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Treatment of the surgical field before abdominal surgery. Preoperative preparation

teacher LAGODICH Leonty Grigorievich, surgeon

TREATMENT OF THE SURGICAL FIELD

About the manipulation technique

"Treatment of the surgical field

bactericidal drugs"

2-79 01 01 “Medicine”,

2-79 01 31 “Nursing”

Treatment of the surgical field

bactericidal drugs

Treatment begins immediately (if the operation is under local anesthesia), or after the patient is put under anesthesia.

The surgical field is treated with antiseptic agents.

1) disinfection and tanning of the skin of the surgical field.

Workplace equipment:

1) sterile dressing material;

2) sterile forceps;

4) sterile surgical linen;

7) antiseptics;

8) tool table;

9) containers with disinfectant solutions for disinfecting surfaces and used equipment.

Preparatory stage of performing the manipulation.

1. The day before, inform the patient about the need to perform and the essence of the manipulation.

2. Wash your hands with running water, soaping them twice, and dry them with a sterile cloth.

3. Perform surgical treatment of hands.

4. Wear a mask and gloves.

5. Place the necessary equipment on the tool table.

The main stage of the manipulation.

1. Widely treat the surgical field from the center to the periphery with an antiseptic with two balls on a forceps.

2. Limit the incision site with sterile surgical linen.

3. Re-treat the surgical field with an antiseptic (before the incision).

4. Before suturing, treat the skin around the surgical wound with an antiseptic.

5. After suturing, treat the surgical field with an antiseptic.

1. Place used instruments and dressings in different containers with disinfectant solutions.

2. Remove rubber gloves and place in a container with a disinfectant solution.

3. Wash your hands under running water and soap and dry

1. Order of the Ministry of Health of the Republic of Belarus dated June 21, 2006 No. 509 “On standardization of training in the technique of performing medical manipulations in institutions providing secondary specialized education in a medical field.”

2. I.R. Gritsuk, I.K. Vankovich, “Nursing in surgery” - Minsk: Higher School, 2000.

3. Yaromich, I.V. Nursing and manipulation techniques - Minsk: Higher School, 2006.

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Treatment of the surgical field

On the eve of the planned operation, the patient takes a bath or shower, his underwear and bed linen are changed. On the day of surgery, the surgical field and the surrounding area are carefully shaved and treated with a 70% alcohol solution. Treatment of the surgical field begins either immediately (if the operation takes place under local anesthesia) or after the patient is put under anesthesia. Before emergency surgery, the surgical field is carefully shaved and the patient is taken to the operating room. For many years, the most common method of treating the surgical field was according to Filonchikov - the surgical field was treated several times with a 5-10% alcohol solution of iodine. This method is currently prohibited due to the occurrence of iodine contact dermatitis, burns and general allergic reactions.

To treat the skin of the surgical field in modern surgery, various antiseptic solutions are used.

Iodonate treatment. Iodonate with a free iodine concentration of 5% is available in bottles. To treat the surgical field, the original solution is diluted 5 times with boiled or sterile water. Without prior washing, the skin of the surgical field is treated 2 times with sterile swabs moistened with 5 - 7 ml of iodonate solution (with a free iodine concentration of 1%) for at least 1 minute. Before suturing, the skin is treated again with the same solution.

Treatment with iodopirone. Iodopirone is a mixture of iodine and polyvinylpyrrolidone. Compared to iodine, it has a number of advantages: soluble in water, shelf stable, non-toxic, odorless, and does not cause allergic skin reactions. Use a 1% solution of iodopyrone. The surgical field is treated with iodopirone using the same method as when using iodonate.

Treatment with hibitane (chlorhexidine diglunate). Gibitan is available in the form of a 20% clear aqueous solution. To treat the surgical field, use a 0.5% solution (the drug is diluted with 70% alcohol in a ratio of 1:40). The surgical field is treated twice for 3 minutes; the skin is additionally treated with the same solution before suturing the skin and after suturing.

After treatment, the surgical field is covered with sterile sheets.

Treatment of the surgical field.

Preliminary sanitary and hygienic treatment is carried out. On the operating table, the surgical field is treated with chemical antiseptics (organic iodine-containing preparations, 70˚ alcohol, chlorhexidine, pervomur, sterile adhesive films).

