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, a teenager 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 specific sequence.
All 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 be more numerous for children.
The following is a nearly complete report on all measures undertaken by surgery and their typical sequence. All the measures aren’t 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 exactly the same way at the place where you have surgery or perhaps work.
Greatest variation is perhaps to be found in the choice between general anesthesia and only regional or local anesthesia, specifically 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 stomach area the digestive tract often must be totally empty and clean. This is achieved by instructing the individual to avoid eating and only continue drinking a minumum of one day before surgery. The patient may also be instructed to take some laxative solution that may 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 when a total stomach cleanse isn’t necessary, in order to avoid content in the stomach ventricle which can be regurgitated and cause breathing problems.
Once the patient arrives in hospital a nurse will receive him and he will be instructed to shift to some kind of hospital dressing, that may typically be considered a gown and underpants, or a sort of pajama.
If the intestines have to be totally clean, the individual will often also get an enema in hospital. Chirurg This can be given as one or even more fillings of the colon through the anal opening with expulsion at the toilet, or it really is distributed 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 circulation pressure and pulse rate. Especially children will often get 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 make certain the patient is fit for surgery, like listening to the center and lungs, palpating the abdominal area, examining the throat and nose and asking about actual symptoms. The anesthetist could also ask the patient if he has certain wishes concerning the anesthesia and pain control.
The individual 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 patient 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 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 several surgeries to keep down cost. Some will ask the individual which kind of anesthesia he prefers plus some will switch to another sort of anesthesia than that of the policy if the patient demands it.
Once the anesthetist have signaled green light for the surgery to take place, the nurse gives the individual a premedication, typically a kind 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 would be to make the individual calm and drowsy, to eliminate worries, to alleviate pain and hinder the patient from memorizing the preparations that follow. The repression of memory sometimes appears as the most crucial aspect by many medical professionals, 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 will often say and do strange and funny things before he could be so drowsy that he calms totally down. Then your patient is wheeled into a preparatory room where in fact the induction of anesthesia takes place, or right into the operation room.
MEASURES PERFORMED BEFORE ANESTHESIA
Before anesthesia is set up the patient will undoubtedly 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 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 a syringe or perhaps a tube called intravenous line (IV) into a blood vessel, typically a vein in the arm. Several 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 patient to ensure all areas of the body work in a way that allows the surgery to take place or even to detect abnormalities that require special measures during surgery.
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 begins the general anesthesia by 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.
Once the patient is dormant, we shall always get gas blended with a higher concentration of oxygen for some 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 perhaps a helper will give a dose of medication through the IV line that paralyzes all muscles in your body, including the respiration, except the heart.
Then the anesthetist will start the mouth of the patient and insert a laryngeal tube through his mouth and at night 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, a musical instrument with a probe that is inserted down the trout that allows him to look down into the airways and in addition guides the laryngeal tube during insertion.