This is an account of precisely what happens, or you can do, during and around a surgical intervention and sometimes also when complicated examinations are performed.
Chirurgie When a child, a teenager or a grown-up 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 before the surgery as such. After the surgery the supporting measures are disconnected in a specific sequence.
All the measures are basically the same for children and adults, but the psychological preparations will differ for different age ranges and the supporting measures will sometimes be more numerous for children.
The following is really a nearly complete listing of all measures undertaken by surgery and their typical sequence. Each of the measures aren’t 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 a similar way at the place where you have surgery or simply 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 system often must be totally empty and clean. That is achieved by instructing the patient to avoid eating and only continue drinking at least one day before surgery. The individual will also be instructed to take some laxative solution that will loosen all stomach content and stimulate the intestines to expel the content effectively during toilet visits.
All patients will be instructed to stop eating and drinking some hours before surgery, also when a total stomach cleanse isn’t necessary, to avoid content in the stomach ventricle that can be regurgitated and cause difficulty in breathing.
When the patient arrives in hospital a nurse will receive him and he will be instructed to shift to some sort of hospital dressing, that may typically be a gown and underpants, or a sort of pajama.
If the intestines need to be totally clean, the individual will often also get an enema in hospital. This can be given as one or more fillings of the colon through the rectal opening with expulsion at the toilet, or it might 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 circulation pressure and pulse rate. Especially children will often get yourself a plaster with numbing medication at sites where intravenous lines will undoubtedly be inserted at a later stage.
Then the patient and also his family members will have a talk with the anesthetist that explains particularities of the coming procedure and performs a further examination to ensure that the individual is fit for surgery, like listening to the center 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’s got 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 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 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 most surgeries on adults and all surgeries on children. Some could have a general policy of local anesthesia for several surgeries to keep down cost. Some will ask the patient which kind of anesthesia he prefers and some will switch to some other kind of anesthesia than that of the policy if the individual demands it.
When the anesthetist have signaled green light for the surgery to take place, the nurse gives the patient 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 purpose of this medication is to make the individual calm and drowsy, to take away worries, to alleviate pain and hinder the patient from memorizing the preparations that follow. The repression of memory is seen as the most important aspect by many doctors, but this repression will never be totally effective so that blurred or confused memories can remain.
The individual, and especially children, will most likely get funny feelings by this premedication and can often say and do strange and funny things before he could be so drowsy he calms totally down. Then the patient is wheeled 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 receive a sensor at a finger tip or at a toe connected to a unit that may monitor the oxygen saturation in the blood (pulse oximeter) and a cuff around an arm or perhaps a leg to measure blood pressure. He will also get yourself a syringe or perhaps 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 patient to ensure all parts 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 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 will start the general anesthesia giving gas blended with oxygen through a mask. It can as an alternative be started with further medication through the intravenous syringe or through drippings into the rectum and continued with gas.
After the patient is dormant, we will always get gas blended with a high concentration of oxygen for a few 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 areas of the body. Then the anesthetist or a helper will give a dose of medication through the IV line that paralyzes all muscles within the body, including the respiration, except the center.
Then the anesthetist will start the mouth of the patient and insert a laryngeal tube through his mouth and past the vocal cords. There is a cuff around the end of the laryngeal tube that is 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.
