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Is it possible to brush your teeth before anesthesia? How to properly prepare for elective surgery

Particular attention should be paid to preparing patients for anesthesia. It begins with personal contact between the anesthesiologist and the patient. First, the anesthesiologist needs to familiarize himself with the medical history and clarify the indications for the operation, and he must find out all the questions that interest him personally.

During planned operations, the anesthesiologist begins examining and getting to know the patient at least one day before the operation. In emergency cases, the examination is carried out immediately before the operation.

The anesthesiologist must know occupation the patient, whether his work activity is associated with hazardous production (nuclear energy, chemical industry, etc.). Of great importance anamnesis of life patient: concomitant and past diseases (diabetes mellitus, coronary heart disease (CHD) and previous myocardial infarction, arterial hypertension), regularly taken medications (glucocorticoid hormones, insulin, antihypertensive drugs). A special allergy history should be collected.

The doctor providing anesthesia must be aware of the condition of the patient's cardiovascular system, lungs, liver and kidneys. Mandatory methods of examining the patient before surgery include: a general blood and urine test, a biochemical blood test, and a study of the blood coagulation system (coagulogram). It is mandatory to determine the blood type and Rh factor, and perform electrocardiography. In the preoperative period during planned operations, it is necessary, if possible, to correct existing disturbances in the homeostasis of the patient’s body. In emergency cases, preparation is carried out to a reduced but necessary extent.

After assessing the patient’s condition, the anesthesiologist determines the degree of risk of general anesthesia and selects the most adequate method of the latter.

A person who is about to undergo an operation is naturally worried, so a sympathetic attitude towards him and an explanation of the need for the operation are necessary. Such a conversation can be more effective than the effects of sedatives. The state of anxiety in a patient before surgery is accompanied by the production of adrenaline by the adrenal medulla and its release into the blood and, consequently, an increase in metabolism, which complicates general anesthesia and increases the risk of developing heart rhythm disturbances. Therefore, before surgery in a hospital setting, all patients are prescribed premedication. It is carried out taking into account the psycho-emotional state of the patient, his age, constitution and life history, reaction to the disease and the upcoming operation, features of the surgical technique and its duration.

Premedication for planned surgery sometimes begins several days before surgery with oral tranquilizers. In case of emergency surgery, it is advisable to administer premedication directly on the operating table under the supervision of an anesthesiologist.

On the day of surgery, the patient should not eat. Before surgery, you should empty your stomach, intestines, and bladder. In emergency cases, this is done using a gastric tube or urinary catheter. If the patient has dentures, they should be removed from the mouth.

To prevent aspiration of gastric contents, an antacid substance can be administered once before anesthesia. To reduce the volume of gastric secretion and acidity, instead of antacids, you can use a blocker of H2-histamine receptors of the stomach (cimetidine, ranitidine) or hydrogen pump (omeprazole, omez and etc.).

Immediately before the operation it is prescribed direct premedication, pursuing goals:

Sedation and amnesia- effective premedication suppresses the increase in cortisone in the blood during stress. Most versatile morphine and its derivatives, benzodiazepines (diazepam, tazepam and etc.). Neuroleptics (droperidol) prescribed as antiemetics (0.3–0.5 ml of 0.25% solution).

Analgesia- is especially important in the case of pain existing before surgery. Narcotic analgesics are used. In the last decade, before the start of anesthesia, non-narcotic analgesics from the group of NSAIDs (non-steroidal anti-inflammatory drugs) have been included in premedication, which prevents the formation of severe postoperative pain syndrome.

Inhibition of the parasympathetic nervous system- prevention of vagal cardiac arrest. It is achieved by using atropine. For patients suffering from glaucoma, atropine is replaced metacin.

Antihistamines can be included in premedication according to indications. (diphenhydramine, suprastin), especially in patients with a history of allergic reactions. The drugs are usually administered intramuscularly 30–60 minutes before the start of general anesthesia.