The following rules are observed:

- wide processing; — sequence “from the center to the periphery”; — contaminated areas are treated last; - multiple processing during the operation (Filonchikov-Grossikh rule): skin treatment is carried out before restriction with sterile linen, immediately before the incision, periodically during the operation, as well as before and after applying skin sutures.

In addition to knowing the basics of treating the surgeon’s hands and the surgical field, it is necessary to follow a certain sequence of actions before starting any surgical operation.

The operating nurse is the first to prepare for the operation. She changes into an operating suit, puts on shoe covers, a cap, and a mask. Then, in the preoperative room, the hands are treated using one of the above methods. After which he enters the operating room, opens the bag with sterile linen (by pressing the pedal, or with the help of an operating nurse) and puts on a sterile gown, ties the strings on the sleeves of the gown, and the nurse ties the gown from the back (her hands are not sterile, so she may only touch the inside of the robe). In general, during the entire operation, the nurse's and surgeon's gown from the front to the waist is considered sterile. Sterile hands should not rise above the shoulders and cannot be lowered below the waist, which is associated with the possibility of violating sterility with careless movements. After putting on sterile clothes, the nurse puts on sterile gloves and sets a sterile table to perform the intervention: the small operating table is covered with 4 layers of sterile linen and the sterile instruments and dressings necessary for the operation are laid out on it in a certain sequence.

The surgeon and assistants change clothes and treat their hands in the same way. After this, one of them receives from the sister’s hands a long instrument (usually a forceps) with a napkin moistened with an antiseptic and treats the surgical field, changing the napkin with an antiseptic several times. Then surgeons limit the surgical field with sterile surgical linen (sheets), securing it with special linen clamps or clips. The skin is processed again and an incision is made, i.e. the operation begins.

Prevention of endogenous infection.

Prevention of endogenous infection is an essential component of modern surgery. There is a distinction between the prevention of endogenous infection during planned and emergency operations.

The planned operation should take place against the most favorable background. Therefore, one of the tasks of the preoperative period is to identify possible foci of endogenous infection. There is a minimum examination carried out in all patients. It includes: a general blood test, a general urine test, a biochemical blood test, chest fluorography, ECG, EDS (Wassermann reaction), feces for eggworm, hepatitis markers, form 50 (for antibodies to HIV), a dentist’s report on the sanitation of the oral cavity. For women - a gynecologist's report. If the examination reveals a source of endogenous infection (caries, adnexitis, etc.), a planned operation cannot be performed until the inflammatory process is eliminated. Acute respiratory infections (ARVI), influenza are contraindications for elective surgery. After suffering an acute infectious disease, you cannot undergo routine surgery for another 2 weeks after complete recovery.

A different situation arises when providing emergency assistance. Here, a full examination in a short time is not possible, and it is impossible to cancel a vital operation. However, it is necessary to take into account foci of endogenous infection in order to prescribe adequate treatment immediately before surgery and in the postoperative period.

Hospital infection – diseases or complications, the development of which is associated with infection of the patient that occurred while he was in a surgical hospital. Hospital infection has recently been called nosocomial (noso - disease, komos - acquisition). Hospital infection remains an important problem in surgery, despite the constant improvement of aseptic and antiseptic methods.

Legislative framework of the Russian Federation

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Federal legislation

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ORDER of the USSR Ministry of Health dated July 31, 1978 N 720 “ON IMPROVING MEDICAL CARE FOR PATIENTS WITH PURULENT SURGICAL DISEASES AND STRENGTHENING MEASURES TO COMBAT IN-HOSPITAL INFECTION”

Their duration depends on the urgency of the operation, chronic diseases, complications, the severity of the patient’s condition, and the skills of the medical personnel.

Training standard

Preparation for surgery is necessary in any case, even if the patient is urgent (i.e., emergency). It provides the following actions:

Twelve hours before surgery and the morning before it, you need to wash the patient. Further treatment of the surgical field depends on how clean the patient is.
Before the operation, under general anesthesia, you need to do a cleansing enema or drink a laxative. This is necessary so that after the administration of muscle relaxants and relaxation of the smooth muscles of the intestines, there is no sterilization of the operating room.
On the day of the procedure, you should not eat or drink anything.
More than half an hour before surgery, you must call an anesthesiologist for premedication.
The main task that needs to be accomplished at this stage is to maximally protect both the patient and the surgeons from surprises during the operation.

