What diseases of the legs are contraindicated in surgical treatment. Complications of peptic ulcer
Surgical interventions are divided into
▪ Life-saving surgery (eg, injuries complicated by internal or external bleeding; tracheostomy for upper airway obstruction; pericardial puncture for cardiac tamponade).
▪ Urgent (emergency) operations carried out within the shortest time from the moment of injury to prevent severe complications. To reduce operational risk, intensive preparation is prescribed before the operation. Depending on the nature of the pathology, the allowable time frame from the moment of admission to the clinic to the operation is, for example: - for embolism of the vessels of the extremities up to 2 hours; - with open fractures up to 2 hours. ▪ planned
Absolute readings to surgery ▪ Open injuries. ▪ Complicated fractures (damage to the main vessels and nerves). ▪ Risk of complications during closed reposition for fractures. ▪ Ineffectiveness of conservative methods of treatment. ▪ Soft tissue interposition. ▪ Avulsion fractures.
Relative readings. Planned interventions after injuries and previous surgical interventions (a preliminary outpatient examination of the patient is required).
For example: ▪ hip arthroplasty after a subcapital hip fracture; ▪ removal of metal structures.
When determining indications for surgical interventions, the following factors should be taken into account: - diagnosis of damage; - danger of damage; - prognosis without treatment, with conservative and surgical treatment; - the risk of surgery; - risk on the part of the patient (general condition, medical history, concomitant diseases).
In addition to complicated fractures and other life-threatening injuries requiring surgical intervention, the absolute and relative indications for surgery must be justified, and the intervention, c. on a case-by-case basis, may be delayed or rescinded.
Absolute contraindications:
- Severe general condition of the patient.
- Cardiovascular insufficiency.
- Infectious complications from the skin.
- Recent severe infectious diseases.
Relative contraindications may arise primarily due to the following risk factors:
- elderly age;
- premature baby;
- respiratory diseases (eg, bronchopneumonia);
- cardiovascular disorders (eg, unresponsive hypertension, BCC deficiency);
- impaired renal function;
- metabolic disorders (eg, uncompensated diabetes mellitus);
- blood clotting disorders;
- allergies, skin diseases;
- pregnancy.
Without taking into account these risk factors, the implementation of planned surgical interventions can lead to serious complications!
After the surgeon determines the indications for surgical treatment, the patient is examined by an anesthesiologist. The anesthesiologist prescribes additional studies to diagnose concomitant diseases and determines measures to stabilize impaired functions. The anesthesiologist is entirely responsible for the choice of the method of anesthesia and the implementation of anesthesia (after agreement with the surgeon).
Any surgical intervention is accompanied by the use of anesthesia. The introduction of potent drugs into the body, especially with deep anesthesia, often entails not the most pleasant manifestations for the body. However, there are situations when their use has contraindications. This means that general anesthesia is performed only for urgent medical reasons or when the risk to the life of the patient is justified by the risk of using anesthetics.
Absolute contraindications
This list is conditional. In some cases, as mentioned above, deep anesthesia is used even if they are available. We list the main contraindications to anesthesia:
- The patient has a disease such as bronchial asthma in a severe or progressive form. This condition is directly related to the risk of laryngeal intubation during deep anesthesia. This manipulation can cause closure of the glottis or the occurrence of bronchospasm, dangerous for human life. That is why a rather dangerous combination.
- Pneumonia. After surgery in this case, pulmonary edema may develop.
- Serious diseases of the cardiovascular system. These include myocardial infarction transferred earlier than six months, acute heart failure, as well as uncompensated heart failure. The latter is often accompanied by severe sweating, swelling and severe shortness of breath. Atrial fibrillation, in which the heart rate reaches one hundred beats per minute, also refers to unacceptable conditions.
- Epilepsy, schizophrenia and some other psychiatric and neurological diseases. Contraindications for such diagnoses are associated with an unforeseen reaction of the body of a sick person to the use of anesthetics.
- Temporary, but absolute contraindications, in which the operation is usually not performed under anesthesia, is the state of alcohol or drug intoxication. The point here is that anesthetics will not work, so this procedure is impossible. Surgical intervention in a patient who is in a state of alcoholic or drug intoxication can be performed only after a complete detoxification of the body. Often in this case, the help of a narcologist is needed. General anesthesia is used for patients who are in a state of alcoholic or drug intoxication only for emergency medical reasons. However, in this case, large doses of anesthetics and narcotic analgesics are introduced into the body, which can subsequently lead to an unpredictable effect.
In what cases it is impossible to use mask anesthesia?
It is worth noting that there are contraindications to the use of long-term. First of all, they include the presence of tuberculosis in a patient. It is also prohibited in case of diabetes mellitus and impaired renal function, including with unstable work of the adrenal glands.
In any case, it is up to the anesthesiologist to decide which anesthesia is best for you. It takes into account all diseases and possible contraindications. Carefully approach the choice of specialists and be healthy!
I created this project to tell you about anesthesia and anesthesia in simple language. If you received an answer to your question and the site was useful to you, I will be glad to support it, it will help to further develop the project and compensate for the costs of its maintenance.
Related questions
Olga 10.09.2019 05:50
Good afternoon Mom (73 years old) was diagnosed with a giant cystoma of the right ovary. A CT scan was done, all organs were examined, there were no metastases. In the extract, the doctor writes: cystoma? disease of the right ovary (implying oncology)?, i.e., the diagnosis is not known. Due to the fact that the cystoma squeezed all the organs, there are malfunctions in the work of the heart. An operation was planned to remove the cystoma, but after consultation with the anesthesiologist, it was postponed. The anesthesiologist said that the risk is high due to severe tachycardia. Previously, my mother did not complain about her heart. I received a referral for blood donation for a tumor marker (I had donated blood earlier, there was an excess), we will wait for the choice of an alternative treatment. It is difficult for her to move around, she eats little due to the fact that food simply does not fit in a squeezed stomach, in other words, she loses her strength. Should I insist on surgical intervention?
Inna 05/17/2019 09:50
Good afternoon. Tell me, with vertebroplasty, local anesthesia is done, I have 4 mature gastric erosions on FGDS, I have been treated for 3 weeks, soon again on FGDS. If they don't heal, will the operation be denied? After all, I am still undergoing treatment, and during the operation, drugs for the stomach can be taken. Can there be bleeding from local anesthesia?
Yana 05.02.2019 11:57
Hello! A 3-year-old child has congenital dropsy of the testicles, will soon have an operation under general anesthesia, the child often complains about his knee and we did an ultrasound of the knee joint, in conclusion they wrote that moderate synovitis of the right knee joint with a slight effusion into the cavity, and we also adenoids of the 2nd degree. Can we go to the operation under general anesthesia or should we postpone it for now? And what could be the consequences?
Alexander Grigorievich 21.01.2019 16:57
Hello! I am 68 years old. Diagnosis: Chronic polypous rhinosinusitis. The operation was performed using video endoscopic technologies. There is a concomitant diagnosis: Arterial hypertension 3 st 1 st risk 4. Question. How relevant is the use of general anesthesia in this case? Thank you.
Svetlana 05.10.2018 20:03
The gynecologist prescribed the operation, my grandmother has a strong prolapse of the uterus! + The doctor found that the bladder turned over as it were. Grandmother has epilepsy (drinks benzanal) since about 23 years old, bladder stones, hypertension in the evening and at night, the pressure rises very high, it used to be over 200, they were taken away in an ambulance, 2 times over the summer. I'm very worried about my grandmother. What tests need to be done to check the body's reaction to anesthesia? Is it worth doing an operation at that age?
