For which leg diseases is surgical treatment contraindicated? Complications of peptic ulcer
Surgical interventions are divided into
▪ Emergency operations performed for life-saving reasons (for example, injuries complicated by internal or external bleeding; tracheostomy for obstruction of the upper respiratory tract; pericardial puncture for cardiac tamponade).
▪ Urgent (emergency) operations performed within the immediate future from the moment of injury to prevent severe complications. To reduce surgical risk, intensive preparation is prescribed before surgery. Depending on the nature of the pathology, the acceptable time frame from the moment of admission to the clinic to the operation is, for example: - for vascular embolism of the extremities, up to 2 hours; - for open fractures up to 2 hours. ▪ planned
Absolute readings for surgery ▪ Open injuries. ▪ Complicated fractures (damage to great vessels and nerves). ▪ The threat of complications when performing closed reduction for fractures. ▪ Ineffectiveness of conservative treatment methods. ▪ Soft tissue interposition. ▪ Avulsion fractures.
Relative indications. Planned interventions after injuries and previous surgical interventions (preliminary outpatient examination of the patient is required).
For example: ▪ hip replacement after a subcapital femoral fracture; ▪ removal of metal structures.
When determining indications for surgical interventions, the following factors should be taken into account: - diagnosis of injury; - danger of damage; - prognosis without treatment, with conservative and surgical treatment; - risk of surgical intervention; - 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, absolute and relative indications for surgery must be justified, and the intervention, c. In each specific case, it may be postponed or cancelled.
Absolute contraindications:
- Severe general condition of the patient.
- Cardiovascular failure.
- Infectious complications of the skin.
- Recent severe infectious diseases.
Relative contraindications may arise primarily due to the following risk factors:
- old age;
- premature baby;
- respiratory diseases (eg, bronchopneumonia);
- cardiovascular disorders (eg, untreatable hypertension, blood volume deficiency);
- renal dysfunction;
- metabolic disorders (eg, uncompensated diabetes mellitus);
- blood clotting disorders;
- allergies, skin diseases;
- pregnancy.
Without taking these risk factors into account, 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 choosing the method of anesthesia and administering 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 during deep anesthesia, often entails not the most pleasant manifestations for the body. However, there are situations when their use is contraindicated. This means that general anesthesia is performed only for emergency medical reasons or when the risk to the patient's life 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 present. We list the main contraindications to anesthesia:
- The patient has a disease such as bronchial asthma in severe or progressive form. This condition is directly related to the danger of laryngeal intubation during deep anesthesia. This manipulation can cause closure of the glottis or bronchospasm, which is life-threatening. That is why it is a rather dangerous combination.
- Pneumonia. After surgery, pulmonary edema may develop in this case.
- Serious diseases of the cardiovascular system. These include myocardial infarction suffered 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, is also an unacceptable condition.
- Epilepsy, schizophrenia and some other psychiatric and neurological diseases. Contraindications for such diagnoses are associated with an unexpected reaction of the sick person’s body to the use of anesthetics.
- Temporary but absolute contraindications, in which surgery is usually not performed under anesthesia, is a state of alcohol or drug intoxication. The point here is that anesthetics will not work, so this procedure is impossible. Surgical intervention for a patient who is under the influence of alcohol or drugs can only be performed after complete detoxification of the body. Often in this case, the help of a narcologist is necessary. General anesthesia is used for patients under the influence of alcohol or drugs 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 should mask anesthesia not be used?
It is worth noting that there are contraindications to long-term use. First of all, these include the presence of tuberculosis in the patient. It is also prohibited in case of diabetes mellitus and impaired renal function, including unstable functioning of the adrenal glands.
In any case, the decision about which anesthesia will be best for you is made by the anesthesiologist. It takes into account all diseases and possible contraindications. Choose your specialists carefully and be healthy!
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Questions on the topic
Olga 09.10.2019 05:50
Good afternoon My mother (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 (meaning oncology)?, i.e., the diagnosis is unknown. Due to the fact that the cystoma has compressed all organs, disruptions in the functioning of the heart are observed. An operation to remove the cystoma was planned, but after consulting an anesthesiologist, it was postponed. The anesthesiologist said that there was a high risk due to severe tachycardia. Mom never complained about her heart before. I received a referral to donate blood for a tumor marker (I donated it earlier, there was an excess), we will wait for the choice of alternative treatment. It is difficult for her to move, she eats little due to the fact that food simply cannot fit into her compressed stomach, in other words, she loses strength. Should I insist on surgical intervention?
Inna 05/17/2019 09:50
Good afternoon. Tell me, during vertebroplasty, local anesthesia is administered, my FGDS revealed 4 mature gastric erosions, I’ve been undergoing treatment for 3 weeks, and soon I’ll go back to FGDS again. If they are not healed, will the operation be denied? I am still undergoing treatment and I can take stomach medications during the operation. Can local anesthesia cause bleeding?
Yana 02/05/2019 11:57
Hello! A 3-year-old child has congenital hydrocele of the testicles, soon there will be an operation under general anesthesia, the child began to often complain about the knee and we did an ultrasound of the knee joint, in the conclusion we wrote that there was moderate synovitis of the right knee joint with a slight effusion into the cavity, as well as adenoids 2 degrees. Can we undergo surgery 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, grade 3, grade 1, 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 an operation; my grandmother had severe uterine prolapse! + the doctor discovered that the bladder seemed to have turned over. My grandmother has epilepsy (she has been drinking benzanal) since she was about 23 years old, she has stones in the bladder, hypertension, and her blood pressure rises very high in the evening and at night, sometimes over 200, she was taken away in an ambulance, 2 times over the summer. I'm very worried about my grandma. What tests need to be taken to check the body’s reaction to anesthesia? Is it worth having surgery at this age?
ANATOLY GRIGORIEVICH 24.07.2018 19:05
HELLO DOCTOR!!! I am 69 years old and have been diagnosed with a benign adenolymphoma of the right parotid salivary gland, so far they have advised me to do the operation under general anesthesia, because of the facial nerve so as not to damage it, but I have concomitant diseases, moderate chronic renal failure, dislocation of the left chambers of the heart, the cavity of the right ventricle, atherosclerosis of the aorta, aortic enlargement 51 cm. signs of ischemic heart disease, stage 2 hypertension, cardiosclerosis. Isn’t general anastasia contraindicated for me? I’m afraid to completely transplant the kidneys and heart. What do you doctor recommend? What type of anesthesia is best for my pain? THANK YOU(((((((
Olga 07.07.2018 15:20
Hello, please tell me whether it is possible to perform an operation to remove a 40mm aneurysm using a shunt installed in 2013. On a leg 37cm long? My dad is 75 years old, has flickering arrhythmia, blood pressure sometimes fluctuates, cancer was discovered on the lung about 60 mm. The doctor says general anesthesia is not allowed, is it possible locally?