Psychological preparation

A lot depends on how trusting the relationship is between the patient, the surgeon and the anesthesiologist. Therefore, it is extremely important for the doctor to show sensitivity, care and understanding to the patient’s situation, devote time to him, explain the essence of the intervention, its stages, tell him what and how will happen in the operating room. This will help reassure the patient and give him confidence in the doctor’s qualifications and the professionalism of his team.

The surgeon needs to be able to persuade the patient to make the most correct decision, because, having a lot of scattered information, it is difficult for an unprepared person to understand it. On the day of the operation, the doctor should visit his patient in the morning to find out his well-being and mood. Reassure again if necessary.

Features of training for children and the elderly

Since the child’s body is still growing and developing, and many systems are not fully formed, they require a special approach. First of all, it is necessary to find out the exact age and weight of the small patient (to calculate medications). Prohibit parents from feeding their child six hours before surgery. Clean his intestines with an enema or mild laxative, and during gastric surgery, lavage is recommended. To build a relationship with the child and postoperative supervision, the surgeon must work closely with the pediatrician.

For older people, the surgeon invites a therapist for a consultation. And under his control, he prepares the patient for intervention. It is necessary to collect a complete medical history, do an ECG and a chest x-ray. Anesthesiologists need to take into account the peculiarities of senile physiology and calculate the dose of the drug not only by weight, but also make allowances for the wear and tear of all body systems. The surgeon must remember that, in addition to the main one, the patient also has concomitant pathologies that require attention. Just like with children, it is difficult to build trusting relationships with older people.

Work algorithm

When the patient is transported to the operating room, the nurse begins to perform magic on him. She must prepare a workplace for the surgeon. And he always acts according to the same plan.

Treatment of the surgical field, the algorithm of which every nurse should know, begins with the preparation of instruments:

sterile material for dressings;

forceps;

pins and clamps;

sterile surgical linen, mask, gloves;

antiseptic preparations and containers for disinfection;

Before processing the surgical field begins, the surgical nurse must wash her hands according to the rules of asepsis and antisepsis, put on sterile underwear and transfer all the necessary instruments to the operating table.

Treatment of the patient

Methods for treating the surgical field may differ depending on the type of surgical intervention, but the most common option is the Filonchikov-Grossikh method. It includes four mandatory lubrication of the patient’s skin with an antiseptic solution:

The surgical field is the area of the body within which surgery is performed. Before surgery, the skin of the surgical field needs careful preparation; on its surface, as well as in the depths of the sebaceous glands and hair follicles, there are always microbes, the entry of which into the surgical wound can lead to its suppuration. Before any operation, a hygienic bath or shower and a change of linen are required. During operations on the limbs, if they are heavily soiled, repeated foot or hand baths are needed. During emergency operations, partial sanitation and washing of the skin of the surgical field with gasoline or a solution of ammonia (0.25-0.5%) can be performed. On the day of surgery, it is necessary to shave the area of the surgical field and adjacent areas of the body. For shaving, use sharp razors that do not cause skin irritation. You should not shave on the eve of surgery, as small skin cuts may become infected.

Immediately before the operation, the skin of the surgical field is mechanically cleaned and degreased, rubbing it for 1-2 minutes. gasoline or ; then treat the skin with alcohol and lubricate it twice with a 5% alcohol solution of iodine. This causes thickening (tanning) of the skin and prevents the entry of microbes from deep into the surgical wound. The skin of particularly sensitive areas of the body (neck,) is lubricated with a 5% alcohol solution of iodine, diluted in half with alcohol. If the patient's skin is hypersensitive to iodine, as well as in patients after radiation therapy, the skin of the surgical field is treated with a 5% alcohol solution, 1% brilliant green alcohol solution, and 96% wine alcohol. Regardless of the solution used, the skin of the surgical field is treated from the line of the intended incision to the periphery. After treatment, the surgical field is delimited from the surrounding skin, covering it with sterile sheets or napkins, and after the incision is made, tissues and organs (stomach, intestines) are protected from contact with the edges of the skin incisions. When moving from one stage of the operation to another, the linen and napkins delimiting the surgical field are changed, and the skin is re-treated with a 5% alcohol solution of iodine, alcohol or another solution.

Surgical field is the area of the body within which surgical intervention is performed.

