What Happens Before, After and during Surgery
This is an account of everything that happens, or you can do, during and around a surgical intervention and sometimes also when complicated examinations are performed.
When a child, an adolescent or an adult have surgery, a long list of preparations are performed. During the surgery the bodily processes of the patient is supported and monitored by the means already prepared prior to the surgery as such. Following the surgery the supporting measures are disconnected in a specific sequence.
All of the measures are essentially the same for children and adults, but the psychological preparations will differ for different age groups and the supporting measures will sometimes be more numerous for children.
The following is really a nearly complete report on all measures undertaken by surgery and their typical sequence. All the measures are not necessarily present during every surgery and there are also cultural differences in the routines from institution to institution and at diverse geographical regions. Therefore everything won’t necessarily happen in a similar way at the place where you have surgery or simply work.
Chirurgie Greatest variation could very well be found in the choice between general anesthesia and only regional or local anesthesia, especially for children.
INITIAL PREPARATIONS
There will always be some initial preparations, which some often will take place in home before going to hospital.
For surgeries in the abdominal area the digestive system often must be totally empty and clean. That is achieved by instructing the individual to stop eating and only continue drinking a minumum of one day before surgery. The patient may also be instructed to take in some laxative solution that may loosen all stomach content and stimulate the intestines to expel this content effectively during toilet visits.
All patients will be instructed to avoid eating and drinking some hours before surgery, also whenever a total stomach cleanse is not necessary, to avoid content in the stomach ventricle that can be regurgitated and cause breathing problems.
When the patient arrives in hospital a nurse will receive him and he’ll be instructed to shift to some sort of hospital dressing, which will typically be considered a gown and underpants, or a sort of pajama.
If the intestines must be totally clean, the individual will most likely also get an enema in hospital. This can be given as one or more fillings of the colon through the anal opening with expulsion at the bathroom ., or it could be distributed by repeated flushes through a tube with the patient in laying position.
Then the nurse will need measures of vitals like temperature, blood pressure and pulse rate. Especially children will often get yourself a plaster with numbing medication at sites where intravenous lines will be inserted at a later stage.
Then the patient and in addition his family members will have a talk to the anesthetist that explains particularities of the coming procedure and performs a further examination to make sure that the individual is fit for surgery, like hearing the center and lungs, palpating the abdominal area, examining the throat and nose and asking about actual symptoms. The anesthetist may also ask the patient if he has certain wishes concerning the anesthesia and pain control.
The individual or his parents may also be asked to sign a consent for anesthesia and surgery. The legal requirements for explicit consent vary however between different societies. In some societies consent is assumed if objections aren’t stated at the initiative of the individual or the parents.
Technically most surgeries, except surgeries in the breast and a few others can be performed with the patient awake and only with regional or local anesthesia. Many hospitals have however a policy of using general anesthesia for some surgeries on adults and all surgeries on children. Some could have an over-all policy of local anesthesia for several surgeries to keep down cost. Some will ask the individual which kind of anesthesia he prefers and some will switch to another kind of anesthesia than that of the policy if the patient demands it.
When the anesthetist have signaled green light for the surgery to occur, the nurse gives the individual a premedication, typically a type of benzodiazepine like midazolam (versed). The premedication is usually administered as a fluid to drink. Children will sometimes get it as drops in the nose or as an injection through the anus.
The objective of this medication would be to make the patient calm and drowsy, to eliminate worries, to ease pain and hinder the patient from memorizing the preparations that follow. The repression of memory sometimes appears as the main aspect by many medical professionals, but this repression will never be totally effective so that blurred or confused memories can remain.
The patient, and especially children, will most likely get funny feelings by this premedication and can often say and do strange and funny things before he is so drowsy he calms totally down. Then the patient is wheeled right into a preparatory room where in fact the induction of anesthesia takes place, or directly into the operation room.
MEASURES PERFORMED RIGHT BEFORE ANESTHESIA
Before anesthesia is initiated the patient will undoubtedly be linked to several devices that may stay during surgery plus some time after.
The patient will receive a sensor at a finger tip or at a toe connected to a unit that will monitor the oxygen saturation in the blood (pulse oximeter) and a cuff around an arm or a leg to measure blood circulation pressure. He will also get yourself a syringe or a tube called intravenous line (IV) right into a blood vessel, typically a vein in the arm. A number of electrodes with wires may also be placed at the chest or the shoulders to monitor his heart activity.
Before proceeding the anesthetist will once more check all of the vitals of the patient to ensure that all parts of the body work in a manner that allows the surgery to take place or to detect abnormalities that require special measures during surgery.
Before the definite anesthesia the anesthetist may gives the patient a new dose of sedative medication, often propofol, through the IV line. This dose gives further relaxation, depresses memory, and often makes the individual totally unconscious already at this stage.
INDUCTION OF GENERAL ANESTHESIA
The anesthetist will start the general anesthesia giving gas blended with oxygen by way of a mask. It can alternatively be started with further medication through the intravenous syringe or through drippings in to the rectum and then continued with gas.
After the patient is dormant, we shall always get gas blended with a high concentration of oxygen for a few while to ensure an excellent oxygen saturation in the blood.
By many surgeries the staff wants the individual to be totally paralyzed so that he does not move any body parts. Then the anesthetist or a helper gives a dose of medication through the IV line that paralyzes all muscles within the body, including the respiration, except the center.
Then your anesthetist will start the mouth of the individual and insert a laryngeal tube through his mouth and past the vocal cords. There is a cuff round the end of the laryngeal tube that’s inflated to help keep it set up. The anesthetist will aid the insertion with a laryngoscope, an instrument with a probe that is inserted down the trout that allows him to look into the airways and also guides the laryngeal tube during insertion.