Roman 05/28/2018 22:13
Hello. I am 39 years old. A planned ear operation (chronic purulent otitis media, cholesteatoma) was prescribed. One kidney and spleen were removed (hit by a car as a child), and there was a brain contusion. I have heart problems (arrhythmia, tachycardia) - so I have been taking 2.5 mg of Concor every day for many years. Plus, they discovered the hepatitis C virus (how long I have had it is unknown), ECG - sinus rhythm, 86 beats, interatrial block; on the only kidney there is 1.9 cm of parenchyma and in the middle segment 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, therapist, urologist, neurologist) gave the go-ahead, but a lot of problems were revealed. Thanks in advance for your answer.
Oleg 05/17/2018 02:14
Hello. Please tell me, a 43-year-old patient is undergoing a planned laparoscopic cholecystectomy. Concomitant diseases include 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 05/03/2018 18:40
Hello, please tell me, breast plastic surgery is planned, the ECG shows sinus rhythm with a heart rate of 78 beats. per minute Diffuse disturbances of myocardial repolarization, is this not a contraindication to anesthesia? Thank you.
Karlygash 04/08/2018 16:21
Hello, my aunt is 46 years old, they found stones in her kidney, they said we need to have an operation, but in one clinic we were refused to have the operation, they said that she has 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 what? Will she be okay?
Marina 03/25/2018 22:36
Hello. I would like to know. I have a 4-year-old child who wants to have all his teeth treated at once under general anesthesia. But we recently discovered a pelvis in our right kidney, it is slightly dilated. Can we have such anesthesia?!
Svetlana 03/13/2018 13:28
Hello! I have instability of the 5-6-7 cervical vertebrae, and a hernia of the cervical spine, at the moment the pain has worsened, headaches and poor circulation are added to them. Is it possible to perform an operation under general anesthesia in this condition (the operation lasts 1 hour)?
Natalya 02/27/2018 11:50
Is it possible to undergo surgery to remove a hernia if there is a heart block!? (If not, what consequences may there be) (and if so, will this affect the deterioration of heart function)
Larisa 02/03/2018 07:18
Hello! I have a planned operation to remove the gallbladder, but I have 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 surgery, before surgery?
Sergey. 29.10.2017 21:25
Hello. I want to remove several teeth under general anesthesia. I take cordarone because I have atrial fibrillation. Does it make sense to contact the dental center with this request? Or will it be refused anyway? Thank you.
Elena 10.26.2017 15:03
Hello! A relative (74 years old) was diagnosed with stomach cancer (early stage). but he has COPD, the oncologist concluded that surgery and chemotherapy cannot be done (he will not withstand anesthesia), is he right?
Marina 10.20.2017 10:42
Hello! Please tell me, my mother’s kidney ultrasound concluded: Ultrasound signs of cystic transformation of the right kidney. Pronounced diffusion changes in the parenchyma and sinus of the left kidney. ICD. Pielita on the left. Left kidney cyst. Cysts of the right ovary, endometrium, uterine fibroids. Can we have spine surgery? and how dangerous is it?
Ekaterina 10/19/2017 22:49
Hello, my daughter is 3 months old. An ultrasound of the brain revealed dilations of the stomachs of the brain. The liquor-containing system is expanded D>S Depth of the anterior horns: right -7.8 mm, left 6.5 mm (N up to 5 mm) And also an open oval window. We are undergoing cosmetic surgery under general anesthesia (removal of capillary malformation). Is it possible to carry out anesthesia for such a diagnosis?
Natalya 10/13/2017 11:14
Hello, please tell me, we are about to have an operation to remove the adenoids under general anesthesia, but the ECG showed sinusoidal arrhythmia (105 beats), the cardiologist did not give permission, he said that the child has bradycardia. Is this a contraindication?
Oksana 10/11/2017 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, my legs have failed (sensitivity is preserved), my bladder does not work and I have been constipated for 8 days, an enema does not help. They admitted him to the hospital to install metal rods instead of a vertebra, and during an examination at the hospital they found erosion of the stomach and postponed the operation. The question is, is gastric erosion a contraindication to neurosurgery in such a situation? The condition is getting worse every hour. Symptoms of intoxication from constipation began. Or are doctors afraid of developing 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 a herniated disc. 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 have an operation, but the doctor came and said that I could go crazy in simple language. Before he came in the evening, I talked to a girl, an anastasiologist, and 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 wash my face and go to bed, he said that since I was 14 years old I smoke marijuana every day now I’m 19 I haven’t used any other drugs I said she said that I have a very sensitive character, so to speak, when we were sitting I was crying after 30 minutes I had already calmed down and was almost ready for surgery, he told me that I had a diseased gallbladder (biliary dyskinasia and chronic cholecystitis, the gastroeterologist also diagnosed liver steatosis at the moment I have slightly yellowish eyes and skin. I told her that I have gastroudenitis, she suggested spinal anesthesia, an injection in the back after which I will 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 it was dangerous for me to have anesthesia and, to put it simply, I could go crazy because I was so emotionally excited, I was afraid so that I was shaking all over + I waited until this day for several days and was very afraid, in general, they discharged me from the hospital and said come and do it you'll get it in 3 months.
Evgenia 09.20.2017 14:44
Good afternoon An MRI of the brain revealed a 2 mm saccular aneurysm of the anterior communicating artery. Laparoscopy is coming. Are there any contraindications to anesthesia?
Ekaterina 09.16.2017 17:35
Hello, a 6-year-old child has been suffering from asthma for 2 years on basic therapy with Seretide 2 times a day 25/125. and disruption of intraventricular conduction, a slowdown in intraventricular conduction has been noted; surgery to remove grade 2-3 adenoids is pending
Polina 09/12/2017 06:35
Hello! My brother was diagnosed with a pulmonary bulla. He also has inflamed adenoids. They were supposed to have an operation to remove them, but when they found the bulla, they said that it was a contraindication. Is this really true? How then to remove adenoids? Can't you use anesthesia? We also wanted to take him to stem therapy, because... he has ROP of the central nervous system, but he also needs anesthesia (mask). The clinic coordinator said that even with gentle anesthesia, it is unknown how the body will react. What can you do in this situation? Thanks in advance!