The surgical field requires special preparation, since its contamination threatens suppuration. Preparation of the surgical field is based on the same principles of mechanical cleaning, disinfection and tanning as hand treatment (see). Sometimes preparation of the surgical field begins long before the operation. For folliculitis and furunculosis, ultraviolet irradiation, systematic hygienic baths, vitamins, and autohemotherapy are prescribed. For fistulas, the skin in the area of the surgical field is lubricated with Lassara paste or a strong solution of potassium permanganate. Before plastic surgery, the preparation of the surgical field is especially thorough; it includes, in addition to daily baths, alcohol dressings.

Before a planned operation, the patient takes a bath or shower the night before and changes his underwear. If the patient's condition does not allow him to take a bath or shower, the body is wiped with a damp towel. 1-1.5 hours before surgery, the surgical field is shaved without water and soap. Shaving on the eve of surgery is contraindicated due to the possibility of infection of scratches and cuts caused during shaving.

Substances used to treat the surgical field should not damage the skin or damage linen and instruments. The most popular is the Filonchikov-Grossikh method - double lubrication of the surgical field. 10% alcohol tincture of iodine. To avoid burns, 5% iodine tincture is more often used, or after lubricating with 10% tincture, the surgical field is wiped with alcohol. It is dangerous to lubricate folds and those areas where the skin is thin and tender with iodine. Lubricating the surgical field with iodine after preoperative radiotherapy or in case of increased sensitivity to it is contraindicated. There are other methods that allow you to disinfect the surgical field. According to the Spasokukotsky-Kochergin method, the surgical field is wiped 2 times with a cotton or gauze ball moistened with a 0.5% solution of ammonia, then wiped dry with a sterile cloth and tanned with 96° alcohol, 5% picric acid solution, 5% chromic acid solution, 2% solution tannin, etc. During bone operations that require special asepsis, some surgeons lubricate the skin of the surgical field with cleol and seal it with one layer of gauze; the incision is made through gauze. During emergency operations, especially for industrial or street injuries, the surgical field is repeatedly wiped with gasoline, ether or a 0.5% solution of ammonia.

Regardless of the method, treatment of the surgical field is carried out from the incision line to the periphery; if there is a purulent wound or fistula on the surgical field, then in the opposite direction. The fistula opening or wound is covered with a napkin or sealed with cleol. The treated skin area should significantly exceed the size of the surgical field. After treatment, the surgical field is covered with sterile sheets, which are strengthened with special clamps.

When moving from one stage of the operation to another, the linen and napkins covering the surgical field are changed and the skin is re-lubricated with iodine and alcohol. To prevent contamination of the surgical field during surgery, the skin after treatment can be covered with a moisture-proof film (for example, BF-6 glue). The incision and suturing of the wound is made through this film.

The surgical field is illuminated using shadowless lamps so that the light is uniform and does not distort the true color of the tissue. For enhanced illumination of certain areas of the surgical field, side, portable or frontal lamps are used. Germicidal lamps can be built into the lamps.

An operation is a mechanical effect on the human body using special equipment and instruments in order to restore health. Therefore, it is necessary to prepare both the patient and the medical team for the operation. All activities that are carried out between a person’s admission to a surgical hospital and the operation itself are called preoperative preparation.

The time that the patient spends under observation before surgical treatment is divided into two periods:

diagnostic;
period of preoperative preparation.

Their duration depends on the urgency of the operation, chronic diseases, complications, the severity of the patient’s condition, and the skills of the medical personnel.

Training standard

Preparation for surgery is necessary in any case, even if the patient is urgent (i.e., emergency). It provides the following actions:

Twelve hours before surgery and the morning before it, you need to wash the patient. Further treatment of the surgical field depends on how clean the patient is.
Before the operation, under general anesthesia, you need to do a cleansing enema or drink a laxative. This is necessary so that after the administration of muscle relaxants and relaxation of the smooth muscles of the intestines, there is no sterilization of the operating room.
On the day of the procedure, you should not eat or drink anything.
More than half an hour before surgery, you must call an anesthesiologist for premedication.
The main task that needs to be accomplished at this stage is to maximally protect both the patient and the surgeons from surprises during the operation.

Psychological preparation

Features of training for children and the elderly

Work algorithm

When the patient is transported to the operating room, the nurse begins to perform magic on him. She must prepare a workplace for the surgeon. And he always acts according to the same plan.

