preoperative period

7/30/2019 Preoperative Period

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Preoperative period is thetime spent by the patient

in hospital from the

moment when thediagnosis is establishedand the decision aboutsurgery is taken till thebeginning of surgery.


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The tasks of preoperative period

To diagnose the disease, to detect thecomplications of the basic disease andconcomitant diseases. To assess thecondition and extent of affection of thepatients organs and systems. To determine the indications for surgery,

to assess the surgical andanesthesiological risks, to choose themethod of intervention and of anesthesia.


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The tasks of preoperative period

To inform the patient of the coming surgeryand to prepare him psychologically.

To take measures to improve impairedfunctions of the patients organs andsystems and to cure, if possible, concomitant

diseases.To reduce the risk of endogenous infection.


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Surgery can be Immediate if the patient is not operatedimmediately upon admission, he can die or developserious complications (hemorrhage, peritonitis). Urgent it is performed some time after admission

which has to do with confirmation of the diagnosis andpreparation of the patient. This period is usually 24-48-72 hours. Surgery cannot be delayed for longer asthe pathological process progresses and the patients

state may deteriorate (malignant tumours,pneumothorax, hemotharx without continuousbleeding). scheduled it can be performed at any time withoutdamaging the patients health.


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The main signs of cardiovascular and respiratory

failure shortness of breath, especiallyupon slight physical exertion andin rest;

cyanosis;tachycardia;edema.


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All patients preparing forscheduled surgery should have the

following taken:

blood pressure, pulse andrespiratory rate daily;ECG (if normal, only once);Chest X-ray.


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Clinical urine analysis gives

preliminary information about: concentration ability of the kidneys(density of urine),disorder of filtration ability (excretionof protein with urine),

possibility of inflammatory process(considerable levels of leucocytes anderythrocytes)


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Diabetes .anamnesis and complaints (in most casesthe patients report themselves that theyhave diabetes)

blood sugar analysis (N=3.3-5.5mmole/l).If there is diabetes or blood sugar is

high, blood sugar is observed over a day(blood sugar test is done every 3 hours)and an endocrinologist is invited to take

part in the preoperative preparation.


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In urgent surgery investigations should be done by all means:

taking case history, the patients complaints; physical examination (palpation, percussion,auscultation);heart rate, respiratory rate, blood pressure;

ECG for all patients over 40 (young people receive itif they have complaints or cardiovascular diseases inpast history);Chest X-ray if there are complaints aboutrespiratory system or in past history;Clinical blood test;Clinical urine test;Blood sugar;

Blood grouping, Rhesus-factor.


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lassification of surgical risksSomatically healthy people havingscheduled surgery (herniotomy,scraping of uterine cavity, diagnosticprocedures).Patients with completely compensatedpathology of inner organs having minor

surgery.Somatically healthy patients havingmore serious surgery likecholecystectomy.


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lassification of surgical risksPatients with completely compensated pathology of inner organs having serious extensive surgery(stomach resection, surgery on large intestine,chest surgery).

Patients with partially compensated pathology of inner organs having minor or medium surgery.Patients with a combination of profound somaticdisorders (acute or chronic ones caused, for

example, by myocardial infarction, trauma, shock,massive hemorrhage, peritonitis, sepsis,intoxication) having urgent surgery.


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General preparation is given toall patients independently of diagnosis and the type of surgery.

Specialized preparation is given

to patients with concomitantdiseases or those facing certaintypes of surgery.


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Preparation of respiratory organs.

Smoking should be dropped for at least 2-3weeks before surgery.If the patient stops smoking on the eve of surgery, the secretion of bronchial treeincreases.

As the patient has difficulty expectorating

the sputum, the infected phlegm isaspirated into deeper parts of bronchialtree which can cause postoperativepneumonia.


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Mendelsons syndrome

If the contents of stomach cannot beevacuated for some reason, thesurgical risk raises by two points.It is important because duringanesthesia muscles relax and gastriccontents can flow into thestomatopharynx and then beaspirated into the trachea.


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Preparation of skin for surgery On the eve of surgery all patients should take abath or shower. For seriously ill patients the areaof incision is washed.On the day of surgery the hair is shaved in thearea of preoperative skin treatment), the skin iscovered with a clean cloth.In the operating unit the skin is prepared by the

Filonchikov-Grossich method.The operative field is surrounded with sterilenapkins.Before incising the skin is once again wiped with

iodine.


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When can patients be operatedwithout their consent?

children (the consent is asked of theirparents);

invalid patients with mental disease (theconsent is asked of the guardian);unconscious patients (the decision about

operation is made by a consultation of atleast 3 doctors).


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Premedication usually includes:

1.0 of 0.1% Atropine solution(spasmolytic, reduces salivation)1.0-2.0 of 1% benadryl solution(desensitizing drug with a hypnoticeffect)

1.0 of 2% promedol solution (narcoticanalgesic).


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Before urgent surgery the extent of preoperative preparation becomes minimalbut the following is absolutely necessary:

to obtain the patients consent to surgery to stabilize his condition, if possible (relievethe shock, replenish blood loss and so on)to administer gastric tube (it is not advisableto wash out the stomach before urgent

surgery; in impeded passage of food it can bewashed out with a small amount of 4% sodasolution)

to shave the skin

preoperative period

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