Currently, premedication should include drugs to eliminate fear and anxiety (tranquilizers with a predominant anti-anxiety (anxiolytic) effect). In this regard, the most effective are alprozolam, phenazepam, midazolam, and atarax. Other means for these purposes are used according to indications. The use of narcotic analgesics, antihistamines, and neuroleptics in premedication slows down awakening and is irrational for constant use. In outpatient anesthesiology, “heavy” premedication is not used. All patients who have received premedication are taken to the operating room on a gurney, accompanied by medical staff (nurses).

Inhalation anesthesia

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

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

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

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

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

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

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

Preparing for surgery

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

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

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

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

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

Fear of surgery under anesthesia

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

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

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

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

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

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

Psychological attitude

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

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

Physical training

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In addition to outpatient emergency operations, most operations are performed only after special preparation of patients. The time during which the patient remains in the department awaiting surgery is called the preoperative period, the time after the operation is called the postoperative period.

Examination of internal organs before surgery. To obtain the best results and for greater safety of surgery, the general condition of the patient before surgery should be taken into account very carefully. Therefore, his heart, lungs, kidneys and other organs are examined in detail.

A comprehensive familiarization with the condition of the internal organs is necessary to resolve the issue of the possibility of general anesthesia in order to avoid severe complications and sometimes death when using anesthesia for pulmonary, cardiac and other seriously ill patients. In addition, we must not forget that surgery often exacerbates the patient’s existing diseases. Therefore, if such diseases are detected in a patient, surgery is postponed, if possible. Sometimes you have to abandon the operation altogether, as it can do more harm than good. The exception is emergency cases, such as strangulated hernia, intestinal obstruction, and injuries to internal organs. In these cases, surgery has to be used even if the internal organs are in poor condition, since it is often the only hope for saving the patient’s life.

A preliminary examination of the patient consists primarily of examining the condition of his heart and lungs. For this, in addition to special studies (listening, tapping, measuring blood pressure, x-ray examination), it is important to monitor the patient, find out whether he has shortness of breath, cyanosis, cough, or whether there have been any changes in the pulse. Nursing staff should immediately inform the doctor about any changes noticed. This is especially important because the patient is under long-term supervision of nursing staff, and changes in the patient’s condition can occur after examination by a doctor. These changes may force you to change both the method of pain relief and the method of surgery, or cancel it altogether. If the lungs have not been sufficiently examined and the patient undergoes surgery, and especially anesthesia, in the presence of catarrh of the respiratory tract, then the postoperative course is often complicated by bronchitis and pneumonia; in the presence of severe heart disease, surgery and anesthesia can often lead to a subsequent drop in cardiac activity.

Preliminary (2 times a day) temperature measurement for several days before surgery is very important. Temperature is a good indicator of the body's condition, and if it rises, it is better to postpone surgery. Of course, this does not apply to those cases when the elevated temperature depends on the disease for which the patient is undergoing surgery, for example, with an abscess, phlegmon, acute appendicitis.

When preparing women for surgery, it is necessary to find out whether the operation and the first postoperative days coincide with the menstrual period. In the first days of menstruation, complications are more often observed due to a decrease in the body's resistance and, in addition, postoperative care and maintaining cleanliness are more difficult. In some cases, under the influence of excitement, women's menstruation does not appear on time, and this must be inquired about in advance.

Every patient undergoing surgery must have their urine examined, and the most important from a surgical point of view is the detection of protein, formed elements (casts, red and white blood cells) and sugar in the urine. The presence of signs of kidney inflammation usually causes the surgeon to refrain from surgery or use safer local anesthesia. The determination of sugar in urine is very important, since in case of diabetes mellitus (diabetes), postoperative wounds heal very poorly: such a patient is very prone to infection, while the purulent process often proceeds unfavorably, giving local gangrenization of tissues, the spread of infection and often general purulent infection. Therefore, in relation to patients with diabetes, one must be especially careful with surgical intervention.

Before the operation, it is very important to know the condition of the patient’s blood, both in relation to red (degree of anemia) and white blood (presence of leukocytosis), and especially in relation to its coagulability.

Preparing the patient's psyche. The neuropsychic state of the patient is of great importance for the outcome of the operation and for the course of the postoperative period.