Alla 09.10.2017 15:58
Hello, my 4-year-old child had upset stools 2 days before surgery (phimosis), tell me, will the surgery be postponed in this case?
Petimat 09.09.2017 23:13
Hello. I wanted to know that we are having an adenotomy operation in five days. The boy is 8 years old, but yesterday he had a stuffy nose, slight clear snot, no fever, and his throat was slightly red. There is no cough, but I coughed a couple of times at night. Do we have any contraindications for surgery? It’s just that if we are denied surgery, I will no longer wait for recovery. Then I’ll wait until the summer, because as September gets colder, we get sick all the time. Not even 10 days later, we get sick again. Thanks in advance.
Elena 09/05/2017 14:12
Hello. I need to have a laparoscopy in 15 days. I have VSD, I waited a long time for support 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 it goes away. The gynecologist also prescribed me lutein hormone 200 for ten days, so that my body could adjust to the date of the operation. Can I have the operation? I wanted to know your opinion, I’ll ask my anesthesiologist, but it’s interesting to know your opinion.
Dmitry 08/17/2017 05:43
Hello! I would like to know if I can undergo anesthesia if I am diagnosed with “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 Singulair and courses of Flexotide. Did the neurologist send you for an MRI of the brain under 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 08/03/2017 06:35
Hello, please tell me what kind of anesthesia is possible for my child. I have a 9 year old daughter. A questionable diagnosis of laryngeal papillomatosis was made. She did not allow herself to be examined in a mirror without anesthesia. We were told that they would do the examination under anesthesia. She was diagnosed with LLC. By school the condition had improved and they said it was overgrown. The child is very nervous. Thank you very much for the information.
Daria 07/01/2017 05:40
Hello. The child is 2y 10m. An operation to remove the adenoids is performed under general anesthesia. ECG revealed boadicardia. 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 on it. Is this true?
Alexandra 06/27/2017 16:42
Hello. A 6-month-old child will undergo surgery for grade 2 vesicoureteral reflux. The child has increased intracranial pressure (moderate) and an enlarged thymus gland (grade 3). Is it possible to use anesthesia?
Waag 06.26.2017 17:59
Good afternoon. My father must undergo surgery to remove a cervical hernia, and he has a heart aneurysm. Is there a risk of surgery under long-term anesthesia? Thank you.
Alexandra 06/25/2017 08:21
One of these days, my 6-year-old son will undergo surgery to remove adenoids under general anesthesia. An ECG was performed, the conclusion was: sinus rhythm, heart rate = 87 beats/min, s type ECG. Intraventricular conduction is impaired. Can they refuse anesthesia for this result?
Evgeniya 06/16/2017 10:48
Hello! The child is one year and 8 months old and will undergo surgery under mask anesthesia. ECG shows sinus rhythm with heart rate 89-109, with periods of bradycardia. It is not possible to get a consultation with a pediatric cardiologist. The pediatrician has doubts. Please tell me whether it is dangerous to undergo surgery with such ECG data. We'll survive. Thanks in advance.
Irina 06/09/2017 11:26
Good afternoon, my mother was discharged from the hospital on May 31, 2017. Diagnosis: Cerebrovascular disease: Brain infarction dated May 11, 2017. Coronary heart disease: post-infarction cardiosclerosis. Persistent form of atrial fibrillation. Background disease: Hypertension stage 3, stage III, risk of cardiovascular complications 4. Complication: NC 2A (Strazhenko-Vasilenko) On 06/07/2017 she was taken to the hospital with suspected intestinal hemorrhage. The next day, the coloproctologist said that there was no blood in the stool and most likely the mucous membrane was damaged due to constipation (Mom is bedridden, the right side is paralyzed). Since it is necessary to constantly take anticoagulant therapy, the doctor still advised a colonoscopy under anesthesia. What is the risk? Is it worth carrying out this examination under anesthesia, taking into account the above?
Elena 05/30/2017 00:34
Hello! The child is 1 year 7 months old and needs to undergo FGS under general anesthesia. An ECG examination revealed a diagnosis of 1st degree AV block. Is it possible to do this? How does general anesthesia affect the brain of an actively growing child? Thanks in advance.
Natalya 04/24/2017 08:37
Hello, I am having a planned operation (lipoma) under local anesthesia, I have a sore throat, I am taking Ingoverine, should I cancel the operation or not?
Arthur 04/11/2017 09:26
She is undergoing surgery to remove an inguinal hernia. I am 56 years old, permanent atrial fibrillation. Two years ago, during coronary angiography, there was ventricular febrillation. Now I'm afraid to undergo surgery under general anesthesia. Help with advice, thanks.
Oksana 04/08/2017 12:28
We did a laparoscopy of the ovary, the anesthesiologist said that there were problems with me: a difficult and narrow glottis. What does it mean?
Anastasia 04/04/2017 13:50
Hello. We have a question? We go to the hospital for a CT scan under anesthesia. We have staphylococcus since birth, and later we discovered that we also have adenoids. The bottom line is that we have eternal problems with snot. They never go away. Will they do a CT scan for us under anesthesia if we blow our noses well before doing this?
Tanya 04/02/2017 23:51
Good afternoon An operation is required to remove the placental polyp. I have tachycardia up to 90 beats per minute. Should I worry that it will take me a long time to recover from anesthesia? Isn't it contraindicated for me? I’m currently drinking rose hips to regulate my pulse, does it really help? Thank you!
Oksana 03/19/2017 09:38
Hello, I am undergoing a colpoperineorrhaphy operation under local anesthesia. I am currently treating acute bronchitis. Surgery in a week. Is it possible to perform surgery under such conditions?
Irina Nikolaevna 28.02.2017 13:25
I am contacting you again because I have not found an answer. I need to have 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’ll also add Sirdalud. I have neuropathy due to stenosis of the lumbosacral spine. Age 67 years. With respect, 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. This is all at the discretion of your anesthesiologist.
Vyacheslav 02/26/2017 06:35
Hello, my father is 67 years old and has coronary artery disease. He suffered a myocardial infarction 3 years ago and is now suffering from an inguinal hernia. Can he be given anesthesia, and if so, what kind in this situation?
Abdurakhman 02/19/2017 22:39
Hello, I have Parkinson's syndrome and I had a bad fall and broke my femoral neck and now I have to undergo surgery to replace the femoral neck, please tell me whether anesthesia is contraindicated for me or not
Olga 02/18/2017 23:45
Hello, what type of anesthesia is used during surgery to remove hygroma of the tendon of the abductor pollicis longus muscle of the wrist joint? Are there any risks? The child is 13 years old.