ANATOLY GRIGORYEVICH 24.07.2018 19:05
HELLO, DOCTOR!!! I was 69 years old and was diagnosed with benign adenolymphoma of the right parotid salivary gland, while they advised me to do the operation under general anesthesia, because of the facial nerve so as not to damage, but I have concomitant sores, moderate chronic renal failure, dislocation of the left heart, right ventricular cavity, aortic atherosclerosis, enlargement of the aorta 51cm. signs of ischemic heart disease cardiosclerosis hypertension stage 2. Is general anastasia contraindicated for me, I'm afraid to completely plant the kidneys and heart. What do you doctor recommend? What type of anesthesia is best for my sore? THANK YOU(((((((
Olga 07/07/2018 15:20
Hello, please tell me if it is possible to perform an operation to remove a 40mm aneurysm on a shunt delivered in 2013. On the leg 37 cm long? Dad is 75 years old, flickering arteremia, pressure sometimes jumps, they found oncology on the lung about 60 mm. The doctor says general anesthesia is impossible, is it possible locally?
Roman 05/28/2018 22:13
Hello. I am 39 years old. Scheduled ear surgery (chronic suppurative otitis media, cholesteatoma) was scheduled. Removed one kidney and spleen (hit by a car in childhood), there was a brain contusion. There are problems with the heart (arrhythmia, tachycardia) - therefore, for many years I have been taking Concor 2.5 mg every day. Plus, they found the hepatitis C virus (how long I have had it is unknown), ECG - sinus rhythm, 86 beats, interatrial blockade; on the only kidney, the parenchyma is 1.9 cm and in the middle segment there is a hyperechoic formation of 0.8 cm, plus, it seems. liver problems (heterogeneous structure). Is it safe to have surgery? Formally, all the doctors in the local regiment (cardiologist, internist, urologist, neurologist) gave the go-ahead, but a lot of sores were revealed. Thanks in advance for your reply.
Oleg 05/17/2018 02:14
Hello. Please tell me, a 43-year-old patient will have a planned laparoscopic cholecystectomy. Of the comorbidities, there is stage 1 hypertension, narrowing of the bifurcation of the carotid artery by 60% on one side with a history of ischemic attacks. How dangerous is general anesthesia in this case and is it possible to use regional anesthesia in this patient. Thank you.
Elena 03.05.2018 18:40
Hello, tell me please, breast plastic surgery is planned, sinus rhythm on ecg with a heart rate of 78 beats. in min. Diffuse disorders of myocardial repolarization, is this a contraindication to anesthesia? Thank you.
Karlygash 04/08/2018 16:21
Hello, my aunt, 46 years old, they found stones in her kidney, they said she needed to have an operation, but in one clinic they refused to do the operation, they said that we were going to have a weak heart now we are going to go to another city, I have a question if she has a very weak heart, is it possible to have an operation and they will be under anesthesia do or how? Will she be all right?
Marina 03/25/2018 22:36
Hello. I would like to know. For my 4-year-old child, we want to treat all the teeth at once under general anesthesia for a day. But we recently discovered a pelvis in our right kidney, it is slightly enlarged. Can we have such anesthesia ?!
Svetlana 13.03.2018 13:28
Hello! I have instability of 5-6-7 cervical vertebrae, and a hernia of the cervical region, at the moment the pains have aggravated, headaches are added to them, and circulatory disorders. Is it possible to perform an operation under general anesthesia in this state (duration of the operation 1 hour)?
Natalya 27.02.2018 11:50
Is it possible to have an operation to remove a hernia with a heart block!? (If not, what are the consequences) (and if so, will this affect the deterioration of the heart)
Larisa 03.02.2018 07:18
Hello! I have a planned operation to remove the gallbladder, but there are heart diseases such as extrasystole and paroxysmal tachycardia. I take sotahexal 80, magnesium. During treatment with sotahexal, paroxysmal tachycardia did not occur. Is general anesthesia possible for these problems? And is it possible to take sotahexal on the day of the operation, before the operation?
Sergey. 29.10.2017 21:25
Hello. I want to extract some teeth under general anesthesia. I am taking Cordarone because I have atrial fibrillation. Does it make sense to apply with this request to the dental center? Or will it be denied anyway? Thank you.
Elena 10/26/2017 15:03
Hello! A relative (74 years old) was diagnosed with stomach cancer (initial stage). but he has COPD, the oncologist gave a conclusion that surgery and chemotherapy cannot be done (it will not withstand anesthesia), is he right?
Marina 20.10.2017 10:42
Hello! Tell me, please, my mother made a conclusion on the ultrasound of the kidneys: US-signs of cystic transformation of the right kidney. Pronounced diffusion changes in the parenchyma and sinus of the left kidney. ICD. Pyelitis on the left. Left kidney cyst. Cysts of the right ovary, endometrium, uterine fibroids. Can we reschedule spinal surgery? And how dangerous is it?
Ekaterina 10/19/2017 22:49
Hello, my daughter is 3 months old. On ultrasound of the brain, expansion of the stomachs of the brain was revealed. Livosrderzhaschaya system expanded D>S Depth of the anterior horns: right -7.8 mm, left 6.5 mm (N to 5 mm) And another open oval window. We are going to have a cosmetic surgery under general anesthesia (removal of capillary malformation) Is it possible to perform anesthesia with such a diagnosis
Natalya 10/13/2017 11:14
Hello, please tell me, we are going to have an operation to remove adenoids under general anesthesia, but sinusoidal arrhythmia (105 beats) was written on the ECG, the cardiologist did not give permission, he said that the child has bradycardia. Is this a contraindication?
Oksana 11.10.2017 22:35
Hello. Please reply urgently. My friend has stage 3 lung cancer and metastasis in T7 with a pathological fracture of the vertebral body and compression of the spinal cord. At the moment, the legs have failed (sensitivity is preserved), the bladder does not work and constipation for 8 days, the enema does not help. They put him in the hospital to install metal rods instead of a vertebra, and during the examination in the hospital they found an erosion of the stomach and the operation is postponed. The question is, is gastric erosion a contraindication to neurosurgery in such a situation? The condition worsens every hour. Symptoms of intoxication from constipation began. Or doctors fear the development of pulmonary embolism? How to insist on neurosurgical surgery
Ivan 05.10.2017 11:17
Hello. I have a spring allergy to flowering (April-May), I need to have an operation to remove the intervertebral hernia. Is it possible with such an allergy? Thank you.
Dmitry 09/25/2017 20:02
Good day Dear doctor, I have an umbilical hernia that needs to be sutured, right today We wanted to do surgery, but the doctor came and said that I could go crazy in plain language before he came in the evening I talked with the girl an anesthetist told her the whole truth that I am very much afraid that I have panic attacks when my heart is pounding, my heart is pounding for 10 minutes I go to wash my face and go to bed, said that from the age of 14 I have been smoking black marijuana every day now I am 19 or any other drugs I have not used told her that I have a very impressive character, so to speak, when we were sitting, I cried after 30 minutes I calmed down and was almost ready for surgery, told me that I had a diseased gallbladder (biliary dyskenasia and chronic cholecystitis, a gastroenterologist also diagnosed liver steatosis at the moment I have slightly yellowish eyes and my skin told her that I had gastroudenitis, she suggested spinal anesthesia, an injection in the back after which I would not move my legs for 6 hours (but I have a hernia along the white line of the abdomen above the navel) in general, today I was discharged from the hospital and they said that anesthesia is dangerous for me to do and, simply speaking, I can go crazy because I’m so emotionally excited, I’m afraid so I’m trembling all over + I waited several days until this day and was very afraid, in general, they discharged me from the hospital and said come do it you're done in 3 months.
Eugene 20.09.2017 14:44
Good afternoon MRI of the brain revealed a saccular aneurysm of the anterior communicating artery 2 mm. A laparoscopy is due. Are there any contraindications to anesthesia?
Ekaterina 16.09.2017 17:35
Hello, a child of 6 years old suffers from asthma for 2 years, basic therapy with Seretide 2 times a day 25/125. and a violation of intraventricular conduction, the appearance of a slowdown in intraventricular conduction was noted.