The works of I.P. Pavlov showed the enormous importance of the central nervous system during pathological processes. His students further deepened our understanding of the role of the nervous system in pathological processes. One influence on the psyche can sometimes cause the development of a disease or, conversely, contribute to its more favorable course. Incorrect behavior of staff towards a patient, first of all informing him of the presence of a serious illness, especially in cases where it is only suspected, can cause enormous harm to the patient, causing him loss of appetite, weight loss, general weakening, pain, etc. .and even a picture of the disease, similar to the suspected disease. If a patient has a serious illness, especially such as cancer, you cannot tell him about it.

A depressed psyche makes it very difficult to manage the postoperative period, reduces the patient’s overall resistance and contributes to the emergence of a number of complications. Often patients have either a too frivolous attitude towards the operation or a panicky fear of it. This fear, among other reasons, can be caused by the fact that any operation, even a small one, cannot be considered safe, since sometimes complications arise that are sometimes completely impossible to prevent. In addition, the presence of seriously ill patients in the department, especially their death, causes fear for their health and life among those awaiting surgery. It is desirable that the patient does not have to wait long for surgery; in any case, he should not look at other operations or observe preparations for his own. Before surgery, patients usually ask many questions about possible complications and what will be done and how. It would be wrong to completely avoid answering these questions. It is best to delicately reject the patient’s questions and send him for an explanation to the attending physician, especially bearing in mind that the patient will still ask the doctor, and the discrepancy in the answers of the doctor and the nurse may be misunderstood by the patient and have a serious impact on his well-being. Statements about the insignificance and complete safety of the operation may lead to the patient no longer trusting the medical staff. A calm and even attitude has the best effect on the patient; it instills in him the consciousness of the need for surgery. Caring for the patient’s psyche, especially in the preoperative period, during surgery and the postoperative period, is an extremely important factor that can influence the course of the disease and significantly alleviate the severe subjective sensations associated with the operation (excitement before the operation, pain during the operation itself and after it, general malaise, nausea, vomiting, etc.).

The enormous importance of the patient’s psyche for the course of diseases led to the development of the doctrine of deontology, that is, the duty of a medical worker in relation to the patient. Our scientists, in particular N.N. Petrov, developed in detail the rules of behavior of medical personnel in relation to the patient.

The experience of the Makarov Hospital, which developed and practically applied the teachings of I.P. Pavlov in its work, became widely known. At the Makarovskaya hospital, a “protective regime” was created for patients. Through a series of measures, they were provided with maximum peace, good sleep, painless treatment procedures, careful, caring care and protection of their psyche from any traumatic moments.

An important circumstance is the patient’s adaptation to the hospital environment, which is often completely alien to him, and to the hospital regime. In particular, for some operations that subsequently require lying down, it is advisable to teach patients to urinate and defecate in a bedpan, since after surgery it is sometimes difficult for the patient to get used to this due to pain in the wound area. In order for the patient to get used to the general hospital regime, it is advisable to place him in the hospital 2-3 days before the operation.

Measures to improve the functioning of the cardiovascular system and respiratory organs. When cardiac activity is weakened, measures are often taken in the preoperative period to improve it: camphor, strychnine and other cardiac drugs are administered.

To increase the strength of very exhausted patients, especially those who have been starving for a long time, and if they have malignant tumors (cachexia), they resort to preliminary administration of glucose solutions (grape sugar) in enemas, under the skin or vein. To do this, the patient is administered 500 ml of a 5% glucose solution in drip enemas or 20 ml of a 40% glucose solution into a vein over a period of 2-3 days. Along with glucose, for better absorption, insulin is often injected under the patient’s skin at the rate of 1 unit per 1 g of sugar, but not more than 15-20 units. In very dehydrated and anemic patients (prolonged vomiting, narrowing of the esophagus and pyloric region), it is advisable, in addition to glucose, to administer a subcutaneous saline solution to replenish the lack of fluid in the body.

Before very difficult operations or especially weakened patients, preliminary blood transfusion is often used.

Chronic bronchitis and some other lung diseases are subject to preliminary treatment. It is necessary to find out the presence of such chronic diseases as syphilis, tuberculosis, malaria, diabetes, and take measures to treat them.