Olga 02/11/2017 00:09
Hello! Please tell me, I have had VSD for 2 years now and am now pregnant with my 3rd child. Is he afraid of VSD? Thank you!!!
Natalya 02/02/2017 17:57
Hello, I am undergoing surgery to remove a tumor in the posterior part of the mediastinum, my child is 1 year and 1 month old. The child has a runny nose and is teething. Is this a reason not to have surgery at this time?
Olga 01/20/2017 18:56
Thank you. But is it really advisable to put yourself at risk for the sake of some kind of cardiogram? Why in simple cases (which do not require sutures, do not touch muscles, nerves, or blood vessels) not hold the child, secure him with belts (they did this to me, though a long time ago) and use local anesthesia? Sorry for the intrusiveness, this question worries me very much.
Olga 01/19/2017 20:43
Hello. A 3.9-year-old child wants to remove a lipoma (5 mm) on his leg under general anesthesia. A wen on the surface of the skin, under a layer of skin approximately 1 mm thick, the contents are clearly 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 without ANY reason other than their own convenience? Why don’t they measure the amount of work and offer other methods (for example, resorption using a drug injection)? Please help, is this not a violation of the patient’s rights?
Andrey 01/19/2017 00:38
Good afternoon My wife is about to give birth, and she has a polyvalent allergy (even to the point of anaphylactic shock). Tell me what drugs for anesthesia are used during childbirth, and whether it is possible to do allergy tests for them in advance. If yes, where? I would also be grateful for any recommendations in such cases.
Sima 12/17/2016 18:23
Hello, my son is 29 years old. He has diangosis - PMD and he needs to have his gallbladder removed. The doctor refused to perform the operation because he cannot be given anesthesia. Tell me what to do? Thanks for the information.
Maria 26.11.2016 21:10
Hello. The patient was prescribed CABG (coronary artery bypass grafting) as planned. During a preliminary examination by specialists, the ophthalmologist diagnosed Suspicion of glaucoma. And he signed that there are no contraindications to the operation. But the cardiac surgery department refused to take the patient in for surgery, since Glaucoma was questionable; they said that the patient needed to find out for sure whether he had glaucoma or not. Since Glaucoma is a contraindication to CABG. Is this true?
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 is stage 2 CICM (atherosclerotic, hypertensive). Previously suffered an ischemic stroke in the right side of the anterior spinal cord (cystic transformation in the occipital lobe according to CT scan). Transient ischemic attack in BLSMA a year ago. Concomitant: stage 3 hypertension, degree 3. Hypertensive heart. Atheromatosis of the aortic valve. Risk 4. Mixed nephropathy. BP C2. CHF 1. FC1 Diabetes mellitus 2. Obesity 1st degree. Hyperrumemia. Dyslipidemia. type. Surgical treatment was recommended for atherosclerosis of the vessels of the neck, extracranial section of the bracheocephalic vessels. Occlusion of both ICAs. Stenosis of the proximal segment of the left vertebral artery up to 60%, refused surgery. X-rays later diagnosed COPD. Diffuse pneumosclerosis, pulmonary emphysema. Can we count on surgery now or is this a contraindication?
Ulyana 01.11.2016 12:39
Good afternoon My son is 5.5 years old, the ECG result is a local disturbance of intraventricular conduction, is it possible to do adenotomy under anesthesia?
Alina 01.11.2016 00:34
Hello. My 6-year-old child was diagnosed with cicatricial phimosis and surgical treatment was recommended. I am also concerned about the issue of general anesthesia. The fact is that the child suffers from asthma and has MAS. Anomaly of the notochordal apparatus. During examination by a cardiologist, bradycardia was recorded on the ECG. ECHOCG shows MAS. The stress ECG, according to the cardiologist, is normal. This bradycardia is associated with VSD. The operation is coming up in 2 weeks, we are very worried. Can we have general anesthesia?
Marina 10/15/2016 09:02
frequent extrasystole 4 degrees, bigenymia. trigenymia. jogging of gastrointestinal tachycardia, ischemic heart disease. 58 years old, woman. Is it possible to have surgery to remove the gallbladder? What is the risk?
Evgeniy 10/08/2016 11:28
Hello! I want to do chin plastic surgery + SMAS lift. A year ago, I had heart problems due to nervousness; an ECG showed a scar on the back wall of the heart. In the conclusion it is written: “According to Echo-CG, there are signs of atherosclerotic lesions of the aorta, the cusps of the aortic vertae and the mitral valves. Prolance (unintelligible word?!) of the anterior cusp of the mitral valve, stage I, with symptoms of mitral regurgitation, stages I - II. Moderate hypertrophy of the left ventricular myocardium with signs of diastomic dysfunction. Signs of aneurysm of 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: 10/29/2015. Sometimes, once every few days, the heart may tingle quite a bit (2-3 “pricks”), but there are no serious complaints about the heart now. I do not perform heart treatment. Well, what could be the consequences of anesthesia if it is contraindicated for me, and I hide the above from the plastic surgeon?
Aldyn 09.30.2016 12:49
Hello, my grandmother is 70 years old, the cavity of her uterus is filled with purulent-hemorrhagic contents, curettage of the uterus was indicated, but due to the presence of chronic bronchitis it was refused (they said anesthesia may not work). Is this really true? Thanks for the answer.
Natalya 09.21.2016 11:56
Good afternoon. Question about anesthesia. A gynecological operation is coming up to remove a polyp in the uterus. The operation is for the day after tomorrow. I have a fractured wrist, my arm has been in a cast for a month now. Will they accept me for the operation or may they refuse to operate? Thank you.
Daria 09/16/2016 01:09
Hello. Question about anesthesia. I am preparing for gynecological surgery, endometrial curettage. Is general anesthesia suitable for 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 09.13.2016 14:22
My daughter is scheduled for laparoscopy (removal of a cyst on the left ovary), I have hepatitis B, they said general anesthesia... I’m very afraid of contraindications and consequences. I'm interested in your opinion
Valentina 09/08/2016 17:32
Hello. In 2013, I had a caesarean section due to a breech fetus under epidural anesthesia. About 5 minutes after the start of the operation, it became very difficult for me to breathe, I felt like half of my lungs were missing, I felt dizzy, it was hard to speak, I felt faint. As the anesthesiologist said: the pressure dropped significantly. After 20 minutes the condition returned to normal. Now I have to deal with it again, I’m very afraid of a repetition of this condition, especially lack of air. By the way, after the first caesarean section, the feeling of lack of air passed only after 2 months. In the anamnesis, IVP, VSD, mitral valve prolapse is not hemodynamically significant, high myopia. During my first pregnancy I had inferior vena cava syndrome, but now I don’t. Age 28 years old. Tell me, what type 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 repeating now? Thank you in advance.
