For the operation to be successful, do not forget that you must be directly involved in its preparation. Compliance with doctors' instructions will help avoid possible risks and complications.

Preparation for surgery under general anesthesia

General anesthesia is prescribed to the patient if during the operation it is impossible to use local anesthesia for complete pain relief. Hundreds of thousands of people go through this procedure every day. Proper preparation for anesthesia will help reduce the likelihood of complications, both during and after surgery. The patient is required to strictly follow the recommendations that will help him prepare for the upcoming test physically and psychologically.

In many cases of surgical intervention, it is impossible to do without general anesthesia. Despite its relevance and necessity, such anesthesia still remains not entirely subject to human will. Medicine cannot give a 100% guarantee that this artificial sleep will not have a negative effect. An honest and open dialogue between the patient and the anesthesiologist is important when planning an operation, which should be prepared in advance.

Advantages and disadvantages of anesthesia

Back in the middle of the last century, anesthesia before surgery was associated with a risk to the patient’s life. Today, thanks to a huge leap in the development of all branches of medicine, as well as due to the use of advanced technologies, there is no longer any need to talk about mortality due to anesthesia. However, there remains a small possibility of a threat to the health of the human brain (mental impairment is possible).

Almost everyone who has to go through this procedure experiences fear, sometimes turning into panic. But, since there is no alternative to such anesthesia, it is necessary to use all available possibilities to achieve maximum safety. To do this, before anesthesia, it is important to prepare your body in accordance with established rules and the individual requirements of the attending physician. If you do everything as the anesthesiologist advises, you can reduce the likelihood of complications.

The advantages of general anesthesia include such factors as the patient’s lack of sensitivity to the surgical procedures being performed, and the patient’s absolute immobility, allowing surgeons to work with concentration and without tension. In addition, a person under general anesthesia is completely relaxed, which allows doctors to work even with hard-to-reach vessels and tissues, without wasting time. Another advantage is that the patient’s consciousness is turned off during the operation, and therefore there is no fear.

In some cases, anesthesia is accompanied by side effects such as attention disorder, nausea, vomiting, disorientation, pain and dry throat, and headaches.

These unpleasant sensations are temporary, and their intensity and duration can be adjusted if you prepare for the upcoming operation as required by the doctor, for example, by not eating or drinking water for several hours before the procedure.

Preparing for surgery

It is important to properly prepare for surgery under general anesthesia. Depending on the complexity of the upcoming surgical intervention, the general health of the patient and many other factors, the preparation time can vary from 2 weeks to six months. During this time, the patient sometimes develops a persistent fear of surgery and anesthesia, which is fueled by stories from other patients or anonymous testimonies read in the tabloid press.

The anesthesiologist, together with the surgeon who will operate on the patient, should have an informative conversation with precise instructions on what you can eat and drink a month before the operation, a week before it and on the day of it. In addition, the patient must be examined by other specialized doctors who study the state of his health and also give him useful advice on adjusting, for example, smoking, weight, lifestyle, sleep.

Even before a short and simple operation under general anesthesia, at least the following examination of the patient’s health condition is carried out:

• blood test (general);
• urine test (general);
• blood clotting test;
• general urine analysis.

It is important to tell the truth about how you feel. If the patient was properly preparing for surgery, but a few days before the operation he noticed an increase in temperature or an exacerbation of a chronic disease, for example, gastritis, the attending physician should know this! If the patient is not feeling well, the operation must be postponed.

Fear of surgery under anesthesia

Feeling afraid of anesthesia or a surgeon’s scalpel is normal and should not be ashamed. To reduce feelings of anxiety, you can seek help from a psychologist. In many developed countries, each patient is required to be consulted by such a specialist before surgery, and if necessary, consultations can be multiple. In our country, few clinics and hospitals can boast of such an opportunity, so patients themselves sometimes have to ask their doctor for a referral to a psychologist or psychiatrist for a conversation.

It is believed that the patient’s psyche is traumatized already in the clinic, when the doctor recommends surgical treatment to his patient. Even then, fear begins to occupy a dominant position in a person’s consciousness. Anyone undergoing surgery needs the sensitivity of the medical staff.

Every patient without exception should be reassured and encouraged. If the patient shows a particularly intense feeling of fear (cries often, talks about death, sleeps and eats poorly), he needs urgent consultation with a psychologist. In the preoperative period, most patients are in dire need of preparation for surgery, not only medicinally, but also psychologically. There are several areas of mental support for patients:

• training of children and elderly people;
• preparation for emergency surgery;
• preparation for planned surgery.

Fear is a strong emotion, which in this case plays a negative role, preventing the patient from adjusting to a favorable outcome of the operation.

Since the consequences of anesthesia depend not only on the anesthesiologist, but also on the patient, you should carefully consider your own emotional experiences and promptly see a specialist to restore mental balance. You can be afraid of anesthesia or the outcome of surgery, but at the same time live a full life, without poisoning it either for yourself or your loved ones. To do this, you should prepare for the operation psychologically and physically, controlling not only what you can eat or drink, but also what you can and should think about.

Psychological attitude

First of all, you should give up ostentatious bravado and admit to yourself: “Yes, I’m afraid of anesthesia.” Every patient who is about to undergo major surgery experiences fear. This is a normal state, since a person is accustomed to controlling the work of his own body, and the thought that he will be helpless inspires fear and anxiety. In addition, there is fear for the consequences of anesthesia and the success of the operation itself. Such anxiety is normal if it is not constantly present and does not disrupt the patient’s usual rhythm of life.

To psychologically prepare for an operation under anesthesia, while experiencing fear, you can do auto-training, yoga, and meditation. It is enough to master the technique of proper relaxation and breathing in order to feel peace of mind and peace after just a few sessions. Breathing exercises and a positive attitude will help overcome fear and panic.

Physical training

In addition to the psychological aspect, body preparation is important:

• The anesthesiologist and the attending surgeon should know about all medications taken (even about 1 tablet of aspirin);
• you should tell doctors about recent illnesses and allergic reactions;
• You cannot hide diseases suffered in the past that are popularly considered indecent (syphilis, gonorrhea, tuberculosis);
• you should not eat or drink 6 hours before surgery;
• It is advisable to quit smoking 6 weeks before the appointed date;
• Removable dentures and piercings must be removed from the oral cavity;
• you need to remove contact lenses and hearing aids (if any);
• Decorative varnish is removed from the surface of the nails.

A week before surgery, you should eat foods that help cleanse the intestines of toxins and gases. If you prepare correctly, the body will tolerate anesthesia easily and without complications. A competent approach and following the instructions will help you not to be afraid of the upcoming procedure and will allow you to restore strength after the operation.

The duty of the attending physician is to help the patient overcome fear and depression of pain, as well as prepare the patient’s body systems for surgery.

The patient should be open and talk honestly about everything that worries him. Only trusting relationships and strict adherence to rules and regimes will help you get through this period without serious stress on the psyche and body.

How to prepare for surgery?

Any surgical intervention is a severe shock to the body. How successful it will be and how quickly you will recover after the operation depends, not least of all, on proper preparation for surgery.

The site “Beautiful and Successful” will tell you how to prepare a patient for surgery.

How to properly prepare for surgery in advance?

If you are undergoing a planned operation, the doctor must prescribe a mandatory examination of your body. There are several goals. Of course, the surgeon needs to know everything about the problem for which the operation is needed, and you may be prescribed different types of examinations depending on the diagnosis.

But besides this, it is very important to know if there are any other health problems - even in other organs or parts of the body!

Firstly, any inflammation or infection can complicate the healing of the operated area. Secondly, there are many factors that can affect the tolerability of anesthesia (especially when it comes to how to prepare for surgery under general anesthesia!). Before any surgical intervention, the patient will be prescribed the following examinations:

• Cardiogram. It is important to know how the heart works (evenness of heart rate), whether there are any problems with blood circulation.
• Fluorography. Lung function is also a very important point.
• Complete blood count, complete urine test. The goal is to identify subtle problems, asymptomatic changes in the body, etc.
• Sometimes a biochemical blood test may be prescribed.
• Blood clotting time test. It is vitally important to know that blood clots normally!
• Tests for certain allergens (to make sure that a person is not allergic to certain medications administered during or after surgery). There are, for example, allergies to antibiotics, etc.
• Sometimes, mainly during abdominal operations, an ultrasound of the abdominal organs is prescribed - to see the current condition of the operated area and adjacent areas, and to make sure that there are no additional problems: neoplasms, metastases, stones, polyps, etc.
• In some cases, an x-ray of the operated part of the body is prescribed.