Polina 12.09.2017 06:35
Hello! My brother was found to have a lung bulla. He also has inflamed adenoids. They had to do an operation to remove them, but when they found a bulla, they said that it was a contraindication. Is it really true? How then to remove adenoids? Can't use anesthesia? We also wanted to take him to stem therapy, because. he has ROP of the central nervous system, but anesthesia (mask) is also needed there. The coordinator of the clinic said that, even with the use of gentle anesthesia, it is not known how the body will react. What can be done in this situation? Thank you in advance!
Alla 10.09.2017 15:58
Hello, my child, 4 years old, 2 days before the operation (phimosis), the stool was upset, tell me, in this case, the operation will be postponed?
Petimat 09.09.2017 23:13
Hello. I wanted to know if we have an adenotomy operation in five days. The boy is 8 years old, but his nose was blocked yesterday, the snot is slightly transparent, there is no temperature, his throat is slightly red. There is no cough, but at night he coughed a couple of times. Do we have any contraindications for the operation. It's just that if we are denied an operation, I will no longer wait for recovery. I'll wait until the summer then, since September gets colder, we get sick all the time. Not like 10 days of days, we get sick again. Thanks in advance.
Elena 09/05/2017 14:12
Hello. I need to do a laparoscopy in 15 days. I have an VSD, I waited for support for a long time and was nervous, it got to the point that I wake up at night because it’s stuffy and I start to lose consciousness when I go out into the fresh air. The genecologist also prescribed lutein hormone 200 for ten days for me to adjust my body to the date of the operation. If I could do the operation, I would like to know your opinion, I will ask my anesthesiologist, but it is interesting to know your opinion.
Dmitry 08/17/2017 05:43
Hello! I would like to know if it is possible for me to do anesthesia if the diagnosis is "Impaired intraventricular conduction, accessory chord in the left ventricle"?
Elena 08/07/2017 11:27
Good afternoon A 7-year-old child is diagnosed with bronchial asthma (mild form) of an allergic nature (to dust mites). We constantly take Singular and courses of flexotide. Did the neurologist send you for an MRI of the brain with anesthesia through a mask? Is such anesthesia dangerous for a child with asthma? What is the best way to prepare for anesthesia? Thank you.
Marina 03.08.2017 06:35
Hello, tell me, please, what kind of anesthesia is possible for my child. I have a 9 year old daughter. A diagnosis of papillomatosis of the larynx was made. She did not allow herself to be examined in a mirror without anesthesia. We were told that they would do an examination under anesthesia. She was diagnosed with OOP. By school, the condition improved, they said that it was overgrown. The child is very nervous. Thank you very much for the information.
Daria 07/01/2017 05:40
Hello. Child 2y 10m. An operation to remove the adenoids under general anesthesia is expected. ECG revealed boadycardia. Pulse rate 80 beats/min. The cardiologist said that the operation would have to be postponed, because. with such a pulse, they simply won’t take us to it. Is it so?
Alexandra 06/27/2017 16:42
Hello. The child is 6 months old. An operation is due for vesicoureteral reflux of the 2nd degree. The child has increased intracranial pressure. (Moderate) and an enlarged thymus (Stage 3). Is it possible to use anesthesia?
Waag 26.06.2017 17:59
Good afternoon. My father is due to undergo surgery to remove a cervical hernia, and he has a heart aneurysm. Is there a risk of surgery under prolonged anesthesia. Thank you.
Alexandra 06/25/2017 08:21
One of these days, a 6-year-old son will have an operation to remove adenoids under general anesthesia. Passed an EKG, the conclusion: sinus rhythm. with heart rate = 87 beats / min., s type ECG. Impaired intraventricular conduction. Can they refuse anesthesia with such a result.
Eugene 06/16/2017 10:48
Hello! The child is 1 year and 8 months old and will undergo surgery under mask anesthesia. on the ECG sinus rhythm with a heart rate of 89-109, with periods of bradycardia. There is no way to get advice from a pediatric cardiologist. The pediatrician doubts. Tell me please, is it dangerous to go for an operation with such ECG data. We'll survive. Thank you in advance.
Irina 06/09/2017 11:26
Good afternoon, my mother was discharged on May 31, 2017 from Bol. diagnosis: Cerebrovascular disease: cerebral infarction dated May 11, 2017. Ischemic heart disease: post-infarction cardiosclerosis. Persistent form of atrial fibrillation. Background disease: Hypertension stage 3, stage III, CVC risk 4. Complication: NK 2A (Strazhenko-Vasilenko) On 06/07/2017, she was taken to the hospital with suspected intestinal hemorrhage. On the next day, the coloproctologist said that there was already no blood in the stool and most likely the mucous membrane was damaged due to constipation (Mom is lying down, the right side is paralyzed). Since you need to constantly take anticoagulant therapy, the doctor nevertheless advised to perform a colonoscopy under anesthesia. What is the risk? Is it worth it to conduct this examination under anesthesia, given the above?
Elena 05/30/2017 00:34
Hello! A child aged 17 months needs to undergo FGS under general anesthesia. ECG examination diagnosed AV blockade of the 1st degree. Can it be done? How does general anesthesia affect the brain of an actively growing child? Thank you in advance.
Natalia 04/24/2017 08:37
Hello, I have a planned operation (lipoma) under local anesthesia, my throat hurts, I drink Ingoverine, should I cancel the operation or not?
Arthur 11.04.2017 09:26
An operation is scheduled to remove the inguinal hernia. I am 56 years old, atrial fibrillation in a permanent form. Two years ago, during coronary angiography, there was ventricular fibrillation. Now I'm afraid to go for surgery under general anesthesia. Help advice, thanks.
Oksana 04/08/2017 12:28
They did an ovarian laparoscopy, the anesthesiologist said that there were problems with me: a hard-to-remove and narrow glottis. What does it mean?
Anastasia 04.04.2017 13:50
Hello. Do we have such a question? We go to the hospital for a CT scan under anesthesia. We have had staphylococcus aureus since birth, and later we discovered that we also had adenoids. The bottom line is that we have eternal problems with snot. anesthesia, if before that we blow our nose well?
Tanya 04/02/2017 23:51
Good afternoon An operation is planned to remove the placental polyp. I have tachycardia up to 90 beats per minute. Should I be worried that it will take me a long time to get off anesthesia? Is it contraindicated for me? I'm drinking rose hips now in order to regulate my pulse, does it really help? Thank you!
Oksana 19.03.2017 09:38
Hello, I am going to have a colpoperineorrhaphy surgery under local anesthesia. I am currently suffering from acute bronchitis. Operation in a week. Is it possible to carry out the operation under such conditions
Irina Nikolayevna 28.02.2017 13:25
I am contacting you again because I did not find an answer. I need to do a colonoscopy and I would like to do it under anesthesia. Is it possible to do this if I take lyrica (pregalbin) zoloft and spitomin I will also add sirdalud. I have neuropathy against the background of stenosis of the lumbosacral spine. Age 67 years. Sincerely, Irina Nikolaevna.
27.02.2017 14:26
Olga, all the concomitant diseases you listed are not a contraindication to anesthesia. Spinal anesthesia is also possible. Everything is at the discretion of your anesthesiologist.
Vyacheslav 26.02.2017 06:35
Hello, my father is 67 years old, he has coronary artery disease, he suffered a myocardial infarction 3 years ago, now he is suffering from an inguinal hernia. Is it possible for him to use anesthesia, if possible, what kind in this situation?
Abdurakhman 19.02.2017 22:39
Hello, I have parkinson's syndrome and I didn't successfully fall and broke my femoral neck and now I have to have an operation to replace the femoral neck, please tell me if anesthesia is contraindicated or not
Olga 18.02.2017 23:45
Hello, what kind of anesthesia is done during the operation to remove the hygroma of the tendon of the long muscle of the abductor thumb of the wrist joint? Are there any risks? The child is 13 years old.