Treatment of the surgical field, the algorithm of which every nurse should know, begins with the preparation of instruments:

sterile material for dressings;
forceps;
pins and clamps;
sterile surgical linen, mask, gloves;
antiseptic preparations and containers for disinfection;

Treatment of the patient

before covering with sterile linen;
after applying surgical linen;
before suturing;
after suturing.

Antiseptics

Antiseptics for treating the surgical field may be different. But most often it is iodonate in a 5% concentration, diluted five times. Treatment of the surgical field can be carried out even on dirty skin. The effect of the drug should last at least a minute.

The next remedy is iodopirone. It is a mixture of iodine and a synthetic antibacterial drug. Compared to ordinary iodine, it is easy to store, dissolves in water, has no odor and does not cause allergies.

And the last drug is Gibitan. It is already available in the form of a solution, but before surgery it is diluted another forty times. Treatment of the surgical field takes longer, since the exposure of the antiseptic must last more than three minutes, and it must be repeated twice.

Final processing stage

But the use of antiseptics does not end the treatment of the surgical field. The algorithm should be logically completed by cleaning its workplace. To do this, the nurse places all used instruments and material in containers with disinfectant solutions. Then he takes off rubber gloves and washes his hands under running water, according to the rules of asepsis and antiseptics.

The patient is ready for surgery; all that remains is to wait for the surgeon and anesthesiologist - and we can begin.

Preparation of the operation field consists of four stages:

1. Mechanical cleaning
2. Degreasing
3. Antiseptic treatment (asepticization)
4. Isolation of the field of operation.
1. Mechanical cleaning includes washing with soap (preferably household soap), removing hair by shaving or cutting. In this case, the size of the prepared surgical field must be sufficient to ensure sterile operating conditions. Mechanical cleaning is a particularly important step in preparing the surgical field, and it must be carried out especially carefully, since it removes the bulk of dirt and microorganisms.

Preference is given to shaving, since asepticity with this method is achieved more thoroughly. In practice, a safety razor is most often used. It has been established that shaving hair is best done on the eve of surgery, which allows not only to thoroughly remove hair, but also to thoroughly wash the surgical field, which, as a rule, is heavily contaminated. In addition, the skin irritation observed after shaving disappears by the time of surgery, as a result of which the skin becomes less sensitive to the iodine solution and dermatitis develops less frequently. Accidental wounds to the skin during shaving by the time of surgery have time to become covered with a dense scab due to coagulated blood.

2. Degreasing of the surgical field is carried out with a sterile gauze swab soaked in a 0.5% solution of ammonia or gasoline for 1-2 minutes. The degreased surgical field is treated with an antiseptic using one of the following methods.
3. Asepticization with an antiseptic.

The Grossikh-Filonchikov method was proposed in 1908. The essence is that the defatted surgical field is “tanned” and asepticized with a 5% iodine solution, first after mechanical cleaning, and then immediately before the incision or after infiltration anesthesia. In this case, the interval between treatments should be at least 5 minutes.

Mytin's method is that after shaving, mechanical cleaning and degreasing, the surgical field is treated with a 10% aqueous solution of potassium permanganate.

Borchers method. proposed in 1927 and is based on the use of a 5% formaldehyde solution in 96° alcohol after mechanical cleaning, shaving and degreasing of the skin. The method makes it possible to achieve, unlike most other methods, sterility in a protein environment (when contaminated with pus), since formalin retains its antiseptic properties.

Treatment of the surgical field with an antiseptic begins from the center (incision or puncture site) to the periphery. The exception is the presence of an opened purulent focus, in which treatment begins from the periphery and ends in the center.

Treatment of the surgical field with catapol was proposed in 1986 (Vision V.N., 1986). The method consists in the fact that after traditional mechanical cleaning, the surgical field is thoroughly washed with a 1% aqueous solution of catapol for 1-2 minutes. Sterility is maintained for up to 1 hour.

Treatment of the surgical field with etonium. Proposed in 1986 (Vision V.N., 1986). According to this method, after mechanical cleaning, the surgical field is treated with a 0.5-1% aqueous solution of ethnium for 1-2 minutes. In addition to the antimicrobial effect, degreasing of the skin is observed.

4. Isolation of the surgical field is carried out using sterile sheets or oilcloths, which are attached to one another with special clips (Backhouse terminals).