Love 09/02/2016 15:51
Hello! I will have a planned cesarean section at 38 weeks, now I’m 37 weeks and the migraine has worsened again. I have had migraines since 2014 in spring and autumn. During pregnancy, it is not as acute for me (without an aura) as it was before pregnancy. I also have tachycardia, my pulse goes from 100 to 110. I'm afraid of general anesthesia because... Last time my recovery was very difficult (fainting and vomiting). What kind of anesthesia is possible for me?
Elena 08/31/2016 10:45
Hello! We are preparing for the operation, we are undergoing tests and found sand in the child’s kidneys and changes in the urine (protein), and according to the ECG there is a pronounced sinus arrhythmia!, tell me, is this a contraindication for surgery with anesthesia? child 4 years old: main diagnosis is merosin-negative muscular dystrophy. the anesthesia was said to be inhalation with Sevuran (if I spelled the name correctly)
Natalya 08/28/2016 08:24
Hello. Please tell me whether it is possible to use general anesthesia in my situation. In 2005, the following operations were performed: (first stage) - operation of a right-sided ventriculoperitoneal shunt, and second stage - operation of a right-side paramedian access, removal of a tumor of the left cerebellopontine angle. Currently, the neurologist's diagnosis is: CVD, DE st. complex genesis (hypertensive, atherosclerotic, postoperative), hypertensive-hydrocephalic syndrome, left-sided pyramidal insufficiency, liquorodynamic disorders, moderate vestibulo-atactic, cognitive impairment. Chronic cholecystitis, Gallbladder polyposis. Dyslipidemia. Is it possible in my situation to use general anesthesia - gynecological surgery (endometrial hyperplasia), removal of the gallbladder. What consequences are possible after using general anesthesia on the brain? Are there any contraindications for general anesthesia in my situation?
Natalya 08/18/2016 17:11
Hello. Please tell me, can mental retardation be a reason for refusal to undergo gall bladder surgery? A 63-year-old woman, disabled since childhood, mental retardation and mental retardation. There are complications after the treatment in the form of speech impairment, severe stuttering. Fully capable. She underwent the examination necessary for planned hospitalization. There are no contraindications to the operation. Gallstone disease, constant pain. Periodically nausea, vomiting, diarrhea. She was hospitalized several times by ambulance during an exacerbation period. The gastroenterologist recommended surgical treatment.
18.08.2016 16:32
Yulia, it is not clear from the question whether we are talking about routine vaccination or treatment of the disease. If it’s a vaccination, I can’t be 100% sure, but most likely there’s nothing wrong with it, but it’s still better to reschedule it for after surgery. And if we are talking about a disease, then additional consultations with doctors are needed, an assessment of the risk and the need for surgery.
Anastasia 08/16/2016 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 delay the operation, let the body recover - after all, pregnancy and childbirth are a strong stress for a woman’s body, especially since there was a cesarean section, which means there was anesthesia, or anesthesia. Now I'll go back to anesthesia again. 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 or a year and a half has passed. Good luck to you!
Azat 08/10/2016 11:47
Hello, is it possible to undergo surgery to remove the gallbladder with angle-closure glaucoma, and what anesthesia is prescribed (anthropine is contraindicated)? What anesthesia is used for the operation, local or general?
Olga 08/03/2016 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, is it possible to have surgery?
Diana 08/02/2016 19:59
Hello! I have a drug allergy to all local anesthetics. Only ultracaine showed 30% (as I understand it is possible, but with tavegil). Please tell me what other anesthesia options may be suitable for 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, on August 12, my 7-year-old daughter has her adenoids removed under general anesthesia. Is it possible to get a tetanus vaccination (the time has come) before the operation or is it better to postpone it?
Lydia 07/26/2016 16:39
Meniscus resection (arthroscopy): which anesthesia to choose? Good afternoon I ask for help with choosing a method of pain relief during knee arthroscopy (the operation will take at least an hour). The surgeon recommends spinal anesthesia. But what stops me is that due to a 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 appear even after six months to a year. General anesthesia - everything is fine, but I have already undergone several operations under general anesthesia and I’m afraid it might be too much. My memory and reaction speed have deteriorated, and I suffer from insomnia. In addition, I have arrhythmia and problems with blood pressure (there were cases when it dropped to 40). Local anesthesia, according to the surgeon, is not an option at all. Conduction anesthesia (regional) remains. I would be very grateful if you express your opinion on this matter. P.S. I haven’t talked to the anesthesiologist yet, but I would like to understand what to ask him for.
Larisa 07/25/2016 21:07
Hello! My sister fell ill a month ago, and an MRI revealed a sequestered hernia of the L4-S1 vertebra. They began to prepare for a neurosurgical operation. An ECG showed that there were changes in the heart. A cardiac examination (ultrasound) was performed, which showed the presence of an aneurysmal deformation of the lower left atrium into the cavity of the left atrium with an interruption of the echo signal of 3.7 mm with a slight pathological discharge of blood. Rhythm disturbance. The thickness of the pancreas PS is 8.2 mm. The conclusion also states that there is a tendency to dilatation of the cavities of both atria. Concentric hypertrophy of the LV myocardium with decreased contractile function. Type 1 diastolic dysfunction Consolidation and mild calcification of the valves of the mitral valve and the aortic root. Mitral insufficiency 1-1.5 degrees. Aortic regurgitation grade 0-1. Tricuspid insufficiency 1.5 degrees. Pulmonary regurgitation stage 1. Myocardial hypertrophy. Moderate pulmonary hypertension. R syst. LA 40 mm/Hg. The neurosurgeon is ready for the operation, but the anesthesiologists twice categorically refused the operation, indicating the presence of a heart defect, which greatly frightened us. We had a consultation with a cardiac surgeon, who said that cardiac surgery in this situation is not indicated and there are no obstacles to performing a neurosurgical operation. Help me figure out whether it’s really impossible to give anesthesia or are anesthesiologists just taking insurance? Is there a real direct threat to life? The operation usually lasts 3-3.5 hours under general anesthesia. I also write that the hospital is a base for training students at a medical university (maybe this is the reason?) located in our city; the operation was to be performed by a high-class neurosurgeon who previously worked in one of the federal centers. I will also say that we found out about the existing heart disease only during the examination. For us, this is a “find”, since there have never been any complaints about the heart.