Olga 11.02.2017 00:09
Hello! Please tell me, I have been pregnant for 2 years now with a 3rd child, I will have a cop. Is he scary at all? Thank you!!!
Natalya 02.02.2017 17:57
Hello, the operation is to remove the tumor of the posterior part of the mediastinum, the child is 1 year 1 month old. The child has a runny nose, teeth are climbing. Is this a reason not to have surgery at the moment?
Olga 01/20/2017 18:56
Thank you. But is it advisable to put at risk for the sake of some kind of cardiogram? Why in simple cases (not requiring sutures, not touching muscles, nerves, blood vessels) not to hold the child, fix it with belts (I did this, though for a long time) and get by with local anesthesia? Sorry for the intrusiveness, this question is very worrisome.
Olga 19.01.2017 20:43
Hello. A 3.9-year-old child wants to remove a lipoma (5 mm) on the leg under general anesthesia. Wen on the surface of the skin, under a layer of skin about 1 mm thick, the contents are perfectly visible to the naked eye, the size of a sunflower seed .. You don’t even have to put stitches. Why do doctors go for general anesthesia for NO reason other than their own convenience? Why do not they measure the amount of work and do not offer other methods (for example, resorption by injection of the drug)? Please help, is this a violation of the rights of the patient?
Andrey 19.01.2017 00:38
Good afternoon The wife is due to give birth, and she has a polyvalent allergy (up to anaphylactic shock). Tell me, what drugs for anesthesia are used during childbirth, and is it possible to do allergy tests on them in advance. If yes, where? I would also be grateful for any advice in such cases.
Sima 12/17/2016 18:23
Hello, my son is 29 years old. He has diangosis - PMD, and he needs to remove his gallbladder. The doctor refused to do the operation because he should not be given anesthesia. Tell me what to do? Thanks for the information.
Maria 11/26/2016 21:10
Hello. The patient was scheduled for CABG (coronary bypass grafting) in a planned manner. During a preliminary examination of narrow specialists, the ophthalmologist diagnosed Suspicion of glaucoma. And he signed that there are no contraindications to the operation. But the patient in cardiac surgery was refused to take the operation, since Glaucoma is in question, they said that the patient needs to find out exactly whether or not glaucoma exists. Since Glaucoma is a contraindication to CABG. Is it so?
Tatyana 11/15/2016 09:28
Thanks a lot!
Tatyana 09.11.2016 10:12
Good afternoon! The patient is 53 years old. The main diagnosis of CIHM stage 2 (atherosclerotic, hypertensive). Postponed ischemic stroke in BZSMA on the right (cystic transformation in the occipital lobe on CT). Transient ischemic attack in BLSMA a year ago. Hypertensive heart. Atheromatosis of the aortic valve. Risk 4. Nephropathy mixed. BP S2. CHF 1. FC1 Diabetes mellitus 2. Obesity 1 st. Surgical treatment was recommended for atherosclerosis of the vessels of the neck of the extracranial bracheocephalic vessels. Occlusion of both ICAs. Stenosis of the proximal segment of the left vertebral artery up to 60%, refused surgery. X-ray later established COPD. Diffuse pneumosclerosis, emphysema. Can we now count on the operation or is this a contraindication?
Ulyana 01.11.2016 12:39
Good afternoon My son is 5.5 years old, the result of the ECG is a local violation of intraventricular conduction, is it possible to do adenotomy under anesthesia?
Alina 01.11.2016 00:34
Hello. My child is 6 years old, was diagnosed with cicatricial phimosis, and surgical treatment was recommended. I'm also concerned about general anesthesia. The fact is that the child suffers from asthma and has MAS. Anomaly of the chordal apparatus. During examination by a cardiologist, bradycardia was registered on the ECG. ECHOCG shows MAC. ECG with exercise, according to the cardiologist, is normal. This bradycardia is associated with VSD. Surgery is due in 2 weeks, we are very worried. Can we have general anesthesia?
Marina 10/15/2016 09:02
frequent extrasystole 4 degrees, bigenimia. trigenimia. jogging, biliary tachycardia, coronary heart disease. What is the risk?
Eugene 08.10.2016 11:28
Hello! I want to do a chin plastic surgery + SMAS lift. A year ago, there were problems with the heart due to nerves, the ECG showed a scar on the back wall of the heart. In conclusion, it is written: “According to Echo-KG, there are signs of atherosclerotic lesions of the aorta, aortic vertae cusps and mitral valves. signs of diastomic dysfunction.Signs of an aneurysm with / from the interatrial septum.Right type". Is anesthesia contraindicated for me? I had a heart problem in October 2015. (one year ago), date of the above conclusion: 29.10.2015. Sometimes, once every few days, the heart can stab quite a bit (2-3 "shots"), there are no serious complaints about the heart now. I do not treat the heart. Well, what are the consequences of anesthesia if it is contraindicated for me, and I hide the above from the plastic surgeon?
Aldyn 30.09.2016 12:49
Hello, my grandmother is 70 years old, the cavity of her uterus is filled with purulent-hemorrhagic contents, curettage of the uterus is indicated, but due to the presence of chronic bronchitis, it was refused (they said anesthesia might not pull). Is it true? Thanks for the answer.
Natalya 21.09.2016 11:56
Good afternoon. Anesthesia question. A gynecological operation is coming, the removal of a polyp in the uterus. Operation for the day after tomorrow. I have a broken wrist, my arm has been in a cast for a month now. Will they accept me for surgery or can they refuse to operate? Thank you.
Daria 16.09.2016 01:09
Hello. Anesthesia question. I am preparing for a gynecological operation, endometrial scraping. Is general anesthesia applicable to me, is it possible to minimize the risks? I have type 1 diabetes on insulin with concomitant diseases, chronic pyelonephritis, cholecystitis, anemia, low blood pressure.
Irina 13.09.2016 14:22
My daughter was scheduled for a laparoscopy operation (removal of a cyst on the left ovary), I have hepatitis B, they said general anesthesia .... I'm very afraid of contraindications and consequences. Interested in your opinion
Valentine 08.09.2016 17:32
Hello. In 2013, I underwent a caesarean section due to breech presentation of the fetus under epidural anesthesia. About 5 minutes after the start of the operation, it became very difficult for me to breathe. There was a feeling that half of my lungs were missing, my head was spinning, it was hard to speak, I was fainting. As the anesthesiologist said: the pressure dropped a lot. After 20 minutes the condition returned to normal. Now I have to again, by the way, I am very afraid of a repetition of this state, especially lack of air. By the way, after the first CS, the feeling of lack of air disappeared only after 2 months. In the anamnesis, JVP, VSD, mitral valve prolapse is not hemodynamically significant, high myopia. At the first pregnancy there was a syndrome of the lower vena cava, now it is not. Age 28 years. Tell me, what kind of anesthesia is still preferable for me and what is the reason for this condition during the first operation? What is the likelihood of such a reaction happening now? Thank you in advance.
Love 02.09.2016 15:51
Hello! I will have a planned caesarean at 38 weeks, now I am 37 weeks and the migraine has worsened again. I have had a migraine since 2014 in spring and autumn. During pregnancy, I have it not as acute (without aura) as it was before pregnancy. I also have tachycardia, my pulse is from 100 to 110. I'm afraid of general anesthesia. departed last time very hard (fainting and vomiting). What anesthesia can I have?