Methods for preparing the surgical field using a 1% solution of iodopirone, degmin, chlorhexidine (gibitate), pervomur, decamethoxin (in particular the decamethoxin-containing drug amosept) (Paliy PK. et al. 1997), asepura, sagrotan may be promising.

The surgical field is prepared in the following sequence: starting from the center (incision site, puncture site) to the periphery. In the presence of a purulent process (especially an opened one), on the contrary, they start from the periphery and end near the abscess. Mucous membranes are asepticized according to a different principle. So, the conjunctiva is washed with a solution of ethacridine lactate (rivanol) at a dilution of 1:1000. The mucous membranes of the mouth and nasal cavity are treated with the same solution, and the skin around the circumference of the entrance to these cavities with a 5% iodine solution. The mucous membranes of the gums are lubricated with a 5% iodine solution.

The vaginal mucosa is treated with a solution of ethacridine lactate diluted 1:1000 or 2% Lysol, 1% lactic acid solution. The skin of the labia is lubricated with a 5% iodine solution.

The rectal mucosa is treated from an enema mug with a 1% solution of potassium permanganate or 2% Lysol, and the skin around the anus is treated with a 5% iodine solution.

In recent years, antiseptics have appeared in the form of aerosols (Septonex, Kubatol, Lifuzol, etc.). Their use significantly facilitates the penetration of antiseptics into hard-to-reach areas of the body through thick hair, and especially facilitates asepticity when performing injections, punctures, minor surgical procedures in conditions of distant pastures, barnyards, etc.

Analysis of literature data and the results of our experiments allows us to conclude that the use of surface-active antiseptics is possible with success at all stages of the probable spread of pathogens of purulent complications: the source of infection - transmission routes - a susceptible organism. It should be borne in mind that, according to the teachings of the Russian surgeon Chirikov, microorganisms are found in the deep layers of the skin of the surgeon’s hands and animal skin; during surgery, these bacteria come out of the deep layers of the skin with sweating and contaminate the surgical field. This circumstance makes it impossible to talk about the sterility of the skin even when using the most modern methods of preparing the surgical field and the skin of the surgeon’s hands, including “tanning” proposed by Geisner back in 1906, which indicates the presence of a constant source of microbial contamination of “autoinfection” during surgery.

Our experience in performing operations on animals also confirms that chemical antisepsis and antibiotic therapy are an essential addition to surgical antisepsis. It is surgical antiseptics that is leading, since only it creates optimal anatomical and biological conditions for combating the causative agents of postoperative purulent-inflammatory complications in animals.

However, experience shows that even timely and thorough primary surgical treatment of wounds does not exclude the need to use antiseptics. In this case, in the end, the outcome of the infectious process in a surgical wound is determined not so much by the pathogen as by the biological state of the wound tissue, the functional state of the whole organism. Healthy, viable tissue is the best antiseptic and the determining condition for successful healing of a surgical wound. Thus, the hope of American doctors during the Vietnam War to “destruct” microorganisms with the most modern antibiotics in a wound or purulent focus without excision of non-viable tissue was not confirmed, since they were reliably protected by necrotic tissue (Reyer K.K., 1975). This once again confirms that antibiotic therapy (while remaining the leading method of etiological treatment of animals with infectious pathology) and chemotherapy can only be effective in living, viable tissues. Therefore, the best type of prevention of postoperative purulent-inflammatory complications is a combined method of chemical and surgical antisepsis (excision of necrotic and non-viable tissue and adequate drainage) in combination with antibiotic therapy, adequate symptomatic treatment, and, if necessary, immunocorrection.

To summarize, it can be noted that when using antiseptics, you must be guided by the following provisions:

1) no antiseptic will help sterilize wound tissue as long as there is dead tissue, retained pus, or foreign bodies and rest conditions are not created,
2) the active role of protection falls on the wound tissue, and antiseptic agents only create favorable conditions for this protection,
3) for all significant deep fresh wounds, primary surgical treatment should come first, that is, excision of everything contaminated and dead, removal of foreign bodies, opening of detachments, pockets and ensuring rest,
4) surgical treatment of the wound combined with chemical is the best prevention of infection,

5) chemical antiseptics cannot be used in cases where surgical excision of a contaminated wound is not possible.