But even in addition to these examinations and their results, it is advisable to treat all third-party inflammatory processes before surgery: for example, ARVI, carious teeth, “problem” gums, stomatitis, herpes on the lips, etc. Pay special attention to areas of infection in the mouth.

Also, 1-2 weeks before surgery, you need to bring your lifestyle as close as possible to a healthy one (excluding sports and physical activity, if doctors do not recommend them for your diagnosis): less spicy, salty, smoked and fried foods in your diet, more time spent in the fresh air, healthy sleep at least 7 hours a day, etc.

It is highly advisable to quit smoking before surgery! If this is completely problematic, then at least don’t smoke the day before surgery! No matter what type of anesthesia you have to undergo, it won’t hurt to prepare for the operation through general health improvement - then the body will tolerate the intervention easier!

A few weeks before surgery, it is advisable to start losing as much excess weight as possible. Of course, without fanaticism and speed weight loss records! It is not necessary to bring your figure to the ideal of a fashion model, but it is worth looking objectively at the extra pounds - after all, the higher your body weight, the harder your heart works!

How to prepare before surgery the day before?

If you are undergoing general anesthesia, you need to prepare for the operation approximately 24 hours in advance.

A very important point is eating. On the day before the operation, you can eat as usual, but only until 6 pm. There is no need to fast or follow any diet (unless there are special instructions from your doctor) on this day. After 18.00 and until midnight, it is no longer recommended to eat solid food, but you can drink, and not only water, but also juice, broth, weak tea, and other drinks (for the body it is still food, since it has a certain calorie content). After midnight and until the operation itself, you cannot eat or even drink anything.

How to prepare for surgery under general anesthesia if you regularly take any medications? It is your responsibility to inform your attending physician, surgeon and anesthesiologist about them - you may be advised to cancel your appointment on the day of surgery. If you still need to take a pill, it is recommended to swallow it without water, and if this is very difficult, then take it literally in one sip.

On the eve of abdominal surgery, patients are usually prescribed a cleansing enema - during surgery, the gastrointestinal tract must be emptied.

You should take a shower in the evening or morning before surgery. If the surgical intervention affects areas that have hair, then it must be completely shaved off. Sometimes the depilation is done by nurses in the hospital, but sometimes the patient is asked to take care of it.

Another point on how to prepare for surgery is to wash off the manicure polish and/or artificial (extended) nails. There is a special device that is connected to the patient's hands (fingertips) to constantly monitor breathing during surgery, and varnish can distort the readings. You also need to remove all jewelry, piercings, hearing aids, lenses, dentures (dental or otherwise), glasses, etc.

It is also worth knowing how to mentally prepare for surgery.

First, consult with the surgeon and anesthesiologist in advance and ask all your questions. It is advisable to get enough sleep the night before surgery. Sometimes patients are even prescribed sleeping pills to cope with understandable anxiety and insomnia (but you should not take sleeping pills without consulting a doctor!). Bring a book, magazine, or player with your favorite music to the hospital to occupy your time while waiting before surgery.

But, of course, you cannot completely decide on your own how to prepare for surgery - be sure to consult with your doctor, because different diagnoses and types of interventions have their own preparation characteristics!

Preparation for surgery and anesthesia. What is important to do?

Proper preparation for surgery, as well as subsequent strict adherence to the rules of the postoperative regimen, is essential for the health of the patient preparing for surgical treatment.

Preparation for surgery begins long before hospitalization in a medical institution. It includes not only a number of important measures to improve health, prepare the necessary clothing, personal hygiene products, items that allow you to fill the time free from treatment, but also the development of a certain psychological attitude, consisting of a calm, balanced, correct and sober attitude towards the upcoming anesthesia and surgery.

A careful study of the pages of our website will allow you to get answers to many exciting questions regarding the upcoming anesthesia and surgery, which will certainly reduce your anxiety and anxiety, which, in turn, will be a good prerequisite for the successful course of the upcoming anesthesia and surgery.

Proper preparation of the patient for surgery largely determines the smoothness of the anesthesia and operation itself, thereby significantly reducing the risk of adverse effects of anesthesia and anesthesia.

Preparation for surgery and anesthesia can be divided into two important stages:

Preparation for surgery and anesthesia at the stage “before admission to the hospital”

To your health

• You should be as healthy as possible before your anesthesia. If there are any chronic diseases, then with the help of the treating therapist it is necessary to achieve stable remission of these diseases
• Avoid smoking cigarettes 6 weeks before the proposed surgery. This will significantly reduce the risk of respiratory complications after surgery. If you were unable to quit smoking, then at least try not to smoke on the day of surgery.
• If you are overweight, then try to get rid of extra pounds as much as possible, this will avoid many problems and complications after surgery
• If you have loose teeth or crowns, be sure to undergo treatment at the dentist, as these teeth may be lost when the anesthesiologist ensures airway patency (by placing devices specially designed for this in the oral cavity)
• Don't forget to take all your medications to the hospital

Jewelry

• It is necessary to remove all jewelry and jewelery from yourself. If for some reason this is not possible, then it is advisable to wrap them with adhesive tape to prevent damage to them, as well as injury to the skin.

Cloth

• Sometimes clothes can get really dirty, so take some old clothes with you that you wouldn't mind throwing away. Typically, most hospitals will ask you to change into a hospital gown before surgery.

Spending time before surgery

• Often on the day of the operation there is some free time, which seems so unnecessary and the anticipation of the upcoming operation seems so burdensome. Take your favorite book, magazine, MP3 player with you. Try not to forget to take your child’s favorite toys to the hospital.

Preparation for surgery and anesthesia at the stage of “while the patient is in the hospital, before anesthesia”

Fasting mode: do not drink or eat anything before surgery

• Unless you have been given other instructions by your surgeon or anesthesiologist, you may drink fluids and eat your usual food until midnight the day before surgery. We emphasize once again that on the morning of the operation you should neither drink nor eat anything. It is very important when preparing for anesthesia that your stomach is empty, since even a minimal amount of food or water in the stomach can significantly reduce the safety of anesthesia, posing a real threat to life. It should be noted that in pediatric anesthesiology practice, different time frames are established. Thus, food (including formula) is prohibited 6 hours before, breast milk 4 hours before, and water 2 hours before anesthesia. Use these instructions unless otherwise advised by your anesthesiologist.

Personal hygiene

• If there was no prohibiting order from the attending doctor, take a hygienic shower on the evening of the day before surgery. A bath (shower) will cleanse the skin of invisible impurities, which will reduce the risk of infection during surgery
• In the morning, brush your teeth or rinse your mouth with water

Your body

• Before surgery, remove all removable objects, if any, from the oral cavity (dentures, piercings). The oral cavity should also be free of chewing gum and sweets. All these items can cause problems with your breathing after being put under anesthesia.
• When preparing for anesthesia, also remove contact lenses and hearing aids (if you are undergoing regional or local anesthesia, you can leave them on
• Fingernails should be free of manicure varnish, which may cause difficulty in reading breathing information obtained using a special device connected to one of the fingers during anesthesia.

Medicines

• If your anesthesiologist has allowed you to continue taking any medication in the morning (which you were constantly taking before surgery), then the best thing to do is swallow the tablets without washing them down with liquid. If it is difficult to do this, then take the tablets with a minimum sip of water, while shifting the intake of medications to the earliest possible time in the morning
• During your preoperative visit, be sure to inform your anesthesiologist about your use of Viagra. Anesthesia in combination with Viagra can provoke a critical drop in blood pressure, causing serious damage to the heart, brain, and kidneys. Unless otherwise instructed by your anesthesiologist, stop taking Viagra 24 hours before the start of anesthesia.

To complete the picture, it will also be useful to read the article, which provides practical recommendations for preparing for anesthesia.

Let us emphasize once again that proper preparation for anesthesia and surgery is one of the important prerequisites for good anesthesia and a rapid postoperative recovery.