Elena 08/31/2016 10:45
Hello! we are preparing for the operation, we are going through tests and found sand in the kidneys and changes in the urine (protein) in the child, and there is a pronounced sinus arrhythmia on the ECG!, tell me this is a contraindication to surgery with anesthesia? 4-year-old child: the main diagnosis is merosin-negative muscular dystrophy. anesthesia was said to be inhalation with sevuran (if you spelled the name correctly)
Natalya 28.08.2016 08:24
Hello. Please tell me if it is possible to use general anesthesia in my situation. In 2005, the following operations were performed: (first stage) - operation of right-sided ventriculoperitoneal shunting, and the second stage - operation of right-sided paramedian access, removal of the tumor of the left cerebellopontine angle. Currently, the neurologist's diagnosis: CVD, DE st. complex genesis (hypertensive, atherosclerotic, postoperative), hypertensive-hydrocephalic syndrome, left-sided pyramidal insufficiency, liquorodynamic disorders, moderate vestibulo-atactic, cognitive impairment. Chronic cholecystitis, Polyposis of the gallbladder. Dyslipidemia. Is it possible in my situation to use general anesthesia - gynecological surgery (endometrial hyperplasia), removal of the gallbladder. What consequences are possible after the application of general anesthesia on the brain? Are there any contraindications in my situation for general anesthesia?
Natalya 18.08.2016 17:11
Hello. Please tell me, can oligophrenia be the reason for refusing to perform an operation on the gallbladder? A 63-year-old woman, a disabled child, oligophrenia with mental retardation. There are complications after the treatment in the form of speech disorders, severe stuttering. Fully capable. She passed the examination necessary for planned hospitalization. There are no contraindications to the operation. Cholelithiasis, constant pain. Occasional nausea, vomiting, diarrhea. She was hospitalized several times in an ambulance during an exacerbation. The gastroenterologist recommended surgical treatment.
18.08.2016 16:32
Yulia, it is not clear from the question whether we are talking about a planned vaccination, or about the treatment of a disease. If this is a vaccination, I can’t be 100% sure, but most likely there’s nothing to worry about, but it’s better to transfer it to after the operation. And if we are talking about a disease, then additional consultations of doctors, an assessment of the risk and the need for surgery are needed here.
Anastasia 16.08.2016 20:02
Thank you very much for your answer!
16.08.2016 14:51
Anastasia, if there is no lactation, there are no contraindications, then of course you can do it, but I would advise you to postpone the operation, let the body recover - after all, pregnancy and childbirth are a strong stress for the woman’s body, especially since there was a caesarean section, which means there was anesthesia, or anesthesia. Now immediately again anesthesia. Of course, it happens that we do several operations and anesthesia in a row and everything goes well, but you need to understand that if there is no urgency, then it is better to postpone it so that at least a year and a half has passed. Good luck to you!
Azat 10.08.2016 11:47
Hello, is it possible to do an operation to remove the gallbladder with angle-closure glaucoma, and what kind of anesthesia is provided (antropin is contraindicated)? What kind of anesthesia is used during the operation, local or general?
Olga 03.08.2016 15:28
Good afternoon On August 11, a reconization of the cervix was prescribed, the diagnosis was grade 2-3 dysplasia, blood sugar was 7.1 mmol, can I have surgery?
Diana 02.08.2016 19:59
Hello! I am allergic to all local anesthetics. Only ultracaine showed 30% (as I understand it is possible, but with tavegil) Please tell me what other options for anesthesia can suit me. There was a need to remove a wisdom tooth. And also, for the future, because during childbirth, for example, anesthesia is used.
NATALIA 07/31/2016 15:40
hello August 12, 7-year-old daughter, removal of adenoids under general anesthesia, is it possible to get vaccinated against tetanus (the time has come) before the operation or is it better to postpone?
Lydia 26.07.2016 16:39
Meniscus resection (arthroscopy): which anesthesia to choose? Good afternoon I ask for help with the choice of the method of anesthesia for knee arthroscopy (the operation will take at least an hour). The surgeon recommends spinal anesthesia. But what stops me is that because of the neglected spine (osteochondrosis, hernia, etc.), this can be difficult. In addition, I heard negative reviews about this method, including from neurologists. There are opinions that the consequences can manifest themselves even after six months - a year. General anesthesia - everything is fine, but several operations have already been carried out under general anesthesia and I'm afraid there might not be too much. Memory worsened, reaction speed worsened, insomnia torments. In addition, I have arrhythmia, problems with pressure (there were cases when it dropped to 40). Local anesthesia, according to the surgeon, is not an option at all. Remains conduction anesthesia (regional). I would be very grateful if you could give me your opinion on this matter. P.S. I have not talked to the anesthesiologist yet, but I would like to understand what to ask him about.
Larisa 25.07.2016 21:07
Hello! My sister fell ill a month ago, with the help of MRI, a sequestered hernia of the L4-S1 vertebra was revealed. They began to prepare for a neurosurgical operation. The ECG showed that there are changes in the heart. Conducted a study of the heart (ultrasound), which showed the presence of aneurysmal deformity of the n / c MPP in the cavity of the left atrium with an interruption of the echo signal of 3.7 mm with a small pathological shunt of blood. Rhythm disturbance. The thickness of the PS of the pancreas is 8.2 mm. The conclusion also says that there is a tendency to dilatation of the cavities of both atria. Concentric hypertrophy of the LV myocardium with a decrease in contractile function. Diastolic dysfunction type 1 Thickening and unexpressed calcification of the valves of the MV and the aortic root. Mitral insufficiency 1-1.5 tbsp. Aortic regurgitation 0-1 tbsp. Tricuspid insufficiency 1.5 tbsp. Pulmonary regurgitation 1 tbsp. myocardial hypertrophy. Moderate pulmonary hypertension. R sist. LA 40 mm/Hg. The neurosurgeon is ready for the operation, but the anesthesiologists categorically refused the operation twice, pointing out the presence of a heart defect, which greatly frightened us. We had a consultation with a cardiac surgeon, who said that cardiac surgery is not indicated in this situation and there are no obstacles to a neurosurgical operation. Help me figure out whether it is really impossible to give anesthesia or anesthesiologists are just insured? Is there a real direct threat to life? The operation usually takes 3-3.5 hours under general anesthesia. I also write that the hospital is the base for training students of a medical university (maybe this is the reason?), located in our city, a high-class neurosurgeon was supposed to operate, previously he worked in one of the federal centers. I will also say that they learned about the existing heart disease only during the examination. For us, this is a "find", because there have never been any complaints about the heart and there are none.
Egor 25.07.2016 19:29
Hello. Father is 57 years old. After surgery on the carotid artery, progressing signs of stroke were recorded for a year. As a result, the right side of the body was taken away. They did an MRI of the brain a year ago and now - a 4 cm tumor has formed in the brain in a year (I think a post-stroke cyst), but the doctors do not draw a conclusion and simply call it a formation, a tumor (gliastomy). My father walked a little, but fell on his right leg, having received a subtrochanteric fracture of the femur with displacement. Everything would be fine, they wanted to do an operation and install staples on the thigh, but the hospital refused to operate, referring to the impossibility of anesthesia in such a patient. We went to the Institute of Brain Neurosurgery (Tashkent) for permission, where they confirmed to us that no anesthesia can be done, even during surgery on the leg. My father has been in bed for two months and is suffering from a fracture, the bones naturally do not grow together on their own. Please tell me, is it really impossible to do anything? Maybe there is a way to anesthetize only the lower part of the body, for example, during a leg operation? Thank you.
Hello, Doctor! When I was treating my teeth, the doctor gave me some kind of anesthetic, after which I cried. She asked if I was in pain and why I was crying. At that moment, I didn’t feel pain, but I cried on my own, I even smiled when answering. She brought me to my senses with ammonia, after which she said that she realized that it was an "adrenaline swing." She said that it was a reaction to adrenaline, and it seems that she added that I ate something sweet before that, so this is the reaction. She did not consider it necessary to write me a name, since it was not a reaction to the anesthetic, according to her, but she wrote something like "adrianol", I could be wrong. I have to go to the dentist, which without anesthesia will be unbearable, and besides, I am breastfeeding, the baby is 1.2 months old, I am not going to quit yet. I still have a question about the adrenaline swing and how dangerous it can be? Is it worth taking tests for the use of anesthetics, if so, which ones, because the prices bite terribly. By the way, after this incident, I was already given anesthesia after childbirth, when the placenta was removed, the general one, but this is probably a different type of anesthesia. Transferred well.