Slow coagulation during bleeding (hemophilia) and liver disease in icteric patients often forces the surgeon to postpone the operation, or even abandon it altogether. To increase blood clotting before surgery, solutions of calcium chloride are injected into the patient's vein for several days, or normal horse serum (10-20 ml) or 5 ml of 0.3% Vikasol is injected into the muscle, or blood is transfused and only after that the operation is performed. In some cases, prophylactic injections of penicillin are prescribed 2-3 days before surgery.

Preparing for surgery for a patient in a state of shock is especially difficult. It consists of measures to bring the patient out of shock.

Preparing the stomach and intestines. One of the important aspects of preparing patients for surgery is bowel cleansing. Failure to pay attention to this issue causes a number of serious problems. Vomiting during anesthesia with a stomach filled with food masses can cause them to enter the windpipe and suffocate the patient. When the intestines are full, the patient may have involuntary bowel movements on the operating table. In the postoperative period, there is often a tendency to retain stool (constipation), and a large amount of gases can accumulate in the intestines. Filled and swollen intestinal loops are difficult to reduce into the abdominal cavity during surgery. Fullness of the stomach and intestines is especially unfavorable during gastric and intestinal operations, when the contents complicate the operation and create a risk of infection. The other extreme - a strict diet, fasting for several days before surgery and prescribing laxatives that cleanse the intestines - leads to weakening of the patient, significantly aggravating the postoperative condition. Surgeons therefore avoid prescribing laxatives before surgery and limit themselves to a regular cleansing enema.

On the eve of the operation, the patient is given lighter food. A full stomach, especially during operations on it and when it is difficult to empty it normally, is freed by washing it before surgery.

Only during operations on the large intestines (especially on the rectum) should the patient’s preparation be different: a laxative is prescribed 1-2 days before the operation and then enemas. If the operation is not performed on the abdominal organs and under local anesthesia, then special measures to cleanse the intestines need not be taken and the patient can eat regular food both the day before and on the day of the operation. During operations in the pharynx and larynx, gagging is possible when the pharynx is irritated during anesthesia, and therefore the stomach must be free of food.

However, in most emergency surgical operations, time cannot be spent on cleansing the patient's stomach and intestines; in addition, the cleansing of the stomach and intestines itself is associated with danger to the patient’s life, for example, in case of gastrointestinal bleeding, rupture of a stomach ulcer, acute appendicitis, strangulated hernia. Here the picture of the disease is usually so formidable that possible complications, depending on the unpreparedness of the intestines, fade into the background.

Hygienic bath. Compliance with the general rules of cleanliness of the patient’s body is achieved by prescribing a general hygienic bath upon admission of the patient and repeating it, as a rule, on the eve of the operation.

When a patient takes a bath, do not allow him to cool down.

Bathing is prohibited for wounded and sick people with open purulent processes, for example with open abscesses. During a general cleansing bath in such patients, dirt from the skin may get into the wound along with water.

In some cases, if it is necessary to give the wounded a bath, a bandage to protect from getting wet is covered with oilcloth on top, bandaging it tightly, or an ointment bandage is applied, strengthening it with cleol. If the wound or purulent process is located on a limb, then for those who are not seriously ill, a bath or partial washing can be given so that the bandage on the limb remains dry. The bath should not be prescribed to seriously ill patients, as well as to patients with inflammation of the peritoneum, pleurisy, or acute appendicitis. Baths are even more risky and not recommended at all for patients with external and internal bleeding. Finally, they usually do not take a bath in emergency cases that require the fastest possible assistance, for example, when it is necessary to perform an operation to open the windpipe (tracheotomy) due to the fact that the patient is suffocating from acute swelling of the larynx. After a bath on the eve of surgery, the patient needs to change his underwear.

Oral care. You need to be very careful about caring for the patient’s oral cavity. Carious teeth are desirable, and in some operations even absolutely necessary, to be removed. You need to brush your teeth and rinse your mouth. The presence of virulent bacteria in the oral cavity can cause lung disease in the postoperative period, for example, when saliva enters the respiratory tract during anesthesia, as well as disease of the salivary glands (the ear infection is one of the severe postoperative complications).

Preparation of the surgical field. Particular attention is paid to preparing the part of the body where the operation will be performed (surgical field). First of all, you need to inspect the surgical field. Often the operation must be canceled due to skin diseases at the site of the proposed operation or in areas adjacent to it, due to the presence of scratching, rashes, especially pustules, due to the appearance of boils or abscesses.