12 simple tips to prepare for abdominal surgery

Hello. Sometimes in life it happens when we are told that you will have an operation on the abdominal organs (we will not specify which one).

As a rule, in the clinic there is scant information on how to prepare for surgery, and they only give a referral to the hospital after an appropriate examination.

So, you were hospitalized and informed that the operation is planned for tomorrow.

1. On the eve of the operation, light lunch and dinner (no dinner, only drinks).
2. Cleansing enema the evening before and the morning of the operation.
3. It is necessary to properly prepare (shave) the anterior abdominal wall. It is necessary to shave the hair (or use a special gel) only on the day of surgery. They shave everything from the nipples on the chest and below, to the genitals, then treating the skin with an antiseptic. Why can't you shave your hair in advance? But because micropustules (folliculitis) appear on the skin, invisible to the eye, and during the operation, microorganisms from them enter the wound and infection occurs, and then various complications.
4. On the eve of the operation, an anesthesiologist must talk to you and examine you (he will administer anesthesia to you). Tell him about past illnesses and allergies to medications.

You should thoroughly prepare for any operation. Is it true that it is better to go to surgeons with an empty stomach? What should people with heart disease do before surgery? These questions are always of interest to patients. The chief anesthesiologist of the Ministry of Health of Ukraine, head of the Department of Anesthesiology and Intensive Care of the National Medical University named after A. A. Bogomolets, Doctor of Medical Sciences, Professor Felix Glumcher told how to prepare for the operation. An interview with him was published by the weekly magazine “Facts. Events and people."

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

Not at all. Before surgery, a person always talks with an anesthesiologist. The doctor will definitely find out what medications the patient is taking. Some of them, such as aspirin, may need to be stopped because they can increase bleeding and change the effect of anesthetics. But there is no need to stop taking antihypertensive medications - withdrawal can cause a surge in blood pressure.

Many people feel unsure about undergoing surgery. Is it possible to drink a little cognac for courage?

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

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

Is it true that one should go to an operation with an empty stomach, and that it would be better if a person fasted for two days before the operation?

No. The patient needs to eat normally in order to have the strength to survive the operation and recover faster after it. Lean meat, chicken, fish, cottage cheese, kefir and other fermented milk products are healthy. It is better to abstain from foods rich in animal fats (lard, sausages): they are poorly digested. You should not eat exotic fruits and dishes that the person has not eaten before: if an allergy occurs, the operation may be cancelled.

You should also eat well after surgery. Previously, it was believed that chicken broth was better at restoring strength. But, according to the latest data, preference should be given to fish broth. If after the operation the patient cannot eat on his own, a probe is placed in his stomach or intestines, or even special solutions are injected into the blood through a vein. For severe postoperative patients, special formulations have been developed that, say, when introduced into the intestines, are absorbed with virtually no waste.

How do you advise a person with diabetes and coronary heart disease to prepare for surgery?

Continue treatment and administer insulin in doses such that blood glucose levels are within normal limits. You should not stop taking medications prescribed for coronary heart disease. Before surgery, additional medications are often recommended to normalize vascular tone to reduce the risk of pressure surges. These and other medications will be prescribed by the anesthesiologist and surgeon who will perform the operation.

You need to give up solid food eight hours, and liquid food two hours before the operation.

In the old days, surgeons “disabled” the patient using a hammer, which they hit on the crown of the head. There was a time when people were given alcohol to drink for pain relief. What methods are used today?

Most often, general anesthesia is used - the so-called anesthesia. Special substances are injected into a vein or by inhalation into the trachea. This is how they work if you have to operate in the chest or abdominal cavities, or during other complex interventions, when you need to perform complete anesthesia and relax the muscles. If you need to “disable” a part of the body, regional anesthesia (epidural, spinal and other types) can be used. Sometimes local anesthesia is sufficient.

In general, it used to be considered normal for a patient to suffer from pain for some time after surgery. Today they have a different opinion. The fact is that when a person has pain for a long time, the body releases stress hormones, which cause spasm of blood vessels. As a result, the tissues feel a lack of oxygen and nutrients, and the patient’s wounds heal worse. The digestive organs and cardiovascular system are also affected, the functions of the heart and brain are impaired. If regular analgesics or injections do not help, the patient may have medications injected into the epidural space (the area near the spine). When a person does not experience pain, the body recovers faster.

Preparing for surgery: tips on how to prepare for plastic surgery from professionals

The preoperative period is one of the most important aspects of successful elective plastic surgery. The main goal of preoperative preparation is to minimize possible complications and risks during the operating and postoperative periods. One of the main factors of preoperative preparation in plastic surgery is the psychological mood of the patient. It is necessary to clearly understand the need for this or that operation, since it is extremely stressful and requires the patient’s patience and endurance. During the consultation, the patient and the doctor need to come to an understanding, discuss the expected results and possible risks. And also individually select the safest methods of surgical intervention and anesthesia. The patient is obliged to inform the doctor about previous operations, chronic diseases (diabetes mellitus, hypertension, varicose veins, thrombophlebitis, tuberculosis, hepatitis, HIV, etc.), as well as possible allergic reactions and hereditary predisposition. Indicate which medications the patient has taken in the last two weeks.

In addition, during preparation it is necessary to conduct a number of clinical examinations and tests that will help the anesthesiologist and plastic surgeon to objectively assess the health status of the person being operated on and take into account possible risks during or after the operation. To exclude anemia or any inflammatory processes, a general blood test is prescribed, which will need to be taken on an empty stomach in the morning. Based on the results of the analysis provided, the surgeon will be able to determine the level of hemoglobin, leukocytes (white blood cells), the number of erythrocytes (red blood cells), ESR (erythrocyte sedimentation rate), and especially the number of platelets in the blood, since these cells are responsible for the blood clotting process .

To avoid thrombosis or, conversely, bleeding during surgery, the clotting time and coagulogram are determined, which make it possible to determine blood clotting indicators.

In addition, it will be necessary to determine biochemical indicators of blood composition. This study is an indicator of the function of many organs and systems, helps the doctor determine an active inflammatory or rheumatic process, the condition of the liver, kidneys, as well as an imbalance of microelements and a violation of water-salt metabolism. Additionally, a general urine test is prescribed to determine kidney function. Urine collection must be carried out in the morning (the first urination after sleep, the middle portion of urine), after toileting the external genitalia.

An examination is carried out for syphilis, hepatitis B and C. The Rh factor and blood type of the patient are determined. If necessary, a smear is taken from the urethra for flora.

Patients over 40 years of age may need additional tests for general anesthesia: ECG, ultrasound of the abdominal organs, fluorography and consultation with a therapist.

Before breast surgery, an ultrasound of the mammary glands or mammography is required; sometimes, in doubtful cases, an MRI of the mammary glands is prescribed. The purpose of these studies is to exclude the presence of neoplasms in the breast tissue.

If any deviations in the patient's health are detected, the attending physician prescribes preliminary treatment (or refers to a specialist). After recovery and additional control tests, surgery will be scheduled. Since even the most minor deviations in health can cause certain difficulties in the future.

Depending on the surgery, your doctor may make recommendations for changes to your daily diet. For example, prescribe a certain diet that will include a high content of protein, vitamins and microelements (in particular iron), since even the most trivial operation is accompanied by blood loss. It is necessary to stop taking certain medications (oral hormonal contraceptives, aspirin and others). Aspirin, in particular, impairs blood clotting, which leads to difficulties during and after surgery. You will also need to exclude the consumption of any alcoholic beverages and tobacco products.

Women should plan the day of surgery so that plastic surgery does not occur at the beginning of their monthly cycle. Three days before the operation, you will need to stop visiting the gym and refrain from intense physical activity.

In order for the patient to rest and be able to sleep the night before surgery, it will be useful to take valerian or mild sleeping pills the day before. On the day of surgery, you should not eat or drink.

The final result of plastic surgery depends on many factors: the professionalism of the surgeon, the availability of modern equipment and suture material, the individual characteristics of the patient, etc., and to achieve the desired results, the most important element is careful preoperative preparation.

General anesthesia

General anesthesia is used in plastic surgery during aesthetic and reconstructive operations. Unlike local anesthesia, during anesthesia, not only pain is blocked, but also consciousness is turned off and muscle relaxation, accompanied by suppression of external respiration, and therefore preparation for anesthesia requires the consolidated efforts of the doctor and the patient.