Preliminary preparation of the site of the intended incision (surgical field) begins on the eve of the operation and includes a general hygienic bath, shower, change of linen, dry shaving of hair directly at the site of surgical access (for planned operations no earlier than 1-2 hours before surgery in order to avoid possible infection excoriations and abrasions by hospital strains of pathogenic microorganisms). After shaving the hair, the skin is wiped with a 70% alcohol solution.

The most common method of processing the surgical field is classical Filonchikov's method (1904)- Grossikha (1908). And now, instead of the classically proposed 5% alcohol solution of iodine, according to Order No. 720, the surgical field is treated with a 1% solution of iodonate or iodopyrone. It is also possible to use a 0.5% alcohol solution of chlorhexidine digluconate, following the same sequence.

Methodology. Before surgery on the operating table, the surgical field is widely lubricated with a 1% iodonate solution, applying the first smear in the area of the intended incision (stage I). The immediate surgical site is isolated with sterile linen and lubricated again with a 1% iodonate solution (stage II). At the end of the operation, before application (stage III) and after suturing the skin (stage IV), it is again treated with a 1% iodonate solution.

In case of iodine intolerance, the surgical field in adults and children is treated with a 1% alcohol solution of brilliant green (Baccala method).

One of modern methods treatment of the surgical field - the use of the domestic antiseptic “Skitotsida-K”.

The contaminated surface of the skin of the surgical field is cleaned with soap and water or an antiseptic, after which it is dried with a sterile cloth and treated twice with a cloth moistened with 5 ml of the above antiseptic with a 30-second interval for 5 minutes. At the end of the operation, before and after suturing the skin, the wound is lubricated with an antiseptic for 30 seconds.

Abroad, they are widely used to isolate the surgical field. special sterile protective films, securely fixed to the surface of the skin using a special adhesive base.

GENERAL ISSUES IN PAIN RELIEF

Anesthesiology- is a medical discipline whose main task is to provide adequate pain relief and maintain the body’s vital functions during surgery.

Recognition of anesthesiology as a science came in the thirties of our century. Anesthesiology has allowed surgeons to significantly expand their technical capabilities and perform complex procedures, including organ transplants.

1) perform superficial and infiltrative local anesthesia;

2) perform premedication;

3) prepare the laryngoscope for use;

4) prepare the electric pump for operation;

5) monitor the patient after anesthesia.

Currently, the following types of anesthesia are distinguished:

1) local;

2) non-inhalation;

3) inhalation.

Local anesthesia.

The following types are distinguished: local anesthesia:

1) application (terminal, superficial);

2) infiltration;

3) conduction (regional): spinal, epidural, sacral.

Indications:

1) operations that are small in volume and short in time;

2) contraindication to anesthesia.

P contraindications:

1) allergies;

2) mental illness and psychomotor agitation;

3) early childhood;

4) operations requiring muscle relaxation;

lubrication with a swab containing an anesthetic. Widely used in ophthalmology, urology, endoscopy, ENT practice. To perform it, concentrated anesthetics are used, the action of which is associated with the blockade of nociceptive receptors (bunivacaine, dibucaine, lidocaine, sovcaine, trimecaine, etc.).

Infiltration anesthesia according to A.V. Vishnevsky is performed with small concentrations of novocaine solution (0.25-0.5%), starting from the skin and layer-by-layer in depth. In this case, the anesthetic penetrates all the tissues of the surgical access area. During surgery on the limbs, such anesthesia is called case anesthesia. It is used for hernia repairs, resection of the thyroid gland, and removal of small benign tumors.

Conduction (regional) anesthesia carried out using a small amount of concentrated anesthetics that block the conduction of a nerve impulse along the nerve trunk. Anesthesia technique requires a good knowledge of the topography of nerve trunks and blood vessels. There are anesthesia (or block) according to Oberst-Lukashevich (on the fingers), intercostal block, anesthesia of the brachial plexus, cervical vagosympathetic block, paranephric block, block according to Shkolnikov (for pelvic bone fractures).

To regional anesthesia include spinal, epidural, caudal (sacral). They are united by the concept of “central blockade” techniques.

Spinal anesthesia carried out by introducing anesthetics into the subarachnoid space of the spinal canal in a small amount (1-2 ml). Used for operations on the pelvic organs and lower extremities.

Epidural anesthesia- injection of anesthetic into the epidural space; the anterior and posterior roots of the spinal cord are blocked.

Caudal anesthesia used as a type of epidural for operations on the perineum and rectum. The anesthetic is injected into the sacral epidural space.