This is an account of precisely what happens, or may happen, during and around a surgical intervention and sometimes also when complicated examinations are performed.

When a child, an adolescent or an adult have surgery, a long list of preparations are performed. During the surgery the bodily processes of the individual is supported and monitored by the means already prepared before the surgery as such. Following the surgery the supporting measures are disconnected in a specific sequence.

All of the measures are essentially 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 of the measures are not 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 simply work.

Greatest variation is perhaps to be found in the decision 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. That is achieved by instructing the individual to stop eating and only keep on drinking a minumum of one day before surgery. The individual will also be instructed to take in some laxative solution that will loosen all stomach content and stimulate the intestines to expel the content effectively during toilet visits.

All patients will undoubtedly be instructed to stop eating and drinking some hours before surgery, also whenever 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’ll be instructed to shift for some kind of hospital dressing, that will typically be a gown and underpants, or perhaps a sort of pajama.

Chirurgie If the intestines must be totally clean, the patient will often also get an enema in hospital. This could be given as one or more fillings of the colon through the anal opening with expulsion at the bathroom ., or it really is given by repeated flushes by way of a tube with the individual in laying position.

Then the nurse will take 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 could have a talk to the anesthetist that explains particularities of the coming procedure and performs a further examination to make sure that the patient 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 could also ask the patient if he’s got certain wishes about 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 some 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 some others can be performed with the individual awake and only with regional or local anesthesia. Many hospitals have however a policy of using general anesthesia for some surgeries on adults and all surgeries on children. Some may have an over-all policy of local anesthesia for certain surgeries to help keep down cost. Some will ask the individual 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.

Once the anesthetist have signaled green light for the surgery to take place, the nurse gives the individual a premedication, typically a type of benzodiazepine like midazolam (versed). The premedication is normally administered as a fluid to drink. Children will sometimes obtain it as drops in the nose or being an injection through the anus.

The purpose of this medication would be to make the patient calm and drowsy, to eliminate worries, to alleviate pain and hinder the individual from memorizing the preparations that follow. The repression of memory sometimes appears as the most important aspect by many doctors, but this repression will never be totally effective in order that blurred or confused memories can remain.

The individual, and especially children, will often get funny feelings by this premedication and will often say and do strange and funny things before he could be so drowsy he calms totally down. Then your patient is wheeled into a preparatory room where the induction of anesthesia occurs, or right into the operation room.

MEASURES PERFORMED BEFORE ANESTHESIA

Before anesthesia is initiated the patient will undoubtedly be connected to several devices that will stay during surgery plus some time after.

The patient will get a sensor at a finger tip or at a toe linked 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 pressure. He will also get a syringe or perhaps a tube called intravenous line (IV) right into a blood vessel, typically a vein in the arm. A couple 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 again check all the vitals of the individual to make sure that all areas of the body work in a way that allows the surgery to take place or even to detect abnormalities that want special measures during surgery.

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 often 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 as a substitute 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 a few while to ensure a good oxygen saturation in the blood.

By many surgeries the staff wants the patient to be totally paralyzed in order that he does not move any body parts. Then the anesthetist or a helper gives a dose of medication through the IV line that paralyzes all muscles within the body, like the respiration, except the center.

Then the anesthetist will open up the mouth of the individual and insert a laryngeal tube through his mouth and at night vocal cords. There exists a cuff round the end of the laryngeal tube that’s 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 enables him to look down into the airways and in addition guides the laryngeal tube during insertion.