General anesthesia is used during rhinoplasty, breast replacement, reduction mammoplasty, abdominoplasty, modeling the shape of the legs (cruroplasty) and buttocks. You will learn from this article how to prepare for surgery under anesthesia, what you should inform your doctor about, and what contraindications exist for general anesthesia.

Types of general anesthesia

Depending on the method of administering drugs for general anesthesia, inhalation and intravenous anesthesia are distinguished. With inhalation anesthesia, the anesthetic enters the body through the respiratory tract; with intravenous anesthesia, it is injected into the bloodstream. A combined method involving inhalation and intravenous administration of the drug is actively used.

To maintain external respiration, an endotracheal tube or laryngeal mask is used. The first method is called intubation anesthesia (or endotracheal), the second - mask. You will not need deeper knowledge about the specifics of an anesthesiologist’s work; it is much more important to understand how to properly prepare for anesthesia.

Good general anesthesia is the result of the consolidated efforts of the anesthesiologist and the patient. Therefore, we recommend that you read the next section very carefully.

Before general anesthesia: preparation

Preparation for surgery under anesthesia has a great influence on the effectiveness and safety of general anesthesia and the course of the postoperative period. You will have to undergo a comprehensive diagnostic examination, including detailed blood tests, coagulogram, and ECG. According to indications, consultations with narrow specialists are prescribed.

The presence of chronic diseases of the respiratory and cardiovascular systems is of great importance. Be sure to tell your doctor about the following diseases:

• bronchial asthma;
• chronic obstructive bronchitis;
• arterial hypertension;
• history of stroke.

Do not under any circumstances hide the fact that you have a history of chronic diseases and acute vascular events (heart attack, stroke). Not only the outcome of the operation, but also your life depends on this! Also provide your doctor with a complete list of medications you take, including “harmless” analgesics for headaches or menstrual pain.

As practice shows, excess weight negatively affects the rate of recovery after operations under general anesthesia. If you are planning plastic surgery in advance, pay attention to weight loss issues. It is advisable to quit smoking in about six months. If you have not done this, stop smoking a week before the operation, but you should not “quit” the day before anesthesia - this may complicate the rehabilitation period.

On the eve of the operation, pay special attention to nutrition and hydration. You should not drink alcohol 24 hours before plastic surgery. On the day before surgery, you should limit yourself to breakfast and lunch. On the day of surgery, eating and drinking is strictly prohibited!

After general anesthesia

Even after a good general anesthesia, in the first hours there is short-term confusion, disorientation in space and time, drowsiness, nausea, and dizziness. As the anesthetic drugs wear off, pain appears in the postoperative wound, but it is successfully relieved by the administration of strong anesthetics.

After general anesthesia with an endotracheal tube, patients complain of pain and sore throat caused by irritation of the mucous membrane of the upper respiratory tract, but this symptom, like nausea, passes very quickly. As a rule, patients feel well 3-4 hours after surgery, and on the second day they leave the clinic and return home.

Contraindications to general anesthesia

General anesthesia (operations under general anesthesia) is not performed if there are absolute contraindications:

• pathology of the cardiovascular system in the stage of decompensation;
• unstable angina;
• mitral or aortic valve defects;
• severe tachycardia and heart rhythm disturbances;
• atrial fibrillation with a heart rate greater than 100 beats/min;
• exacerbation of bronchial asthma or obstructive bronchitis;
• pneumonia;
• acute neurological disorders;
• acute psychiatric disorders.

What you need to know before surgery

HEAD AND NECK SURGERY

Let's start with what is especially close to me. If the surgical field is in the head and neck area, then two weeks before surgery, sanitize the oral cavity to remove a possible source of infection. Remember that the mouth is its breeding ground. Fill carious cavities, remove what needs to be removed, clean tartar from teeth, treat bleeding gums, etc. Those who have been taking Enap or similar drugs for a long time should be especially careful, as they cause overgrowth of the gum mucosa. Accordingly, secret hiding places for oral microflora are created. If it is not possible to go to the dentist, then at least carry out a course of systematic mouth rinses at home. Prepare two solutions: the first - from salt (1 tsp per glass of water) and soda (1/2 tsp per glass of water); the second - from tanning and anti-inflammatory herbs (oak bark, sage, chamomile - take equal parts per glass of water). Rinse your mouth with each solution 4 times a day, alternating them.

The infection can lurk not only in the teeth, but also in the throat. More precisely, she is “sitting” there for sure. Take a fresh aloe leaf (2 cm), squeeze it into a glass of water and gargle 3-4 times a day. Repeat the procedure daily for 7 days before surgery.

Both of these procedures are also important if the operation is performed under general anesthesia or general anesthesia.

LET'S TALK ABOUT ANESTHESIA AND NARCOSIS

Let's clarify the terms. The term "anesthesia" - the Greek - "insensibility" is translated as loss of sensation. It can be local and general. Local anesthesia is achieved by introducing substances (novocaine, lidocaine) that block the functioning of nerve endings. Everyone who had teeth removed experienced it. A more complex version of local anesthesia is subdural anesthesia. In this case, the anesthetic is injected under the dura mater of the spinal cord. This disables the dorsal roots of the spinal cord. As a result, organs located below the injection site stop sending nerve impulses to the central nervous system (CNS) to the center of pain. With this anesthesia, the patient does not feel pain and is in contact with the surgeon.

The term anesthesia is Greek - numbness, numbness is translated as general anesthesia. In this case, the person receives substances that turn off his central nervous system and falls into a pharmacological deep sleep, accompanied by loss of consciousness, analgesia (pain relief), relaxation of skeletal muscles and inhibition of reflex activity. It is no longer possible to communicate with such a patient. Anesthesia can be inhalational (the patient inhales a substance - nitrous oxide, fluorothane, halothane, ethyl ether, etc.) and non-inhalational (drug intravenously). With shallow anesthesia, the administration of drugs that cause immobilization is required, which paralyze the respiratory muscles, and such patients require artificial ventilation. The entrance to the lungs is through the mouth and oropharynx. Therefore, putting them in order is a strict necessity.

Substances used for anesthesia are destroyed and neutralized by the liver. At the same time, the paths of their neutralization intersect with the metabolic paths of alcohol, which itself was once used for these purposes (remember L. Tolstoy’s “War and Peace”, the scene of the amputation of Anatoly Kuragin’s leg). Anesthesiologists know that drunk people go into anesthesia slowly, difficultly and violently. Therefore, refrain from the desire to go out for the last time.

LET'S HELP THE LIVER AND KIDNEYS

In addition, during the pre- and postoperative period, you will have to process a large number of different medications, and your liver will do this. So try to put it in order. A month before surgery, take a preventive course by taking the drug “Karsil” or “Essential-ale”. The artichoke preparation “Hofitol” is very good. You can prepare a collection of medicinal plants yourself, which should include choleretics, cholekinetics and cholespasmolytics. Choleretics stimulate the formation of bile: calamus, birch, immortelle, knotweed, coriander, corn silk, calendula, tansy, wormwood, mint, burdock, radish, rowan, chicory, rose hips. Cholekinetics improve the functioning of the gallbladder: vegetable oils (especially corn and olive), calamus and immortelle, as well as lingonberries, cornflower, oregano, rhubarb, thyme. Cholespasmolytics relieve spasm of the extrahepatic biliary tract: arnica, valerian, elecampane, St. John's wort, lemon balm, mint, calendula, sage.

The main thing to remember is: the healthier your liver, the less worries your resuscitators will have.

The breakdown products of cut tissues and all applied medications will be excreted through the kidneys. Therefore they must be in perfect order. The simplest collection for preventive purposes: birch (leaf) - 3 parts, flax (seed) - 1 part, bearberry (leaf) - 5 parts, horsetail (grass) 5 parts. Pour 4 tablespoons of the mixture into 1 liter of boiling water and leave in a thermos for 2 hours. Drink 100 ml 6 times a day for a month.

Infection of a sutured wound is more likely the longer it is. Your protection is your immunity. If the operation is not related to organ transplantation, it makes sense to stimulate it. The mildest way to do this is with the tincture of Echinacea purpurea. Moreover, I recommend to you the domestic drug from the company Galenapharm, since at a low price it is very effective.