Egor 07/25/2016 19:29
Hello. Father is 57 years old. After surgery on the carotid artery, progressive signs of stroke were recorded for a year. As a result, the right side of the body became paralyzed. They did an MRI of the brain a year ago and now - a tumor of 4 cm has formed in the brain in a year (I assume a post-stroke cyst), but the doctors do not draw conclusions and simply call it a formation, a tumor (gliastoma). The father walked a little, but fell on his right leg, receiving a displaced subtrochanteric fracture of the femur. Everything would be fine, they wanted to do an operation and install staples on the hip, but the hospital refused to perform the operation, citing the impossibility of anesthesia for such a patient. We went for permission to the Institute of Brain Neurosurgery (Tashkent), where they confirmed to us that no anesthesia could be performed, even during leg surgery. My father has been lying there for two months suffering from a fracture; the bones naturally do not heal on their own. Please tell me, is there really nothing that can be done? Maybe there is a way to numb only the lower part of the body, for example, during surgery on the leg? Thank you.
Hello, doctor! When I was having my teeth treated, 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 was not in pain, but crying on its own, I even smiled while answering. She revived me with ammonia, after which she said that she realized that it was an “adrenaline swing.” She said that this was a reaction to adrenaline, and I think she added that I had eaten something sweet before, so this is the reaction. I didn’t consider it necessary to write me the name, since it was not a reaction to the anesthetic, according to her, but I wrote something like “adrianol”, I could be wrong. I have to undergo dental treatment, which will be unbearable without anesthesia, and I’m also breastfeeding, my baby is 1.2 months old, and I’m not going to give up 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, and if so, which ones, because the prices are terribly high. By the way, after this incident, I was already given anesthesia after childbirth, when the placenta was removed, the general one, but this was probably a different type of anesthesia. She tolerated it well.
Nikolay 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-30 tablets + 100 g of vodka). She remained alive, but with serious consequences. For the first 10 days after the poisoning, I only slept, didn’t eat, just drank water. Then she regained consciousness, began to eat and drink a little, recognized her loved ones, spoke poorly, tried to get up and walk on her own, 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 his arms and legs, making smooth movements (like 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 speak worse (now she doesn’t speak at all), she doesn’t get up, she walks under herself, she doesn’t respond to our calls, she has to be given water and food in her sleep. Now he sleeps 24 hours a day. She has become poor at eating, takes food from a spoon into her mouth and sleeps with it, does not chew or swallow, and 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 this condition to undergo anesthesia for an MRI examination or in our case this is excluded. And if this is so, then 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 periodic use of amphetamine for two years, if the last use was a year ago, and the use of marijuana during the last year, if the last use was a month ago?
Indications for surgery are divided into absolute and relative.
Absolute indications Diseases and conditions that pose a threat to the patient’s life and that can only be eliminated surgically are considered to be considered for surgery.
Absolute indications for 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 ulcer of the stomach and duodenum, acute intestinal obstruction, strangulated hernia), acute purulent surgical diseases (abscess, phlegmon, osteomyelitis, mastitis, etc.).
In planned surgery, indications for surgery can also be absolute. In this case, urgent operations are usually performed without delaying them for more than 1-2 weeks.
The following diseases are considered absolute indications for elective surgery:
Malignant neoplasms (cancer of the lung, stomach, breast, thyroid, colon, etc.);
Stenosis of the esophagus, the outlet of the stomach;
Obstructive jaundice, etc.
Relative indications for surgery include two groups of diseases:
Diseases that can only be cured surgically, but do not directly threaten the patient’s life (varicose veins of the saphenous veins of the lower extremities, non-strangulated abdominal hernias, benign tumors, cholelithiasis, etc.).
Diseases that are quite serious, the treatment of which can, in principle, be carried out both surgically and conservatively (coronary 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 the surgical or conservative method in a particular patient. According to relative indications, operations are performed as planned, subject to 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 the acute stage of myocardial infarction or cerebrovascular accident (stroke). It should be noted that currently, if there are vital indications, it is possible to perform operations against the background of myocardial infarction or stroke, as well as in shock after stabilization of hemodynamics. Therefore, the identification of absolute contraindications is not fundamentally important at present.
Relative contraindications include any concomitant disease. However, their influence on the tolerability of the operation is different.
Contraindications to 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 disease that inevitably leads to death (for example, oncopathology, cirrhosis of the liver, etc.). Such patients, by decision of the council, undergo conservative syndromic therapy.
For relative indications, the risk of surgery and the planned effect of it should be individually weighed against the background of concomitant pathology and the patient’s age. If the risk of surgical intervention 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 allergies.
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 It is performed for patients with common surgical diseases that have little effect on the condition of the body.
Skin should be examined in every patient. Rash, purulent-inflammatory rashes exclude the possibility of performing a planned operation. Plays an important role oral sanitation . Carious teeth can cause diseases that seriously affect the postoperative patient. Sanitation of the oral cavity and regular teeth cleaning are very advisable to prevent postoperative mumps, gingivitis, and glossitis.
Body temperature should be normal before elective surgery. Its increase is explained in the very nature of the disease (purulent disease, cancer in the decay stage, etc.). In all patients hospitalized routinely, the cause of the fever should be found. Until it is detected and measures are taken to normalize it, elective surgery should be postponed.
Cardiovascular system should be studied especially carefully. If blood circulation is compensated, then there is no need to improve it. The average blood pressure level is 120/80 mm. rt. Art., can fluctuate between 130-140/90-100 mm. rt. Art., which does not require special treatment. Hypotension, if it is normal for a given subject, also does not require treatment. If there is a suspicion of an organic disease (arterial hypertension, circulatory failure and cardiac rhythm and conduction disturbances), the patient should be consulted with a cardiologist and the issue of surgery will be decided after special studies.
For prevention thrombosis and embolism the prothombin index is determined and, if necessary, anticoagulants are prescribed (heparin, phenylin, clexane, fraxiparin). In patients with varicose veins and thrombophlebitis, elastic bandaging of the legs is performed before surgery.
Preparation gastrointestinal tract patients before surgery on other areas of the body is simple. Eating should be limited only the evening before surgery and the morning before surgery. Prolonged fasting, the use of laxatives and repeated lavage of the gastrointestinal tract should be carried out according to strict indications, as they cause acidosis, reduce intestinal tone and promote stagnation of blood in the mesenteric vessels.