The nursing staff must inform the doctor about all noticed diseases. For operations that do not require urgent intervention, measures are first taken to eliminate the detected diseases and purulent processes, and then the operation begins; Emergency operations are not canceled even in the presence of skin diseases. If the operation is to be performed on a limb, then if it is heavily soiled, warm baths are given for several days before the operation.

The skin in the surgical area is shaved on the morning of the surgery. During operations on the skull, the hair on the entire head is shaved, and only on smaller ones - on half or on a nearby part; during operations in the area of the mouth, cheeks and chin, the mustache and beard are shaved off, during operations near the axillary region - hair in the armpits, during operations on the abdomen - in the pubic area, during perineal and vaginal operations - in the entire perineal and pubic area.

If shaving causes severe pain in the area of the operation (with an abscess, etc.), then in these cases it is necessary to shave after the patient has been euthanized before the operation itself. The ability to shave is the responsibility of the nursing staff. The shaving area is soaped if you shave 1-1% of the hour before the operation, and moistened with alcohol if you shave before the operation itself. Before a clean operation, you should not use a razor that was used for shaving patients with open purulent processes. The razor must be sharp and must be adjusted on the belt before shaving and several times during shaving. If there are small cuts, they should be lubricated with iodine tincture.

Further processing of the surgical field is carried out just before the operation in the preoperative or operating room. The leather is disinfected and tanned by twice lubricating it with 5-10% tincture of iodine. This method was used by N.I. Pirogov, but was developed and known as the Filonchikov-Grossikh method. In some hospitals, before applying iodine, the skin is degreased by washing it with gasoline. Instead of iodine tincture, a number of other solutions are used when treating the surgical field - iodine-gasoline, 5% alcohol-tannin, 1% solution of malachite green in alcohol. The last two remedies are used mainly for operations on those areas where iodine can cause burns (face, neck, scrotum, anus). To prepare the mucous membrane, for example the mouth, for surgery, pre-rinse with weakly disinfecting solutions (hydrogen peroxide, potassium permanganate, boric acid). To prepare the bladder mucosa in the presence of inflammatory phenomena, they resort to rinsing the bladder with disinfectant solutions (rivanol, silver nitrate solution). The rectal mucosa can be prepared with non-irritating disinfectant enemas.

What needs to be done before sending the patient to the operating room. First of all, it is necessary for the patient to urinate. This is especially important during gynecological operations, as well as those accompanied by incisions of the abdominal wall along the midline in the lower abdomen, when a filled bladder can easily be injured.

The patient is taken to the operating room when everything is already prepared for the operation and the surgeon and his assistants have already washed their hands.

In most hospitals, 20-30 minutes before surgery, an adult patient is injected under the skin with 1 ml of a 1% morphine solution, then the patient tolerates local anesthesia and anesthesia better.

For local anesthesia, a double dose of morphine is sometimes used one and a half hours and 30 minutes before surgery. During surgery under anesthesia, morphine should be administered no later than 20 minutes before the start of anesthesia.

It is best to transport a patient who has received a morphine injection to the operating room on a gurney.

Preparing for emergency surgery. Preparing for emergency surgery differs significantly from the above.

After a general examination of the patient and clarification of the condition of his heart and lungs, administration of cardiac drugs and drugs, if necessary, the patient undergoes sanitary treatment, consisting only of removing clothes, washing or wiping especially contaminated areas of the body.

The inability to prepare the intestines for surgery forces, if the stomach is full, to insert a tube and rinse the stomach.

The surgical field is treated by washing the skin with gasoline or alcohol and shaving.

The preparation of the surgical field for injury has some special features. The skin around the wound is washed from dirt and blood with the same solutions. After removing the bandage and covering the wound with a thick layer of sterile gauze, first remove the hair with a machine or scissors, then shave it off without soaping, moistening the skin with alcohol or hydrogen peroxide. It is necessary to ensure that the shaved hair does not fall into the wound.

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

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

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

Before general anesthesia: preparation

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

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

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

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

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

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

After general anesthesia

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

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