Nikolai Valentinovich 06/10/2016 16:06
Hello. My wife was diagnosed with stage 4. bladder cancer. A month ago, my wife (64 years old) made an unsuccessful suicide attempt (phenazepam-30tab. + 100g. vodka). She survived, but with serious consequences. For the first 10 days after the poisoning, she only slept, did not eat, only drank water. Then she regained consciousness, began to eat and drink a little, recognized her relatives, spoke poorly, tried to get up and walk herself, although she did not realize where she was and what had happened to her. But mostly she slept, often turning over on one side, then on the other. In a dream, he often slowly raises either his arms or legs, making smooth movements (as in ballet). We thought it would take a week or two and everything would be restored, but every day her condition worsened: she began to talk worse (now she doesn’t speak at all), she doesn’t get up, she walks under herself, she doesn’t respond to our requests, she has to drink and feed in a dream. Now he sleeps 24 hours a day. Eating has become bad, takes food from a spoon into her mouth and sleeps with it, does not chew, does not swallow, does not hear our calls. The oncologist asks us to urgently do an MRI of the brain. But since she can raise her leg or arm at any time, this must be done under anesthesia. The question is whether it is possible for my wife in such a state to undergo anesthesia for an MRI examination, or in our case this is excluded. And if so, do we have any other option for examining the brain without anesthesia or not? Thank you. Nikolai Valentinovich is a pensioner from Moscow.
Elena 04/14/2016 01:15
Hello. Please tell me how important it is to inform the anesthesiologist about the intermittent use of amphetamine for two years if the last use was a year ago, and the use of marijuana within the last year if the last use was a month ago?
Indications for surgery are divided into absolute and relative.
Absolute readings The operation considers diseases and conditions that pose a threat to the life of the patient, which can only be eliminated surgically.
Absolute indications for performing emergency operations are otherwise called "vital". This group of indications includes asphyxia, bleeding of any etiology, acute diseases of the abdominal organs (acute appendicitis, acute cholecystitis, acute pancreatitis, perforated gastric and duodenal ulcer, acute intestinal obstruction, strangulated hernia), acute purulent surgical diseases (abscess, phlegmon, osteomyelitis, mastitis, etc.).
In elective surgery, indications for surgery can also be absolute. In this case, urgent operations are usually performed, not postponing them for more than 1-2 weeks.
The following diseases are considered absolute indications for a planned operation:
Malignant neoplasms (cancer of the lung, stomach, breast, thyroid, colon, etc.);
Stenosis of the esophagus, the output of the stomach;
Mechanical jaundice, etc.
Relative indications for surgery include two groups of diseases:
Diseases that can be cured only by a surgical method, but not directly threatening the life of the patient (varicose saphenous veins of the lower extremities, uninjured hernia of the abdomen, benign tumors, cholelithiasis, etc.).
Diseases that are quite serious, the treatment of which can in principle be carried out both surgically and conservatively (ischemic heart disease, obliterating diseases of the vessels of the lower extremities, peptic ulcer of the stomach and duodenum, etc.). In this case, the choice is made on the basis of additional data, taking into account the possible effectiveness of a surgical or conservative method in a particular patient. According to relative indications, operations are performed in a planned manner under optimal conditions.
There is a classic division of contraindications into absolute and relative.
To absolute contraindications include a state of shock (except for hemorrhagic shock with ongoing bleeding), as well as an acute stage of myocardial infarction or cerebrovascular accident (stroke). It should be noted that at present, if there are vital indications, it is possible to perform operations against the background of myocardial infarction or stroke, as well as in case of shock after stabilization of hemodynamics. Therefore, the allocation of absolute contraindications is currently not fundamentally decisive.
Relative contraindications include any concomitant disease. However, their impact on the tolerability of the operation is different.
Contraindications for surgical treatment.
According to vital and absolute indications, operations should be performed in all cases, with the exception of the preagonal and agonal state of the patient, who is in the terminal stage of a long-term current disease, leading inevitably to death (for example, oncopathology, liver cirrhosis, etc.). Such patients, according to the decision of the council, undergo conservative syndromic therapy.
With relative indications, the risk of surgery and the planned effect of it should be individually weighed against the background of concomitant pathology and the age of the patient. If the risk of surgery exceeds the desired result, it is necessary to refrain from surgery (for example, removal of a benign formation that does not compress vital organs in a patient with severe allergy.
126. Preparation of organs and systems of patients at the stage of preoperative preparation.
There are two types of preoperative preparation: general somatic skye And special .
General somatic training is carried out for patients with common surgical diseases that have little effect on the state of the body.
Skin should be examined in every patient. Rash, purulent-inflammatory rash exclude the possibility of performing a planned operation. Plays an important role sanitation of the oral cavity . Carious teeth can cause diseases that are severely reflected in the postoperative patient. Sanitation of the oral cavity, regular brushing of teeth are very useful for preventing postoperative parotitis, gingivitis, glossitis.
Body temperature before a planned operation should be normal. Its increase finds its explanation in the very nature of the disease (purulent disease, cancer in the stage of decay, etc.). In all patients hospitalized in a planned manner, the cause of the temperature increase should be found. Until it is detected and measures are taken to normalize it, the planned operation should be postponed.
The cardiovascular system should be studied especially carefully. If blood circulation is compensated, then there is no need to improve it. The average level of arterial pressure is 120/80 mm. rt. Art., may vary between 130-140 / 90-100 mm. rt. Art., which does not necessitate special treatment. Hypotension, if it represents the norm for this subject, also does not require treatment. If there is a suspicion of an organic disease (arterial hypertension, circulatory failure and cardiac arrhythmias and conduction disturbances), the patient should be consulted with a cardiologist and the issue of surgery is decided after special studies.
For prevention thrombosis and embolism determine the protombin index and, if necessary, prescribe anticoagulants (heparin, phenylin, clexane, fraxiparin). In patients with varicose veins, thrombophlebitis, elastic bandaging of the legs is performed before surgery.
Preparation gastrointestinal tract patients before surgery on other areas of the body is uncomplicated. Eating should be limited only on the evening before the operation and in the morning before the operation. Prolonged fasting, the use of laxatives and repeated washing of the gastrointestinal tract should be performed according to strict indications, as they cause acidosis, reduce intestinal tone and contribute to stagnation of blood in the vessels of the mesentery.
Before scheduled operations, it is necessary to determine the status respiratory system , according to indications, eliminate inflammation of the accessory cavities of the nose, acute and chronic bronchitis, pneumonia. Pain and the forced state of the patient after surgery contribute to a decrease in respiratory volume. Therefore, the patient must learn the elements of breathing exercises included in complex of physiotherapy exercises of the preoperative period.
Special preoperative preparation at planned patients can be long and voluminous, in emergency cases short-term and quickly effective.
In patients with hypovolemia, impaired water and electrolyte balance, acid-base state, infusion therapy is immediately started, including the transfusion of polyglucin, albumin, protein, sodium bicarbonate solution for acidosis. To reduce metabolic acidosis, a concentrated solution of glucose with insulin is administered. At the same time, cardiovascular agents are used.
In acute blood loss and stopped bleeding, blood, polyglucin, albumin, and plasma are transfused. With continued bleeding, transfusion is started into several veins and the patient is immediately taken to the operating room, where an operation is performed to stop the bleeding under the cover of infusion therapy, which is continued after the operation.