You can use the drugs Immunal or Arbidol. The drug "Ingaron" is interesting. You can go a slightly different route, not only stimulating the immune system, but also increasing the overall adaptive capacity of the body. Plants containing adaptogens are suitable for this. This could be our native burdock and elecampane or the more exotic goldenseal (Rhodiola rosea). Experiments on animals have already proven that preoperative use of adaptogens facilitates the course of the postoperative period.

Some would-be specialists recommend “cleansing the body of toxins” before surgery. The fact is that the concept of “slag” does not exist either in medicine or in biology. These are inventions of illiterate trade swindlers. No need for experiments. Eating a lot of raw vegetables or repeated enemas can change your condition so much that the operation either has to be postponed or done for urgent reasons.

WHAT YOU WILL NEED IN THE HOSPITAL

Now let's talk about what to take with you. It is quite difficult to give recommendations on this issue without knowing where you will be treated - in a district hospital or in a Central Clinical Hospital. Let's focus on the conditions of a city hospital in an average provincial town. In addition to personal experience, we will also use the recommendations of Dr. V.K. Kovalev, published in the book “An operation is coming.” In any case, you need to take the necessary toiletries. Please note that both men and women may need a razor to prepare the surgical field.

It is better to find out the issue with the dishes in advance. Sometimes they give you a plate, sometimes they don’t. In any case, a mug (or better yet two), a tablespoon, a teaspoon and a sharp knife will not hurt. Don't forget scissors, thread and needle. Boilers are not welcome by the administration, but it is difficult to do without them. Now there are very convenient mugs that have a heating coil built into the bottom. If it works, then buy it. It's safer. You should not boil water in glass jars, as they may burst. It's better to avoid getting burned.

If your hospitalization will last more than a week and there are difficulties with visiting relatives (they live far away, are sick, etc.), then think about the fact that socks, handkerchiefs and other small things tend to get dirty. In addition to toilet soap, take a piece of laundry soap.

Most often, the most basic things like toilet paper are forgotten. In the summer, mosquitoes and flies will get you. Grab a fumigator with odorless plates, which will make life much easier.

If the operation is large in volume (something like coronary artery bypass surgery), then it is advisable to bandage the legs with elastic bandages to reduce the likelihood of blood clots. Therefore, it is also better to purchase them in advance (each length is at least 1.5 m).

Now about the clothes. Think not so much about your appearance, but about convenience.

Do not forget that in the hospital, unfortunately, there is always a chance of catching some kind of infection in addition to your illness. Therefore, try to avoid woolen items. If they are necessary, then try to wear something smooth and easy to wash over them. It is best if you can leave this woolen item in the hospital. And you won’t take the infection home, and you’ll do a good deed for someone homeless.

If your operation involves prolonged bed rest, you will have to use a duck and bedpan. Alas, this does not always work out neatly. In the hospital they should give you oilcloth and a diaper, but nurses and nurses will grumble about a dirty diaper. Take disposable sheets and you will feel calmer and easier. It also makes sense to take your own oilcloth. Somehow it's more pleasant. Just don’t take a kitchen one, but buy a medical one at the pharmacy: a couple of pieces will be enough (about the size of a ½ sheet).

In general, if possible, it is advisable to practice how to use the bedpan and duck before surgery at home or in the hospital. For some this is a serious problem. This is especially necessary for men with prostatitis or prostate adenoma. It is possible that they will not be able to urinate lying down at all. Be sure to warn your doctor about this. In this case, you will need a catheter, and it is better to have it placed by urologists or resuscitation specialists, who have to do this often.

Shvyrkov Mikhail Borisovich, Doctor of Medical Sciences

1. Inform the patient and obtain his consent.

2. Examine the patient for patency of the nasal passages, mobility of the neck and lower jaw.

3. Find out your allergy history.

4. Carrying out the necessary laboratory and clinical studies (to exclude concomitant pathologies or clarify the patient’s current condition).

· UAC, OAM

· Biochemical blood test (total blood protein, transaminase levels, bilirubin);

· Blood for HbsAg

· Determination of blood group and Rh factor;

5. Examination by the attending physician, therapist, anesthesiologist, etc., as necessary.

6. Measure pulse, blood pressure, temperature.

7. On the eve of the operation, weigh the patient (since some anesthetics are administered taking into account body weight);

8. In the evening, the day before, take a hygienic bath, change linen;

9. In the evening, cleansing enema, or 2 hours before surgery;

10. Last meal the day before at 18:00 (we make sure that the patient does not take any food due to the danger of aspiration of vomit and vomiting during anesthesia); hungry in the morning, don't drink, don't smoke.

11. Reassure the patient, explain the essence of pain relief;

12. Provide moral and mental peace.

13. Take care of proper rest and night sleep (when the patient is nervous, adrenaline is produced, and this can complicate the course of anesthesia with arrhythmias, especially when using ftorotan).

14. On the morning of the operation – preparation of the surgical field (dry shaving and treatment with anesthetic);

15. Empty your bladder before surgery.

16. As prescribed by the doctor - medicinal preparation (premedication).

Premedication– introduction of medications to reduce the incidence of intra- and postoperative complications.

Objectives of premedication:

· reduction of the patient’s emotional arousal;

· neurovegetative stabilization;

· decreased response to external stimuli;

· creating optimal conditions for the action of anesthetics;

· prevention of allergic reactions to drugs;

· decreased secretion of glands.

Scheme.

1. On the eve of the operation, take sedatives (barbiturates: phenobarbital; benzodiazepines: radedorm, nozepam, tazepam) and desensitizing agents (diphenhydramine, suprastin, tavegil) at night. For complete rest of the patient.

2. On the day of surgery, 30 minutes before the start of anesthesia, IM 2% solution of promedol 1 ml (narcotic analgesics: omnopon, morphine), 1% solution of diphenhydramine 2 ml.

This achieves pre-anesthesia sleep and the patient is taken to the operating room in a calm state.

3. The effect of premedication is enhanced by the administration of droperidol (neuroleptic) and seduxen.

4. On the operating table, administration of a 0.1% atropine solution (reduces solvation and bronchorrhea, blocks vagal reflexes - increases heart rate when administered).

The anesthesiologist is directly involved in preparing the patient for anesthesia and surgery. The patient is examined before the operation, and not only is attention paid to the underlying disease for which the operation is to be performed, but the presence of concomitant pathology is also clarified in detail. If the patient is operated on as planned, then, if necessary, treatment of concomitant diseases and sanitation of the oral cavity are carried out. The doctor finds out and evaluates the patient’s mental state, allergy history, clarifies whether the patient has undergone surgery and anesthesia in the past, pays attention to the shape of the face, chest, neck structure, and the severity of subcutaneous fat. All this is necessary to choose the right method of pain relief and narcotic drug.

An important rule in preparing a patient for anesthesia is cleansing the gastrointestinal tract (gastric lavage, cleansing enemas).

To suppress the psycho-emotional reaction and suppress the functions of the vagus nerve, the patient is given special medication before surgery - premedication. The purpose of premedication is to reduce the incidence of intra- and postoperative complications through the use of medications. A sleeping pill is given at night; patients with a labile nervous system are prescribed tranquilizers (for example, diazepam) 1 day before surgery. 40 minutes before surgery, narcotic analgesics are administered intramuscularly or subcutaneously: 1 ml of 1-2% trimepedine solution or 2 ml of fentanyl. To suppress the functions of the vagus nerve and reduce salivation, 0.5 ml of a 0.1% atropine solution is injected. In patients with a burdened allergic history, premedication includes antihistamines. Immediately before the operation, the oral cavity is examined and removable dentures are removed.

In case of emergency interventions, the stomach is washed out before the operation, premedication is carried out on the operating table, and medications are administered intravenously.

Intravenous anesthesia

The advantages of intravenous general anesthesia are quick induction of anesthesia, lack of excitement, and a pleasant fall asleep for the patient. However, narcotic drugs for intravenous administration create short-term anesthesia, which makes it impossible to use them in their pure form for long-term surgical interventions.

