What Happens Before, After and during 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, a long list of 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 essentially the same for children and adults, however 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 report on 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 will not necessarily happen in exactly the same way at the place where you have surgery or simply work.

Greatest variation is perhaps 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, of which some often will need place in home prior to going to hospital.

For surgeries in the stomach area the digestive tract often has to be totally empty and clean. That is achieved by instructing the individual to stop eating and only continue drinking at least one day before surgery. The patient may also be instructed to take 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 stop eating and drinking some hours before surgery, also when a total stomach cleanse isn’t necessary, in order to avoid content in the stomach ventricle which can be regurgitated and cause difficulty in breathing.

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

If the intestines need to be totally clean, the patient 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 toilet, or it can be given by repeated flushes by way of 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 most likely get yourself a plaster with numbing medication at sites where intravenous lines will be inserted at a later stage.

Then the patient and also his family members will have a talk to the anesthetist that explains particularities of the coming procedure and performs an additional examination to ensure the individual is fit for surgery, like listening to the heart and lungs, palpating the stomach area, examining the throat and nose and asking about actual symptoms. The anesthetist may also ask the individual if he has certain wishes concerning the anesthesia and pain control.

The patient 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 a few 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 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 may 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 plus some will switch to some other sort 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 will give the patient a premedication, typically a kind of benzodiazepine like midazolam (versed). The premedication is usually administered as a fluid to drink. Children will sometimes obtain it as drops in the nose or as an injection through the anus.

Chirurgie The objective of this medication would be to make the patient calm and drowsy, to take away worries, to alleviate pain and hinder the individual from memorizing the preparations that follow. The repression of memory is seen as the most crucial aspect by many medical professionals, but this repression will never be totally effective in order 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 your patient is wheeled right into a preparatory room where in fact the induction of anesthesia occurs, or right into the operation room.

MEASURES PERFORMED BEFORE ANESTHESIA

Before anesthesia is initiated the patient will be connected to several devices that may stay during surgery plus some time after.

The patient will get a sensor at a finger tip or at a toe linked to a unit which 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 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 more check all of the vitals of the individual to make certain all parts of the body work in a way 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 frequently makes the individual totally unconscious already at this time.

INDUCTION OF GENERAL ANESTHESIA

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

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

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

Then the anesthetist will open up the mouth of the individual and insert a laryngeal tube through his mouth and past the vocal cords. There exists a cuff around 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.