Before planned operations, it is necessary to determine the condition respiratory system , according to indications, eliminate inflammation of the paranasal cavities, acute and chronic bronchitis, pneumonia. Pain and the forced state of the patient after surgery contribute to a decrease in tidal volume. Therefore, the patient must learn the elements of breathing exercises included in complex of physical therapy for the preoperative period.
Special preoperative preparation at for planned patients it can be long-lasting and extensive, in emergency cases it can be short-term and quickly effective.
In patients with hypovolemia, disturbances in water-electrolyte balance, and acid-base status, infusion therapy is immediately started, including transfusion of polyglucin, albumin, protein, and sodium bicarbonate solution for acidosis. To reduce metabolic acidosis, a concentrated solution of glucose with insulin is administered. Cardiovascular drugs are used at the same time.
In case of acute blood loss and stopped bleeding, blood, polyglucin, albumin, and plasma transfusions are performed. If bleeding continues, transfusion is started in 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.
Preparation of organs and homeostasis systems should be comprehensive and include the following activities:
improvement of vascular activity, correction of microcirculation disorders with the help of cardiovascular drugs, drugs that improve microcirculation (reopolyglucin);
combating respiratory failure (oxygen therapy, normalization of blood circulation, in extreme cases - controlled ventilation);
detoxification therapy - administration of fluids, blood-substituting solutions with detoxification action, forced diuresis, use of special detoxification methods - 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. At this stage, patients often develop a feeling of fear and uncertainty in connection with the expected operation, negative experiences arise, and numerous questions arise. All this reduces the body’s reactivity, contributes to sleep and appetite disturbances.
Significant role in psychological preparation of patients, hospitalized as planned, are allocated medical and protective regime, the main elements of which are:
impeccable sanitary and hygienic conditions in the premises where the patient is;
clear, reasonable and strictly observed internal rules;
discipline, subordination in the relationships of medical personnel and in the relationship of the patient to the staff;
cultural, caring attitude of staff towards the patient;
full provision of patients with medications, equipmentswarm and household items.
Indications for surgery determine its urgency and can be vital, absolute and relative:
$ Vital indications for surgery – diseases or injuries in which the slightest delay threatens the patient’s life. Such operations are performed on an emergency basis, that is, after minimal examination and preparation of the patient (no more than 2–4 hours from the moment of admission). Vital indications for surgery arise in the following pathological conditions:
¾ Asphyxia;
¾ Continued bleeding: with damage to an internal organ (liver, spleen, kidney, fallopian tube during pregnancy, etc.), heart, large vessels, 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 due to 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 thoroughly prepare the patient, but a long delay in surgery can lead to a condition that threatens the patient’s life. These operations are performed urgently after a few hours or days (usually within 24–72 hours of the preoperative period. Long-term delay of surgery in such patients can lead to tumor metastases, general exhaustion, liver failure and other complications. These 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 patient’s life. These operations are performed as planned 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 assessing the severity of the patient’s condition, the upcoming operation and the patient’s response to anesthesia.
Surgery has to be postponed for some time in cases where it is more dangerous than the disease itself or there is a danger of postoperative complications. Most contraindications are temporary and relative.
Absolute contraindications to surgery:
¾ Terminal condition of the patient;
Relative contraindications to surgery (any concomitant disease):
¾ Cardiac, respiratory and vascular failure;
¾ Shock;
¾ Myocardial infarction;
¾ Stroke;
¾ Thromboembolic disease;
¾ Renal - liver failure;
¾ Severe metabolic disorders (decompensation of diabetes mellitus);
¾ Precomatose state; coma;
¾ Severe anemia;
¾ Severe anemia;
¾ Advanced forms of malignant tumors (stage IV), etc.
If there are vital and absolute indications, relative contraindications cannot prevent emergency or urgent surgery after appropriate preoperative preparation. It is advisable to carry out planned operations after appropriate preoperative preparation. It is advisable to carry out planned surgical interventions after eliminating all contraindications.
Factors that determine surgical risk include the patient’s age, the condition and function of the myocardium, liver, lungs, kidneys, pancreas, degree of obesity, etc.
The established diagnosis, indications and contraindications allow the surgeon to resolve issues of urgency and scope of surgical intervention, method of pain relief, and preoperative preparation of the patient.
Question 3: Preparing patients for planned operations.
Planned operations – when the outcome of treatment practically does not depend on the execution time. Before such interventions, the patient undergoes a full 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 a non-strangulated hernia, varicose veins, cholelithiasis, uncomplicated gastric ulcer, etc.
1.General activities: General measures include improving the patient’s condition by identifying and maximizing the elimination of dysfunctions 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 must treat preoperative preparation with full responsibility and understanding. She is directly involved in examining the patient and performing treatment and preventive measures. Basic and mandatory studies before any planned surgery:
J Measurement of blood pressure and pulse;
J Measuring body temperature;
J Measurement of respiratory rate;
J Measuring the height and weight of the patient;
J Carrying out clinical analysis of blood and urine; determination of blood sugar;
J Determination of blood group and Rh factor;
J Examination of stool for worm eggs;
J Statement of the Wasserman reaction (=RW);
J In elderly people - electrocardiographic study;
J According to indications - blood test for HIV; etc.
A) mental and physical preparation: creating an environment around the patient that instills confidence in the successful outcome of the operation. All medical personnel must eliminate as much as possible the moments that cause irritation and create conditions that provide complete rest for the nervous system and the patient. For the proper preparation of the patient’s psyche for surgery, it is of great importance that nursing staff 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 his underwear and bed linen. The moral state of patients admitted for surgery differs significantly from the condition of patients who undergo only conservative treatment, since surgery is a major physical and mental trauma. Just “waiting” for surgery instills fear and anxiety and seriously undermines the patient’s strength. Starting from the emergency department and ending with the operating room, the patient looks closely and listens to everything around him, is constantly in a state of tension, turns, as a rule, to junior and mid-level medical staff, looking for support from them.
Protecting the patient's nervous system and psyche from irritating and traumatic factors largely determines the course of the postoperative period.
Pain and sleep disturbances especially injure the nervous system, the fight against which (prescribing painkillers, sleeping pills, tranquilizers, sedatives and other drugs is very important during the preoperative preparation period.
