Anesthesia - Preparation

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Anesthesia - Preparation
Anesthesia - Preparation
Video: Anesthesia - Preparation
Video: How an Anesthesiologist Sets Up an Operating Room for Surgery 2023, February
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Anesthesia: preparation

Anesthesia for a planned surgery is like preparing for a trip. First of all, all important findings are collected and, if necessary, improved through therapeutic measures before the operation. The patient and the anesthesia team make the decision on the best anesthetic procedure in each individual case. Before and after anesthesia, certain rules of conduct must be observed.

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  • The clarification meeting
  • The educational talk
  • Rules of conduct before anesthesia
  • Before the operation on the ward
  • Before induction of anesthesia in the operating room
  • Before induction of anesthesia in the operating room

The clarification meeting

A detailed risk assessment is required before any planned anesthesia. Dangers recognized in advance can be reduced in a targeted manner. After making an appointment for a planned operation, a clarification meeting takes place. This involves identifying risks, providing information about anesthetic procedures and approving the operation. Most hospitals have set up a so-called pre-anesthesia outpatient department. Here you can speak to your anesthetist on your own, without disturbing influences. These are specialists who have completed a medical degree and specialist training.

If you do not want to or cannot take the opportunity to talk to the pre-anesthesia outpatient clinic or if this facility does not exist in your hospital, the clarification can also be carried out in the private practice area, e.g. in a general medical or internal practice according to an Austria-wide uniform standard (federal quality guideline preoperative Diagnosis).

First, the patient fills out a questionnaire. Then this will be discussed with the doctor. The questions relate to physical resilience, important previous illnesses, medication intake and specific risk factors. All findings and patient IDs should be brought to the clarification meeting (e.g. allergy pass, anesthesia pass, pacemaker pass). This is followed by an examination of the heart and lungs, among other things.

Depending on the upcoming operation and state of health, additional examinations may be prescribed, such as ECG, cardiac ultrasound, lung function test, and certain laboratory tests. Any abnormal findings should be reported to the anesthetist. In certain cases it may be necessary, for example, to correct anemia (anemia) before a major operation with suitable medication in order to avoid a blood transfusion.

The educational talk

This conversation with the anesthetist is a compulsory part of the preparation for an operation and provides the patient with information about

  • process,
  • the benefits and
  • the potential risks of the various anesthetic procedures.

In addition, individual questions from the patient can be clarified. Any additional measures that may be required are also discussed, for example the insertion of a nasogastric tube or urinary catheter, extended monitoring of vital organs, blood transfusions or staying in the intensive care unit after the operation. The patient's consent or, in the case of limited capacity, the legal representative's consent is documented in writing on the information sheet.

Finally, the anesthetist clears the patient for the operation and informs them of all the important rules of conduct prior to the anesthesia, e.g. which medication should be taken or omitted before the operation. In principle, most medications, e.g. for high blood pressure, are continued to be prescribed at the usual intake times. Others, for example with diabetes, are stopped or reduced because of the fasting time before the operation.

Blood-thinning medication is generally continued in small operations with a low risk of bleeding, but paused for up to ten days before major operations, depending on the substance; Depending on the individual risk of vascular occlusion (thrombosis), a bridging treatment with an anticoagulant drug can be used, which should be injected under the skin on the days before the operation. In the case of stents in the coronary arteries, the lifelong intake of the blood-thinning drug (mostly aspirin-containing preparations) must be adhered to in order to avoid stent occlusion and heart attack. Exception: operations in which even the smallest bleeding can lead to serious consequences, e.g. surgery on the brain. As long as two blood-thinning drugs are still being taken (up to twelve months after the stent has been implanted),no planned operation should take place. In most cases, a sedative is prescribed shortly before the operation.

Rules of conduct before anesthesia

Certain rules apply to every anesthetic procedure in all hospitals. They serve the safety of the patients:

  • Do not eat any solid food for six hours before surgery. This is important because with general anesthesia the protective reflexes are switched off and if there is no cough reflex, stomach contents can get into the lungs. This can lead to pneumonia.
  • You should not drink anything two hours before the planned procedure. Before that, you can drink one or two glasses / cups of clear liquid without fat and without solid components (water, tea). In the hot season and in children, a lack of fluids should be avoided because it promotes cardiovascular instability.
  • Long-term medication and any additional medication prescribed can be taken with a sip of water.
  • Smoking, make-up and nail polish etc. should be avoided on the day of anesthesia. Jewelry and contact lenses must be left on the ward.
  • For hygienic reasons, hearing aids, artificial hair pieces and the like should be placed in the operating theater at the latest. Most hospitals provide special bedside containers for this. Removable dentures (prostheses) must be removed at this point because they can lead to an airway obstruction in emergency situations.
  • If you have an illness (e.g. a cold) ten days before the operation, please inform the anesthesia team.
  • Loose teeth (especially incisors) must be rehabilitated or splinted by a dentist in good time before the procedure.

Before the operation on the ward

In the case of minor interventions, admission and discharge can take place on the day of the operation. In the case of major surgery, the patient is usually admitted to the hospital the day before the operation. This leaves enough time for the admission modalities and incomplete examinations can be made up if necessary. With this individual preparation, you will be transferred to the operating area with your bed. The following procedure may differ slightly due to different hospital structures.

Before induction of anesthesia in the operating room

In most cases, the patient is taken to a preparation room in front of the operating room. The name, type and location of the operation and any risk factors, e.g. due to drug allergies, are checked by those responsible in the operating room using a checklist. This avoids patient mix-ups and identifies risks. At this point at the latest, a thin plastic tube (indwelling venous cannula) is placed in a vein (usually on the arm). In addition, the anesthetic drugs, fluids or, if necessary, emergency drugs are administered. The patient is transferred to the operating table and should lie as comfortably as possible.

Before induction of anesthesia in the operating room

Every anesthesia begins with putting on the monitoring devices of the vital organs. The minimum monitoring includes heart activity, blood oxygen levels and blood pressure. The monitoring is expanded depending on the requirements of the upcoming operation or individual risk factors. To monitor general anesthesia, two adhesive electrodes are usually attached to the wrist to control muscle relaxation; sometimes an electrode tape is stuck to the forehead to control the depth of anesthesia.

Depending on the operation and anesthetic method, further measures are initiated, e.g. the insertion of a nasogastric tube, a thin plastic tube into an artery (mostly on the wrist) or on the back for pain control during and after the operation in the so-called epidural anesthesia / epidural analgesia. Sometimes, even before the anesthesia, an access is made into a large vein near the heart, a so-called cava catheter, which can be used to administer medication to support circulation during and after the operation and, if necessary, a special diet after the operation.

A "difficult airway" is a clinical situation that can occur particularly in the operating room. There are problems with ventilation with a mask and / or with so-called intubation. A so-called awake intubation may be necessary to avoid this. The breathing tube is inserted into the windpipe while awake and under local anesthesia.

The many technical devices at the anesthesia workstation can be frightening, but they are used for patient safety. Here - from the preparation phase to the end of the operation and further treatment in the recovery room or the intensive care unit - your anesthesia team is always with you, observes your organ functions, corrects them if necessary and watches over your safety.

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