The preparation of organs and systems of homeostasis should be comprehensive and include the following activities:
improvement of vascular activity, correction of microcirculation disorders with the help of cardiovascular agents, drugs that improve microcirculation (reopoliglyukin);
fight against respiratory failure (oxygen therapy, normalization of blood circulation, in extreme cases - controlled ventilation of the lungs);
detoxification therapy - the introduction of liquid, blood-substituting solutions of detoxification action, forced diuresis, the use of special methods of detoxification - plasmaphoresis, oxygen therapy;
correction of disturbances in the hemostasis system.
In emergency cases, the duration of preoperative preparation should not exceed 2 hours.
Psychological preparation.
The upcoming surgical operation causes more or less significant mental trauma in mentally healthy people. Patients often at this stage have a feeling of fear and uncertainty in connection with the expected operation, negative experiences arise, numerous questions arise. All this reduces the reactivity of the body, contributes to sleep disturbance, appetite.
Significant role in psychological preparation of patients, hospitalized in a planned manner, is given medical and protective regime, the main elements of which are:
impeccable sanitary and hygienic conditions of the premises where the patient is located;
clear, reasonable and strictly observed internal regulations;
discipline, subordination in the relationship of medical staff and in the relationship of the patient to the staff;
cultural, caring attitude of the staff to the patient;
full provision of patients with medicines, apparatusswarm and household items.
Operation indications determine its urgency and can be vital (vital), absolute and relative:
$ Vital indications for surgery – diseases or injuries in which the slightest delay threatens the life of the patient. Such operations are performed on an emergency basis, that is, after a minimum examination and preparation of the patient (no more than 2-4 hours from the moment of admission). Vital indications for surgery occur in the following pathological conditions:
¾ Asphyxia;
¾ Continued bleeding: with damage to the internal organ (liver, spleen, kidney, fallopian tube with the development of pregnancy in it, etc.), heart, large vessels, with stomach and duodenal ulcers, etc .;
¾ Acute diseases of the abdominal organs of an inflammatory nature (acute appendicitis, strangulated hernia, acute intestinal obstruction, perforation of a stomach or intestinal ulcer, thromboembolism, etc.), fraught with the risk of developing peritonitis or gangrene of the organ during thromboembolism;
¾ Purulent - inflammatory diseases (abscess, phlegmon, purulent mastitis, acute osteomyelitis, etc.) that can lead to the development of sepsis.
$ Absolute indications for surgery - diseases in which time is needed to clarify the diagnosis and more thorough preparation of the patient, but a long delay in the operation can lead to a condition that threatens the life of the patient. These operations are performed urgently after a few hours or days (usually within 24-72 hours of the preoperative period. A long delay in surgery in such patients can lead to tumor metastases, general emaciation, liver failure and other complications. Such diseases include:
¾ Malignant tumors;
¾ Pyloric stenosis;
¾ Obstructive jaundice, etc.;
$ Relative indications for surgery - diseases that do not pose a threat to the life of the patient. These operations are performed in a planned manner after a thorough examination and preparation at a time convenient for the patient and the surgeon:
¾ Varicose veins of the superficial veins of the lower extremities;
¾ Benign tumors, etc.
Revealing contraindications presents significant difficulties, since any operation and anesthesia pose a potential danger to the patient, and there are no clear clinical, laboratory and special criteria that assess the severity of the patient's condition, the upcoming operation and the patient's response to anesthesia.
Surgical intervention has to be postponed for some time in cases where it is more dangerous than the disease itself or there is a risk of postoperative complications. Most contraindications are temporary and relative.
Absolute contraindications for surgery:
¾ Terminal state of the patient;
Relative contraindications to surgery (any concomitant disease):
¾ Cardiac, respiratory and vascular insufficiency;
¾ shock;
¾ Myocardial infarction;
¾ Stroke;
¾ Thromboembolic disease;
¾ Renal - liver failure;
¾ Severe metabolic disorders (decompensation of diabetes mellitus);
¾ Pre-comatose state; coma;
¾ Severe anemia;
¾ Severe anemia;
¾ Advanced forms of malignant tumors (stage IV), etc.
In the presence of vital and absolute indications, relative contraindications cannot prevent an emergency or urgent operation after appropriate preoperative preparation. Planned operations are preferably carried out after appropriate preoperative preparation. It is desirable to carry out planned surgical interventions after the elimination of all contraindications.
The factors that determine the operational risk include the age of the patient, the state and function of the myocardium, liver, lungs, kidneys, pancreas, the degree of obesity, etc.
Established diagnosis, indications and contraindications allow the surgeon to resolve issues of urgency and scope of surgical intervention, method of anesthesia, preoperative preparation of the patient.
Question 3: Preparation of patients for planned operations.
Planned operations - when the outcome of treatment is practically independent of the time of execution. Before such interventions, the patient undergoes a complete examination, the operation is performed on the most favorable background in the absence of contraindications from other organs and systems, and in the presence of concomitant diseases - after reaching the stage of remission as a result of appropriate preoperative preparation. Example: radical surgery for non-strangulated hernia, varicose veins, cholelithiasis, uncomplicated gastric ulcer, etc.
1.General activities: general measures include improving the patient's condition by identifying and eliminating as much as possible violations of the function of the main organs and systems. During the period of preoperative preparation, the functions of organs and systems are carefully studied and they are prepared for surgical intervention. The nurse with full responsibility and understanding should relate to preoperative preparation. She is directly involved in the examination of the patient and the implementation of therapeutic and preventive measures. Basic and mandatory research before any planned operation:
J Measurement of blood pressure and pulse;
J Measurement of body temperature;
J Measuring the frequency of respiratory acts;
J Measurement of height and weight of the patient;
J Carrying out a clinical analysis of blood and urine; determination of sugar in the blood;
J Determination of blood group and Rh factor;
J Examination of feces for eggs of worms;
J Statement of the Wasserman reaction (=RW);
J In the elderly - an electrocardiographic study;
J According to indications - a blood test for HIV; others
A) preparation of the psyche and physical condition: creating an environment around the patient that inspires confidence in the successful outcome of the operation. All medical personnel should eliminate the moments that cause irritation as much as possible and create conditions that provide complete rest for the nervous system and the patient. For the correct preparation of the patient's psyche for the operation, it is of great importance that the nurses follow the rules of deontology. Before the operation in the evening, the patient is given a cleansing enema, the patient takes a hygienic bath or shower and changes underwear and bed linen. The morale of patients entering for surgery is significantly different from the state of patients who receive only conservative treatment, since the operation is a great physical and mental trauma. One "waiting" for the operation instills fear and anxiety, seriously undermines the strength of the patient. Starting from the emergency department and ending with the operating room, the patient looks and listens to everything around him, is always in a state of tension, usually turns to the junior and middle medical staff, looking for their support.
The protection of the patient's nervous system and psyche from irritating and traumatic factors largely determines the course of the postoperative period.
The nervous system is especially traumatized by pain and sleep disturbance, the fight against which (prescribing painkillers, sleeping pills, tranquilizers, sedatives and other drugs is very important during the preoperative preparation.