Barbituric acid derivatives- sodium thiopental and hexobarbital cause rapid onset of narcotic sleep. There is no arousal stage, awakening is quick. The clinical picture of anesthesia when using sodium thiopental and hexobarbital is identical. Hexobarbital causes less respiratory depression.

Use freshly prepared solutions of barbiturates. To do this, the contents of the bottle (1 g of the drug) are dissolved in 100 ml of isotonic sodium chloride solution (1% solution) before starting anesthesia. The vein is punctured and the solution is slowly injected at a rate of 1 ml in 10-15 s. After injecting 3-5 ml of solution within 30 seconds, the patient’s sensitivity to barbiturates is determined, then the administration of the drug is continued until the surgical stage of anesthesia. The duration of anesthesia is 10-15 minutes from the onset of narcotic sleep after a single administration of the drug. To increase the duration of anesthesia, fractional administration of 100-200 mg of the drug is used. Its total dose should not exceed 1000 mg. At this time, the nurse monitors pulse, blood pressure and respiration. To determine the level of anesthesia, the anesthesiologist monitors the condition of the pupils, the movement of the eyeballs, and the presence of the corneal reflex.

Barbiturates, especially sodium thiopental, are characterized by respiratory depression, and therefore, when using it for anesthesia, a breathing apparatus is required. When apnea occurs, you need to start mechanical ventilation using a breathing apparatus mask. Rapid administration of sodium thiopental can lead to a decrease in blood pressure and depression of cardiac activity. In this case, it is necessary to stop administering the drug. Sodium thiopental is contraindicated in acute liver failure. In surgical practice, barbiturate anesthesia is used for short-term operations lasting 10-20 minutes (opening abscesses, cellulitis, reducing dislocations, repositioning bone fragments). Barbiturates are also used for induction of anesthesia.

Sodium hydroxydione succinate used at a dose of 15 mg/kg, the total dose on average is 1000 mg. The drug is often used in small doses together with dinitrogen oxide. With large doses, arterial hypotension may develop. In order to prevent complications such as phlebitis and thrombophlebitis, the drug is recommended to be administered slowly into the central vein in the form of a 2.5% solution. Sodium hydroxydione succinate is used for induction of anesthesia, as well as for endoscopic examinations.

Sodium hydroxybutyrate administered intravenously very slowly. The average dose is 100-150 mg/kg. The drug creates superficial anesthesia, so it is often used in combination with other narcotic drugs, such as barbiturates. Most often used for induction of anesthesia.

Ketamine can be used for intravenous and intramuscular administration. The estimated dose of the drug is 2-5 mg/kg. Ketamine can be used for mononarcosis and induction of anesthesia. The drug causes shallow sleep, stimulates the activity of the cardiovascular system (blood pressure rises, pulse quickens). Ketamine is contraindicated in patients with hypertension. Widely used for shock in patients with arterial hypotension. Side effects of ketamine include unpleasant hallucinations at the end of anesthesia and upon awakening.

Propofol- short-acting intravenous anesthetic agent. Available in ampoules of 20 ml of 1% solution. It is a milky-white, water-isotonic emulsion containing propofol (10 mg in 1 ml) and a solvent (glycerin, purified egg phosphatide, sodium hydroxide, soybean oil and water). Causes a rapid (within 20-30 s) onset of narcotic sleep when administered intravenously at a dose of 2.5-3 mg/kg. The duration of anesthesia after a single injection is 5-7 minutes. Sometimes short-term apnea is observed - up to 20 s, and therefore mechanical ventilation is necessary using an anesthesia machine or an Ambu-type bag. In rare cases, allergies and bradycardia may occur. The drug is used for induction of anesthesia, as well as for pain relief during minor surgical operations (opening of phlegmons, abscesses, reduction of dislocations, reposition of bone fragments, laparostomy sanitation of the abdominal cavity, etc.).

Inhalation anesthesia

Inhalation anesthesia is achieved using easily evaporating (volatile) liquids (halothane, isoflurane, etc.) or gaseous drugs (dinitrogen oxide).

Halothane- colorless liquid with a sweetish odor. Boiling point 50.2° C. The drug is highly soluble in fats. Stored in dark bottles, non-explosive. It has a powerful narcotic effect: the introduction of anesthesia is very fast (3-4 minutes), the stage of excitation is absent or weakly expressed, awakening occurs quickly. The transition from one stage of anesthesia to another is rapid, and therefore an overdose of the drug is possible. Influencing the body, halothane inhibits cardiovascular activity, leads to a slowdown in heart rate and a decrease in blood pressure. The drug is toxic to the liver, but does not irritate the respiratory tract, dilates the bronchi, and therefore can be used in patients with respiratory diseases. It increases the sensitivity of the heart muscle to epinephrine and norepinephrine, so these drugs should not be used during halothane anesthesia.

Diethyl ether, chloroform, and cyclopropane are not used in modern anesthesiology.

Isoflurane- colorless liquid that does not decompose in light. The same applies to fluoride-containing anesthetics. The surgical level of anesthesia can be maintained with 1-2.5% of the drug in a mixture of oxygen - dinitrogen oxide. Potentiates the effect of all muscle relaxants. During spontaneous ventilation it causes dose-dependent respiratory depression. The use of the drug in an anesthetic concentration leads to a slight decrease in cardiac output, while a slight increase in heart rate is noted. Isoflurane is less likely than other fluorinated anesthetics to sensitize the myocardium to catecholamines. In small concentrations it does not affect blood loss during caesarean section, and therefore it is widely used in obstetrics. When using the drug, even with prolonged anesthesia, there are no cases of toxic effects on the liver and kidneys.

Sevoflurane It was registered in Russia recently, but in the USA, Japan and the European Union it has been used for about 10 years. Anesthesia is more manageable; introductory mask anesthesia is possible, which is convenient in pediatrics and outpatient practice. Toxic reactions when using the drug are not described.

Dinitrogen oxide- “laughing gas”, colorless, odorless, non-explosive, but in combination with diethyl ether and oxygen it supports combustion. The gas is stored in gray metal cylinders, where it is in a liquid state under a pressure of 50 atm. Dinitrogen oxide is an inert gas, does not interact with any organs or systems in the body, and is released by the lungs unchanged. For anesthesia, dinitrogen oxide is used only in combination with oxygen; in its pure form it is toxic. The following ratios of dinitrogen oxide and oxygen are used: 1:1; 2:1; 3:1; 4:1. The latter ratio is 80% dinitrogen oxide and 20% oxygen. Reducing the oxygen concentration in the inhaled mixture below 20% is unacceptable, as this leads to severe hypoxia. Under the influence of dinitrogen oxide, the patient quickly and calmly falls asleep, bypassing the stage of excitement. Awakening occurs immediately as soon as the supply of dinitrogen oxide stops. The disadvantage of dinitrogen oxide is its weak narcotic effect; even in the highest concentration (80%) it gives superficial anesthesia. There is no muscle relaxation. Under anesthesia with dinitrogen oxide, small, low-traumatic surgical interventions can be performed.

Muscle relaxants

Muscle relaxants: short-acting (suxamethonium chloride, mivacurium chloride), relaxation time 5-20 minutes, medium-acting (20-35 minutes) - atracurium benzilate, rocuronium bromide; long-acting (40-60 min) - pipecuronium bromide.

Anesthesia devices

To carry out inhalation anesthesia with volatile and gaseous narcotic substances, special devices are used - anesthesia machines. The main components of the anesthesia machine: 1) cylinders for gaseous substances (oxygen, dinitrogen oxide); 2) dosimeters and evaporators for liquid drugs (for example, halothane); 3) breathing circuit (Fig. 21). Oxygen is stored in blue cylinders under a pressure of 150 atm. To reduce the pressure of oxygen and dinitrogen oxide at the outlet of the cylinder, reducers are used that reduce it to 3-4 atm. Vaporizers are designed for liquid narcotic substances and consist of a jar into which the narcotic substance is poured. Vapors of the narcotic substance are directed through the valve into the circuit of the anesthesia machine; the concentration of the vapors depends on the ambient temperature. The dosage, especially of diethyl ether, is carried out imprecisely, in arbitrary units. Currently, evaporators with a temperature compensator are common, which allows you to dose the narcotic substance more accurately - in volume percentages.