For the proper preparation of the patient’s psyche for surgery, it is of great importance that nursing staff follow the following rules of surgical deontology:
¾ When a patient is admitted to the emergency department, it is necessary to provide him with the opportunity to calmly communicate with the relatives accompanying him;
¾ The diagnosis of the disease should be communicated to the patient only by the doctor, who decides in each individual case in what form and when he can do this;
¾ It is necessary to address the patient by his first name and patronymic or last name, but do not call him impersonally “sick”;
¾ Before surgery, the patient is especially sensitive to the look, gesture, mood, carelessly spoken word, and catches all the shades of the nurse’s intonation. Conversations should be especially careful during scheduled rounds 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 those around him and the teacher. It is very important that these words and gestures contain goodwill, sympathy, sincerity, tact, restraint, patience, and warmth. The indifferent attitude of the nurse, negotiations of the staff about personal, irrelevant things in the presence of the patient, inattention to requests and complaints give the patient a reason to doubt all further activities and put him on guard. The medical staff's conversations about the poor outcome of the operation, death, etc. have a negative effect. A nurse who carries out assignments or provides any assistance in the presence of patients in the ward must do this skillfully, calmly and confidently, so as not to cause anxiety and nervousness in them;
¾ The medical history and data from diagnostic studies should be stored so that they do not become accessible to the patient; the nurse must be the keeper of medical (medical) secrets in the broad 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 that are far from medicine;
¾ Medical staff must ensure that in the hospital environment surrounding the patient there are no factors that irritate and frighten him: excessive noise, intimidating medical posters, signs, syringes with traces of blood, bloody gauze, cotton wool, sheets, tissue, tissue, organ or parts thereof, etc.;
¾ The nurse must strictly monitor strict adherence to the hospital regime (afternoon rest, sleep, bedtime, etc.);
¾ Medical staff should pay special attention to their appearance, given that untidiness and sloppy appearance raises doubts in the patient about the accuracy and success of the operation;
¾ When talking with a patient before surgery, you should not present the operation to him as something easy, at the same time you should not frighten him with the risk and the possibility of an unfavorable outcome. It is necessary to mobilize the patient’s strength and faith in a favorable outcome of the intervention, eliminate fears associated with distorted ideas about upcoming pain during and after the operation, and report postoperative pain. When explaining, the nurse must adhere to the same interpretation given by the doctor, otherwise the patient ceases to believe the medical staff;
¾ The nurse must promptly and conscientiously carry out the doctor’s orders (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 caring for the patient 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 heightened. Therefore, caring 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 surgery is to be performed. That is, a number of studies are being carried out related to surgery on this organ. For example, during heart surgery, cardiac probing is performed, during lung surgery - bronchoscopy, during stomach surgery - analysis of gastric juice and fluoroscopy, fibrogastroscopy. The stomach contents are removed the morning before. In case of congestion in the stomach (pyloric stenosis), it is washed out. A cleansing enema is given at the same time. The patient's diet on the day before surgery: regular breakfast, light lunch, sweet tea for dinner.
Before surgery biliary tract it is necessary to examine the gallbladder, pancreas and bile ducts using special methods (ultrasound) and study laboratory indicators of the functions of these organs and the exchange of bile pigments.
At obstructive (mechanical) jaundice the flow of bile into the intestines stops, the absorption of fat-soluble substances, which includes vitamin K, is disrupted. Its deficiency leads to a deficiency of coagulation factors, which can cause severe bleeding. Therefore, before surgery, a patient with obstructive jaundice is given vitamin K ( vikasol 1% - 1 ml), calcium chloride solution, blood, its components and preparations are transfused.
Before surgery on the large intestine To prevent endogenous infection, it is very important to thoroughly cleanse the intestines, but at the same time, the patient, often exhausted and dehydrated by the underlying disease, should not starve. He receives a special diet containing high-calorie foods, devoid of toxins and gas-forming substances. Since an operation is expected to open the large intestine, to prevent infection, patients begin to take antibacterial drugs during the preparation period ( colymycin, polymyxin, chloramphenicol etc.). Fasting and the prescription of laxatives are resorted to only when indicated: constipation, flatulence, lack of normal stool. The evening before the operation and in the morning the patient is given a cleansing enema.
For surgery in the area rectum and anus(for hemorrhoids, anal fissures, paraproctitis, etc.) it is also necessary to thoroughly cleanse the intestines, since in the postoperative period the stool is artificially retained in the intestines for 4 - 7 days.
To survey departments colon resort to X-ray contrast (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 moved into the abdominal cavity, this is accompanied by an increase in intra-abdominal pressure, displacement and high standing of the diaphragm, which complicates cardiac activity and respiratory excursions of the lungs. To prevent complications in the postoperative period, the patient is placed on a bed with the leg end raised and, after the contents of the hernial sac are reduced, a constricting bandage or sand bag is applied to the area of the hernial orifice. The body is “accustomed” to the new conditions of a high position of the diaphragm, to an increased load on the heart.
Special training on a limb comes down to cleansing the skin of 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:
· Upon admission – examination;
· Carrying out a general blood test
· Biochemical blood test and, if possible, normalization of parameters
Measurement of heart rate and blood pressure
· ECG taking
Taking into account blood loss - procurement of blood and its preparations
· Instrumental and laboratory research methods (ultrasound of the heart).
¾ Preparation of the respiratory system:
·Smoking cessation
· Elimination of inflammatory diseases of the upper respiratory tract.
· Conducting breath tests
· Teaching the patient proper breathing and coughing, which is important for the prevention of pneumonia in the postoperative period
· Chest fluorography or radiography.
¾ Preparing the gastrointestinal tract
· Sanitation of the oral cavity
Gastric lavage
Suction of stomach contents
· Meals on the eve of surgery
¾ Preparation of the genitourinary system:
· Normalization of kidney function;
· Conduct kidney studies: urine tests, determination of residual nitrogen (creatinine, urea, etc.), ultrasound, urography, etc. If pathology is detected in the kidneys or bladder, appropriate therapy is carried out;
· For women, before surgery, a gynecological examination is required, and, if necessary, treatment. Planned operations are not performed during menstruation, as increased bleeding is observed on these days.
¾ Immunity and metabolic processes:
· Increasing the immunobiological resources of the patient’s body;
· Normalization of protein metabolism;
· Normalization of water-electrolyte and acid-base balance.
¾ Skin:
· Identification of skin diseases that can cause severe complications in the postoperative period, including 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, and changes his underwear;
· The surgical field is prepared immediately before the operation (1-2 hours), since over a longer period of time, cuts and scratches that may occur during shaving may become inflamed.
On the eve of surgery the patient is examined by an anesthesiologist, who determines the composition and timing of premedication; the latter is carried out, as a rule, 30–40 minutes before surgery, 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 operating gurney. 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 must check whether the bloody linen, dressings, and instruments from the previous operation have been removed.
The patient's medical history and x-rays are delivered at the same time as the patient.
