Preparing for Day of Surgery
Modern medicine defines its main goal to diagnose and prevent pathology rather than to treat it for a long time. But sometimes, due to the danger of the disease or due to untimely treatment of patients, it is necessary to perform surgical interventions.
There are various types of surgeries – from small outpatients, which do not require hospitalization, to major planned, urgent and emergency operations, for which both the surgeon and the patient should be well prepared.
In the case of outpatient operations (which do not require hospitalization and are carried out in the clinic), these stages are shortened. The patient is just advised to eat the right food and also receives premedication. But in a full-fledged operation, everything is much more complicated.
Preparation for an operation is no less important stage than the surgery itself. And it is aimed at reducing complications and consists of the following stages:
- Diagnostic – aims to determine the exact diagnosis. The doctor prescribes all the necessary examinations, which are called the “necessary minimum” – blood tests, coagulation time, group and Rh factor, general urine analysis, examination of the chest organs, ECG (electrocardiogram), an examination by the therapist and dentist;
- Definition of indications and contraindications. Any operation has absolute indications (these are the parameters that oblige the surgeon to carry out the intervention, otherwise the delay can badly affect the patient’s health, they are also called vital) and relative (they can potentially lead to complications, the surgeon decides on the type and timing of operations). Contraindications are based on examination data and can exclude or delay the intervention – for example, no surgeon will undertake to operate if the patient has an infectious disease or even a bad tooth – the infection can spread to the surgical area and interfere with the successful outcome of the operation;
- The preparatory phase includes three more states: psychological preparation (the surgeon talks to the patient, explains to him or her what will happen in the operating room, calms the patient and ensures a trusting relationship). At this stage, the patient’s consent to the operation is necessary – he or she signs the paper, which is included in the preoperative epicrisis. The doctor performs somatic (body preparation – the patient’s condition is stabilized, concomitant diseases are treated, infusions are prescribed if necessary) and special preparation (important manipulations that are characteristic only for specific operations are often skipped).
Direct preparation is carried out in the evening before and on the day of surgery, and includes:
- Hygienic procedures – the patient must be thoroughly washed and shaved (the area of the surgery);
- Bowel cleansing – on the day of the operation, a cleansing enema is done and the bladder is emptied.
- Premedication – the introduction of pharmacological agents that facilitate the operation (atropine to reduce peristalsis and secretions of the internal mucosa, diphenhydramine for antihistamines and mild sedative effects, other sedatives, hypnotics, and painkillers).
- A preoperative epicrisis is made up – a paper, which sets out the plan and indications, a team of doctors, the type of anesthesia, examination data, the patient’s consent to the operation.
Anesthesia can be injectable (it is administered through a vein, parenterally) and inhaled (administered as a vapor through an anesthesia mask). These species have their advantages and disadvantages, but the type of anesthesia is also selected on the basis of indications and approved by the anesthetist, the patient should also be aware of what effect the anesthesia has on him or her, what possible side effects can occur. Awareness of the patient increases confidence between him or her and the attending physician.
Degree of risk
At the time of obtaining consent for the operation from the patient or relatives, the surgeon is obliged to inform them about the degree of risk. There are only five of them, and they depend on the complexity of the intervention and the patient’s condition.
- I – the patient is almost completely healthy;
- II – the patient has mild diseases that do not lead to postoperative complications, do not violate vital functions;
- III – the patient has serious diseases that allow the operation to be performed without risk to the health and life of the patient;
- IV – severe pathologies are present that can threaten the course of the operation, but it is performed according to vital indications;
- V – with a high probability, the patient can die within 24 hours after surgery.
Below you can see general recommendations for a patient. But you need to understand that this applies only to scheduled operations. In case of emergency, the rules will be slightly different.
- On the eve of the operation, you need to have lunch and light dinner. You do not need to starve – because most likely you will not be able to eat food for one or several days after the operation;
- You should be examined by an anesthetist. Tell the specialist about all the diseases, allergies to drugs. He or she will prescribe sleeping pills – before the operation, you need to get enough sleep so that the next day you have no surges in blood pressure and other troubles;
- Cleansing enema on the evening before and in the morning on the day of surgery. It is necessary for a bowel movement. It is usually not performed in small operations;
- Preparation of the surgical field: shaving the area in the morning on the day of surgery. If this is done earlier, then micro-abscesses appear on the skin;
- To prevent thromboembolic complications in the morning before surgery, it is necessary to bandage the lower extremities with an elastic bandage (or wear compression stockings);
- It is advisable to purchase a bandage before the surgery. They are different in length and height – consult your doctor in advance which one is best to buy;
- On the day of surgery, it is forbidden to eat and drink, so that there is no vomiting and subsequent aspiration of vomit. Women are not recommended to have surgery during menstruation;
- Visit the toilet before surgery. Then you will be injected intramuscularly with sedatives and painkillers and delivered to the operating room;
- The plan of the operation and the entire length is documented in detail, from the patient’s admission to the type of stitches applied. Such management is necessary to fill out a medical history. This is an important document that can be referenced in the event of all kinds of problems in the postoperative period.