Rice. 21.Anesthesia apparatus (diagram): a - cylinders with gaseous substances; b - block of dosimeters and evaporators; c - respiratory system.

Dosimeters are designed for precise dosing of gaseous drugs and oxygen. Rotational dosimeters - float-type rotameters - are most often used. The gas flow inside the glass tube rushes from bottom to top. The displacement of the float determines the minute gas flow rate in liters (l/min).

The breathing circuit consists of a breathing bellows, a bag, hoses, valves, and an adsorber. Through the breathing circuit, the narcotic substance is directed from the dosimeter and evaporator to the patient, and the air exhaled by the patient is sent to the device.

The narcotic respiratory mixture is formed in the anesthesia machine by mixing gases or vapors of narcotic substances with oxygen.

Oxygen, having passed through the dosimeter, is mixed in a special chamber with dinitrogen oxide and cyclopropane, which also passed through the dosimeter, in certain proportions necessary for anesthesia. When using liquid drugs, the mixture is formed when oxygen passes through the evaporator. Then it enters the respiratory system of the device and then into the patient’s respiratory tract. The amount of incoming drug mixture should be 8-10 l/min, of which oxygen should be at least 20%. The ratio of narcotic gases and exhaled air to atmospheric air may be different. Depending on this, there are four methods of circulation (breathing circuits).

1. Open method (circuit). The patient inhales a mixture of atmospheric air that has passed through the evaporator of the anesthesia machine, and exhales into the surrounding atmosphere of the operating room. With this method, there is a large consumption of narcotic substances and their pollution of the operating room air, which is breathed by all medical personnel participating in the operation.

2. Semi-open method (circuit). The patient inhales a mixture of oxygen and a narcotic substance from the apparatus and exhales it into the atmosphere of the operating room. This is the safest breathing circuit for the patient.

3. Semi-closed method (circuit). Inhalation is made from the apparatus, as in the semi-open method, and exhalation is partly into the apparatus, and partly into the atmosphere of the operating room. The mixture exhaled into the device passes through the adsorber, where it is freed from carbon dioxide, enters the respiratory system of the device and, mixing with the resulting narcotic mixture, is again supplied to the patient.

4. The closed method (circuit) involves inhalation and exhalation, respectively, from device to device. The inhaled and exhaled gas mixtures are completely isolated from the environment. The exhaled gas-narcotic mixture, after being released from carbon dioxide in the adsorber, again enters the patient, combining with the newly formed narcotic mixture. This type of anesthesia circuit is economical and environmentally friendly. Its disadvantage is the danger of hypercapnia for the patient if the chemical absorber is not changed in a timely manner or its quality is poor (the absorber must be changed after 40 minutes - 1 hour of operation).

Inhalation anesthesia

Inhalation anesthesia can be performed using mask, endotracheal and endobronchial methods. First of all, you should prepare the anesthesia machine for use. To do this, it is necessary: ​​1) open the valves of the cylinders with oxygen and dinitrogen oxide; 2) check the presence of gas in the cylinders according to the pressure gauge of the gearbox; 3) connect the cylinders to the device using hoses; 4) if anesthesia is carried out with liquid volatile narcotic substances (for example, halothane), pour them into evaporators; 5) fill the adsorber with a chemical absorber; 6) ground the device; 7) check the tightness of the device.

Mask anesthesia

To perform mask anesthesia, the doctor stands at the patient’s head and places a mask on his face. The mask is secured to the head using straps. Fixing the mask with your hand, press it tightly to your face. The patient takes several breaths of air through the mask, then it is attached to the device. Oxygen is allowed to be inhaled for 1-2 minutes, and then the drug supply is turned on. The dose of the drug is increased gradually, slowly. At the same time, oxygen is supplied at a rate of at least 1 l/min. At the same time, the anesthesiologist constantly monitors the patient’s condition and the course of anesthesia, and the nurse monitors blood pressure and pulse levels. The anesthesiologist determines the position of the eyeballs, the condition of the pupils, the presence of a corneal reflex, and the nature of breathing. Upon reaching the surgical stage of anesthesia, they stop increasing the supply of the narcotic substance. For each patient, an individual dose of the narcotic substance in volume percentage required for anesthesia at the first or second level of the surgical stage (III 1 -III 2) is established. If the anesthesia has been deepened to stage III 3, it is necessary to bring the patient’s lower jaw forward.

To do this, press the angle of the lower jaw with your thumbs and move it forward until the lower incisors are in front of the upper ones. In this position, the lower jaw is held with the third, fourth and fifth fingers. You can prevent tongue retraction by using air ducts that hold the root of the tongue. It should be remembered that during anesthesia at stage III 3 there is a danger of drug overdose.

At the end of the operation, the supply of the narcotic substance is turned off, the patient breathes oxygen for several minutes, and then the mask is removed from his face. After finishing work, close all valves of the anesthesia machine and cylinders. The remaining liquid drugs are drained from the evaporators. The hoses and bag of the anesthesia machine are removed and sterilized in an antiseptic solution.

Disadvantages of mask anesthesia

1. Difficult to control.

2. Significant consumption of narcotic drugs.

3. Risk of developing aspiration complications.

4. Toxicity due to depth of anesthesia.

The anesthesiologist takes a direct and often primary role in preparing the patient for anesthesia and surgery. It is mandatory to examine the patient before surgery, but not only the underlying disease for which surgery is to be performed is important, but also the presence of concomitant diseases, which the anesthesiologist asks about in detail. It is necessary to know how the patient was treated for these diseases, the effect of treatment, duration of treatment, the presence of allergic reactions, and the time of the last exacerbation. If a patient undergoes surgical intervention as planned, then, if necessary, correction of existing concomitant diseases is carried out. Sanitation of the oral cavity is important in the presence of loose and carious teeth, as they can be an additional and unwanted source of infection. The anesthesiologist determines and evaluates the patient’s psychoneurological condition. For example, in schizophrenia, the use of hallucinogenic medications (ketamine) is contraindicated. Surgery during psychosis is contraindicated. If there is a neurological deficit, it is first corrected. An allergy history is of great importance for the anesthesiologist; for this purpose, intolerance to drugs, as well as food, household chemicals, etc. is clarified. If the patient has a burdened allergic anemnesis, not even to medications during anesthesia, an allergic reaction may develop, up to anaphylactic shock. Therefore, desensitizing agents (diphenhydramine, suprastin) are introduced into premedication in large quantities. An important point is whether the patient has had previous operations and anesthesia. It turns out what kind of anesthesia was used and whether there were any complications. Attention is paid to the somatic condition of the patient: face shape, shape and type of chest, structure and length of the neck, severity of subcutaneous fatty tissue, presence of edema. All this is necessary in order to choose the right method of anesthesia and narcotic drugs. The first rule of preparing a patient for pain relief during any operation and when using any anesthesia is cleansing the gastrointestinal tract (the stomach is washed through a probe, cleansing enemas are performed). To suppress the psycho-emotional reaction and inhibit the activity of the vagus nerve, before surgery, the patient is given medicinal preparation - premedication. Phenazepam is prescribed intramuscularly at night. Patients with a labile nervous system are prescribed tranquilizers (Seduxen, Relanium) a day before surgery. 40 minutes before surgery, narcotic analgesics are administered intramuscularly or subcutaneously: 1 ml of 1–2% solution of promolol or 1 ml of pentozocine (Lexir), 2 ml of fentanyl, or 1 ml of 1% morphine. To suppress the function of the vagus nerve and reduce salivation, 0.5 ml of a 0.1% atropine solution is administered. Immediately before the operation, the oral cavity is examined for the presence of removable teeth and dentures, which are removed.

There are three stages of anesthesia.

1. Introduction to anesthesia. Induction of anesthesia can be carried out with any narcotic substance, against the background of which a fairly deep anesthetic sleep occurs without a stage of excitement. They mainly use barbiturates, fentanyl in combination with sombrevin, and promolol with sombrevin. Sodium thiopental is also often used. The drugs are used in the form of a 1% solution and administered intravenously at a dose of 400–500 mg. During induction of anesthesia, muscle relaxants are administered and tracheal intubation is performed.