For the correct preparation of the patient's psyche for surgery, it is of great importance that the nursing staff follow the following rules of surgical deontology:
¾ When a patient enters the emergency department, it is necessary to provide him with the opportunity to calmly communicate with his relatives accompanying him;
¾ The diagnosis of the disease should be communicated to the patient only by a doctor who, in each individual case, decides in what form and when he can do this;
¾ It is necessary to address the patient by name and patronymic or last name, but do not call him impersonally “sick”;
¾ The patient before the operation is especially sensitive to the look, gesture, mood, carelessly spoken word, captures all the shades of the nurse's intonation. Particularly careful should be conversations during a planned round and rounds conducted for pedagogical purposes. At this moment, the patient is not only an object for research and teaching, but also a subject who catches every word of the bystanders and the teacher. It is very important that these words and gestures contain benevolence, sympathy, sincerity, tact, endurance, patience, warmth. The indifferent attitude of the nurse, the negotiations of the staff about personal, irrelevant things in the presence of the patient, the inattentive attitude to requests and complaints give the patient reason to doubt all further measures, alarm him. The talk of the medical staff about the poor outcome of the operation, death, etc. has a negative effect. A nurse who performs appointments or provides any assistance in the presence of patients in the ward must do it skillfully, calmly and confidently so as not to cause them anxiety and nervousness;
¾ Medical history and diagnostic data should be stored in such a way that they cannot become available to the patient; the nurse must be the keeper of medical (medical) secrets in the broadest sense of the word;
¾ In order to distract the patient from thoughts about his illness and the upcoming operation, the nurse should visit him as often as possible and, if possible, involve him in conversations far from medicine;
¾ Medical staff should ensure that in the hospital environment surrounding the patient there are no factors that irritate and frighten him: excessive noise, frightening medical posters, signs, syringes with traces of blood, bloody gauze, cotton wool, sheets, fabrics, tissue, organ or parts of it, etc.;
¾ The nurse must strictly monitor the strict observance of the nosocomial regimen (afternoon rest, sleep, bedtime, etc.);
¾ Medical staff should pay special attention to their appearance, given that untidiness, sloppy appearance causes the patient to doubt the accuracy and success of the operation;
¾ When talking with the patient before the operation, the operation should not be presented to him as something easy, at the same time he should not be frightened by the riskiness and the possibility of an unfavorable outcome. It is necessary to mobilize the strength and faith of the patient in a favorable outcome of the intervention, eliminate the fears associated with perverted ideas about the upcoming pain sensations during and after the operation, report postoperative pain. When explaining, the nurse must adhere to the same interpretation that the doctor gave, otherwise the patient ceases to believe the medical staff;
¾ The nurse must timely and conscientiously fulfill the doctor's prescriptions (taking tests, obtaining research results, medication prescriptions, preparing the patient, etc.), it is unacceptable to send the patient from the operating table to the ward due to his unpreparedness due to the fault of the medical staff; the nurse must remember that nursing at night is of particular importance, since there are almost no external stimuli at night. The patient is left alone with his illness, and, naturally, all his senses are sharpened. Therefore, care for him at this time of day should be no less thorough than during the day.
2.Specific events: these include activities aimed at preparing those organs on which the operation is to be performed. That is, a number of studies are being carried out related to the operation on this organ. For example, during heart surgery, heart sounding is performed, during lung surgery - bronchoscopy, during stomach operations - analysis of gastric juice and fluoroscopy, fibrogastroscopy. On the eve of the evening in the morning, the contents of the stomach are removed. With congestion in the stomach (pyloric stenosis), it is washed. At the same time, a cleansing enema is given. The patient's diet on the day before the operation: a regular breakfast, a light lunch, and sweet tea for dinner.
Before surgery for biliary tract it is necessary to examine the gallbladder, pancreas and bile ducts using special methods (ultrasound) and study the laboratory parameters of the functions of these organs and the exchange of bile pigments.
At obstructive (mechanical) jaundice the flow of bile into the intestine stops, the absorption of fat-soluble substances, which include vitamin K, is disrupted. Its deficiency leads to a deficiency of clotting factors, which can cause severe bleeding. Therefore, before surgery, a patient with obstructive jaundice is given vitamin K ( vikasol 1% - 1 ml), a solution of calcium chloride, transfuse blood, its components and preparations.
Before the operation on the large intestine for the prevention of endogenous infection, it is very important to thoroughly cleanse the intestines, but at the same time, the patient, often emaciated and dehydrated by the underlying disease, should not starve. He receives a special diet containing high-calorie food, devoid of toxins and gas-forming substances. Since an operation with an opening of the large intestine is supposed, to prevent infection, patients begin to take antibacterial drugs during the preparation period ( colimycin, polymyxin, chloramphenicol and etc.). Fasting and the appointment of laxatives are resorted to only according to indications: constipation, flatulence, lack of a normal stool. On the evening before the operation and in the morning, the patient is given a cleansing enema.
For operations in the area rectum and anus(for hemorrhoids, anal fissures, paraproctitis, etc.) it is also necessary to thoroughly clean the intestines, since in the postoperative period the stool is artificially retained in the intestines for 4-7 days.
To survey departments large intestine resort to radiopaque (barium passage, irrigoscopy) and endoscopic (sigmoidoscopy, colonoscopy) studies.
Patients with very large, long-term hernias of the anterior abdominal wall. During the operation, the internal organs located in the hernial sac are set into the abdominal cavity, this is accompanied by an increase in intra-abdominal pressure, displacement and high standing of the diaphragm, which makes it difficult for cardiac activity and respiratory excursions of the lungs. To prevent complications in the postoperative period, the patient is placed on a bed with a raised leg end, and after the contents of the hernial sac have been reduced, a tightening bandage or sandbag is applied to the area of the hernial orifice. The body is "accustomed" to the new conditions of the high standing of the diaphragm, to the increased load on the heart.
Special training on limbs comes down to cleansing the skin from contamination with baths with a warm and weak antiseptic solution (0.5% ammonia solution, 2-4% sodium bicarbonate solution, etc.).
Other diseases and operations require appropriate special studies and preoperative preparation, often in a specialized surgical department.
¾ Preparation of the cardiovascular system:
On admission - examination;
Carrying out a general blood test
Biochemical analysis of blood and, if possible, normalization of indicators
Measurement of heart rate and blood pressure
Removing an ECG
Taking into account blood loss - preparation of blood, its preparations
Instrumental and laboratory research methods (ultrasound of the heart).
¾ Respiratory system preparation:
· To give up smoking
Elimination of inflammatory diseases of the upper respiratory tract.
Carrying out breath tests
Teaching the patient to breathe and cough properly, which is important for the prevention of pneumonia in the postoperative period
· Chest x-ray or X-ray.
¾ Gastrointestinal preparation
Sanitation of the oral cavity
Gastric lavage
Suction of the contents of the stomach
Meals before surgery
¾ Preparation of the genitourinary system:
Normalization of kidney function;
· Carry out studies of the kidneys: urine tests, determination of residual nitrogen (creatinine, urea, etc.), ultrasound, urography, etc. If pathology is detected in the kidneys or in the bladder, appropriate therapy is carried out;
· For women, before the operation, a gynecological examination is mandatory, and if necessary, treatment. Planned operations during menstruation are not carried out, since these days there is increased bleeding.
¾ Immunity and metabolic processes:
Improving the immunobiological resources of the patient's body;
Normalization of protein metabolism;
· Normalization of water-electrolyte and acid-base balance.
¾ Skin covers:
Identification of skin diseases that can cause severe complications in the postoperative period, up to sepsis (furunculosis, pyoderma, infected abrasions, scratches, etc.). Preparation of the skin requires the elimination of these diseases. On the eve of the operation, the patient takes a hygienic bath, shower, changes underwear;
· The operating field is prepared immediately before the operation (1-2 hours in advance), since cuts and scratches that may occur during shaving may become inflamed over a longer period of time.
On the eve of the operation the patient is examined by an anesthesiologist, who determines the composition and timing of premedication, the latter is usually carried out 30-40 minutes before the operation, after the patient has urinated, removed dentures (if any), as well as other personal belongings.
The patient, covered with a sheet, is taken on a gurney head first to the operating unit, in the vestibule of which he is transferred to the gurney of the operating room. In the preoperative room, a clean cap is put on the patient's head, and clean shoe covers are put on his feet. Before bringing the patient to the operating room, the nurse should check whether the bloody underwear, dressings, and instruments from the previous operation have been removed there.
The medical history, x-rays of the patient are delivered simultaneously with the patient.
