What Happens Before, During and After Surgery

This can be 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, more information on preparations are performed. Through 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 particular sequence.

All of the measures are fundamentally the same for children and adults, but the psychological preparations will differ for different age ranges and the supporting measures will sometimes become more numerous for children.

The following is a nearly complete listing of all measures undertaken by surgery and their typical sequence. All of the measures are not necessarily present during every surgery and there’s also cultural differences in the routines from institution to institution and at diverse geographical regions. Therefore everything won’t necessarily happen in exactly the same way at the place where you have surgery or perhaps work.

Greatest variation could very well be to be found in the choice between general anesthesia and only regional or local anesthesia, specifically for children.

INITIAL PREPARATIONS

There will be some initial preparations, which some often will take place in home prior to going to hospital.

For surgeries in the stomach area the digestive tract often must be totally empty and clean. That is achieved by instructing the patient to avoid eating and only keep on drinking a minumum of one day before surgery. The patient may also be instructed to take in some laxative solution that will loosen all stomach content and stimulate the intestines to expel this content effectively during toilet visits.

All patients will undoubtedly 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 may be regurgitated and cause difficulty in breathing.

Once the patient arrives in hospital a nurse will receive him and he’ll be instructed to shift to some kind of hospital dressing, which will typically be a gown and underpants, or a sort of pajama.

If the intestines must be totally clean, the individual will often also get an enema in hospital. This is often given as one or even more fillings of the colon through the rectal opening with expulsion at the toilet, or it can be distributed by repeated flushes through a tube with the individual 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 could have a talk to the anesthetist that explains particularities of the coming procedure and performs a further examination to ensure the patient 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 could also ask the individual if he has certain wishes concerning the anesthesia and pain control.

The patient or his parents will often 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 some others can be carried out with the individual awake and only with regional or local anesthesia. Many hospitals have however an insurance plan of using general anesthesia for some surgeries on adults and all surgeries on children. Some could have a general policy of local anesthesia for certain surgeries to keep down cost. Some will ask the patient which kind of anesthesia he prefers and some will switch to another sort of anesthesia than that of the policy if the individual demands it.

When the anesthetist have signaled green light for the surgery to occur, the nurse will give 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 being an injection through the anus.

The objective of this medication is to make the individual calm and drowsy, to take away worries, to ease pain and hinder the individual from memorizing the preparations that follow. The repression of memory is seen as the main aspect by many doctors, but this repression won’t be totally effective in order that blurred or confused memories can remain.

The individual, and especially children, will often get funny feelings by this premedication and will often say and do strange and funny things before he is so drowsy he calms totally down. Then your patient is wheeled right into a preparatory room where in fact the induction of anesthesia occurs, or directly into the operation room.

MEASURES PERFORMED RIGHT BEFORE ANESTHESIA

Before anesthesia is set up the patient will be linked to several devices which will stay during surgery plus some time after.

The patient will receive a sensor at a finger tip or at a toe linked 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 pressure. He will also get a syringe or a tube called intravenous line (IV) 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 again check all of the vitals of the individual to make sure that all areas of the body work in a manner that allows the surgery to occur or to detect abnormalities that want special measures during surgery.

Right before the definite anesthesia the anesthetist may gives the patient a fresh dose of sedative medication, often propofol, through the IV line. This dose gives further relaxation, depresses memory, and frequently makes the patient totally unconscious already at this time.

INDUCTION OF GENERAL ANESTHESIA

The anesthetist will start the general anesthesia by giving gas blended with oxygen through a mask. It can as a substitute be started with further medication through the intravenous syringe or through drippings in to the rectum and continued with gas.

After the patient is dormant, we will always get gas blended with a high concentration of oxygen for some while to ensure a good oxygen saturation in the blood.

By many surgeries the staff wants the patient to be totally paralyzed so that he does not move any body parts. Then the anesthetist or perhaps a helper will give a dose of medication through the IV line that paralyzes all muscles in the body, including the respiration, except the heart.

Chirurgie Then your anesthetist will start the mouth of the patient and insert a laryngeal tube through his mouth and past the vocal cords. You will find a cuff around the end of the laryngeal tube that is inflated to keep it in place. The anesthetist will aid the insertion with a laryngoscope, a musical instrument with a probe that’s inserted down the trout that allows him to look down into the airways and also guides the laryngeal tube during insertion.