2. Maintaining anesthesia. To maintain general anesthesia, you can use any narcotic that can protect the body from surgical trauma (fluorotane, cyclopropane, nitrous oxide with oxygen), as well as neuroleptanalgesia. Anesthesia is maintained at the first and second levels of the surgical stage, and to eliminate muscle tension, muscle relaxants are administered, which cause myoplegia of all groups of skeletal muscles, including respiratory ones. Therefore, the main condition of the modern combined method of pain relief is mechanical ventilation, which is carried out by rhythmically compressing the bag or fur or using an artificial respiration apparatus.

Recently, neuroleptanalgesia has become most widespread. With this method, nitrous oxide with oxygen, fentanyl, droperidol, and muscle relaxants are used for anesthesia.

Intravenous induction anesthesia. Anesthesia is maintained by inhalation of nitrous oxide with oxygen in a ratio of 2: 1, fractional intravenous administration of fentanyl and droperidol, 1–2 ml every 15–20 minutes. If the pulse increases, fentanyl is administered, and if blood pressure increases, droperidol is administered. This type of anesthesia is safer for the patient. Fentanyl enhances pain relief, droperidol suppresses autonomic reactions.

3. Recovery from anesthesia. Towards the end of the operation, the anesthesiologist gradually stops administering narcotics and muscle relaxants. The patient regains consciousness, spontaneous breathing and muscle tone are restored. The criterion for assessing the adequacy of spontaneous breathing is the indicators PO 2, PCO 2, pH. After awakening, restoration of spontaneous breathing and skeletal muscle tone, the anesthesiologist can extubate the patient and transport him for further observation to the recovery room.

42. Anaphylactic shock (see 39)

43. Rights and responsibilities of nurses. Ethics and deontology in the work of a nurse (see 1)

Any operation- This is stress for the body. Many people are mistaken when they think that the success of the operation lies entirely on the shoulders of the doctor. This is a common misconception. Much also depends on the actions of the patient himself on the eve of the operation. What do you need to know when elective surgery is ahead? Will tell you about Medicine.

Surely many people do not suspect that proper preparation for surgery and subsequent compliance with the rules of the postoperative regime are important for the patient’s health. If a person does not adhere to certain rules that all patients preparing for surgery must strictly follow, the doctor may cancel it. In addition, such a negligent attitude towards your health can significantly change the work of the anesthesiologist for the worse; he may make a mistake and choose the wrong method of anesthesia and the drugs used for you. Therefore, in all medical institutions, doctors strongly advise adherence to strict rules for the preoperative and postoperative period.

Before entering the department

You will see when you learn that preparations begin weeks or even months before you are admitted to the hospital wing. Here everything depends on the patient himself, because the doctor will not be able to constantly monitor the patient’s lifestyle and ensure that he follows all his instructions. So, what is required of the patient before entering a medical facility:

I. General information

1. Before the operation, you must put your body on alert, that is, be as healthy as possible. Due to cough and ARVI, a specialist may well undergo surgery if your condition seems unsatisfactory to him. However, what should those who suffer from chronic illnesses do? Together with the doctor, achieve stable remission by the date for which the operation is scheduled.

2. You should give up bad habits: smoking, alcohol, taking drugs. It is best to avoid smoking cigarettes one and a half months before surgery. Drinking alcohol on the day of surgery is strictly prohibited, because it prevents the person from being anesthetized for a long time. In addition, it negatively affects the functioning of many internal organs. And you need your heart, kidneys, and liver to work at full capacity.

3. Try to lead a healthy lifestyle and eat right. Be sure to include vegetables, fruits, lean meats, and dairy products in your diet (unless you have personal recommendations from a doctor). If a specialist says that you need to lose a couple of extra pounds before going on the operating table, it’s better to listen to him. Obesity leads to frequent complications. A patient who maintains his body in good shape endures the postoperative period much easier than one who does not monitor his weight. Of course, you shouldn’t indulge in sweets, fast food, fatty and salty foods before surgery.

4. It is also better not to go under the knife with loose teeth and weak crowns. The fact is that the anesthesiologist must ensure airway patency during the operation. It sounds paradoxical, but your tooth can simply get lost. It will be worse if you swallow it.

5. Prepare all medications you take in advance. Doctors cannot know about every pill that makes you feel better. Be sure to tell your doctor about all the medications you take. If you resort to alternative medicine (propolis tinctures, various decoctions and ointments), the doctor should also know about this.

II. Personal items

1. All jewelry (earrings, bracelets, rings, etc.) should be left at home. There is no need for you to wear them during surgery. They can interfere with specialists during work and even injure your skin.

2. You should be careful about what to take with you to the hospital. First, don't forget about toiletries (soap, towel, toilet paper, shampoo, washcloth, etc.). You should also take your shaving accessories with you. If you are staying in a paid clinic, you may not need them, but in regular city hospitals it is better to bring everything with you, including dishes. Be sure to bring 1-2 mugs, a cup, a spoon, a fork, a knife, a boiler or small teapot, and tea leaves. Don't forget scissors and thread and needle. It is better to wear comfortable clothes made from natural materials. Please note that it may get dirty or torn, so it is advisable to bring already worn clothes.

3. You will have enough free time before the operation. To calm down and distract yourself, take several books, magazines, and board games (chess, checkers, dominoes) to the hospital. Don't forget your phone or tablet. Take care of chargers. If your child is undergoing surgery, allow him to take his favorite toys into the department.

Before anesthesia

I. Hygiene and appearance

1. If you have not had any instructions from your doctor, be sure to take a shower with soap the evening before the morning surgery (or the afternoon before the evening surgery). Water treatments will help cleanse your skin of impurities invisible to the eye, which will reduce the risk of infection.

2. Don't forget to brush your teeth in the mornings and evenings.

3. Before the operation, your skin should be cleansed of foundation, powder and makeup. It is not allowed to lie down on the operating table with a manicure, because the varnish may interfere with a special device to read data about the patient’s breathing.

4. Piercings, earrings, lenses, hearing aids should also be left in the room.

5. If the operation will be performed on a part of the body where there is hair, it should be thoroughly shaved before the operation. Your doctor should tell you about this. If no recommendations have been received from him, do not use the razor. You can make microscopic cuts that can easily become infected.

II. Food and medicine

1. All medications you take must be agreed upon with your doctor and anesthesiologist. This is a very important question, because even Viagra can provoke a critical drop in blood pressure and a sharp deterioration in the patient’s condition during the operation.

2. If you are allowed to take any medication several hours before surgery, it is better not to take it with liquid.

3. The morning before you have surgery, you are not allowed to eat or drink any liquids, including drinking water. It is extremely important that your stomach is empty during surgery, otherwise your life will be in real danger.

III. Psychological side of the matter

1. Excitement and fear before an operation, even one planned in advance, is a normal human reaction that should not be embarrassed. In order not to worry and feel comfortable, try to collect as much competent information as possible about how such operations are carried out. Read a book, listen to your favorite music. If you are haunted by a persistent feeling of fear, talk to the doctor who will perform the operation.

After operation

After a successfully completed operation, the patient still has to recover from anesthesia. Gradually, muscle sensitivity will return to him and he will regain consciousness. To eliminate medications, the body will need time and concentration. Doctors say that patients recover from anesthesia in 4-5 hours. After that, about another 10-15 hours are spent half asleep. This reaction is completely normal and should not bother you or your loved ones.

What you need to know

• after anesthesia, you need to spend at least a day in a quiet environment: you cannot run, jump, play active games, work with children, etc.;
• It is prohibited to handle any devices that can harm your health (chainsaw, lawn mower, etc.);
• after anesthesia, you should not drive, because your reaction speed will be noticeably slower, you may fall asleep while sitting in the driver’s seat;
• do not take any medications other than those prescribed by your doctor;
• alcohol (including beer, cider, cocktails, etc.) should be excluded for at least a few days, allow the body to recover and rest from the stress experienced;
• if you were discharged from the hospital after anesthesia (a minor operation was performed), ask a friend or relative to monitor your condition for 24 hours and tell the doctor if you get worse;
• Limit yourself in food and drink for the first 3-4 days; your diet should consist of broths, porridges with water, yoghurts, mousses, toast bread.

For the operation to be successful, do not forget that you must be directly involved in its preparation. Compliance with doctors' instructions will help avoid possible risks and complications.