Preoperative preparation and anaesthesiology procedures





PREOPERATIVE PREPARATION OF THE PATIENT

In order to have a comfortable and safe stay in our hospital and to successfully perform the scheduled surgical procedure, it is of utmost importance to familiarize the patient with the preparation for the procedure, the basic anaesthesiology procedures and the supervision after the surgery, as well as with the possible side-effects and complications.

The preparation starts from the moment the patient has decided to undergo surgery, based on a conversation with the orthopaedic surgeon in our hospital. The patient arranges the date of the surgery with the hospital manager and he or she receives all the data necessary for a high-quality and complete preoperative procedure. Among other things, depending on the type of surgical procedure, the patient is given a list of required laboratory results and diagnostic tests that should be done within the period of preparation for the surgery and cannot be older than 15 days regarding the anticipated date of the surgery.
 
PREOPERATIVE EXAMINATION BY THE ANAESTHESIOLOGIST

It is desirable to deliver the results of the listed examinations (except for X-rays) to the hospital before the patient is admitted to the hospital (via fax, e-mail, mail, etc.). The patient fills out the "Questionnaire about the health condition”, where he or she writes the facts about previous diseases and surgeries, possible allergies and medications he or she is taking. Based on these data as well as on the results of the above tests, which is preferable to submit before hospital admission (via fax, e-mail or mail), the anaesthesiologist determines the need for any additional specialist examinations, diagnostic or laboratory tests.
 
ANAESTHESIA

Immediately after the hospital admission, the anaesthesiologist performs the preoperative examination and based on the determined condition, as well as on other data about the patient’s health condition (previous diseases, medication, allergies, laboratory and other surveys), he evaluates how ready the patient is for the planned surgical procedure, regarding his health condition. During the preoperative conversation and examination, the anaesthesiologist gives the patient more detailed information on the methods of anaesthesia, their advantages and disadvantages and possible risks and side-effects. Keeping in mind the patient’s health condition and the requirements of the planned surgery, the anaesthesiologist suggests an optimal type of anaesthesia, based on which the patient makes the final decision.

The main goal of anaesthetic procedures is to eliminate the pain and discomfort caused by certain diagnostic and surgical procedures. This can be achieved by using various methods. Modern anaesthetic equipment provides a complete insight into the functioning of all vital organs, which significantly reduces the risk of anaesthesia. An exceptionally important goal of anaesthesia is also to enable optimal conditions for the work of the surgeon. That is why the range of anaesthesia methods is sometimes narrowed.

There are two basic types of anaesthesia: general and regional / local anaesthesia.
 
GENERAL ANAESTHESIA (NARCOSIS)

General anaesthesia is a state of the body similar to a deep sleep, in which the patient neither feels pain, nor other outer stimuli. It begins by setting up an intravenous infusion to the patient and the injection of fast-acting tranquilizer that makes the patient sleep, after which it is continued by giving strong painkillers and different anaesthetics. The described condition is sustained throughout the operation. Devices to aid the supply of oxygen and, if required, anaesthetic gases are: a mask which is placed on the patient’s nose and mouth, a mask placed in front of the trachea and a tube put into the trachea (endotracheal anaesthesia). Upon completion of the diagnostic or surgical procedure, the anaesthesiologist stops giving anaesthetics and the patient wakes up. Since special attention is given to the prevention and treatment of pain, most patients do not feel any pain after waking up. After the surgery, the patients are placed in the wake-up room, where they are still supervised by professional staff, until the anaesthesiologist estimates whether the patient is fully awake and whether the vital functions are normal and stable.
 
LOCAL/REGIONAL ANAESTHESIA

This type of anaesthesia is also called "anaesthesia of the surgical procedure area”. The drug (a local anaesthetic) is injected directly into the operating field or close to the nerves that supply the particular portion of the body area.

In this way, it is possible to completely eliminate the feeling of pain and at the same time avoid giving other drugs, anaesthetics and analgesics into the bloodstream, as well as their impact on the function of the whole organism. Unlike general anaesthesia, during a local or regional anaesthesia the patient can stay awake during the procedure, talk to the surgeon and sometimes participate in decision making based on a newly turned up condition that could not be predicted before surgery.

Nakon davanja lokalnog anestetika, pacijenta je moguće uspavati blažim sedativima i probuditi ga nakon zahvata. Treba istaknuti da injekcija lokalnog anestetika u većini slučajeva nije bolnija od uboda iglom prigodom vađenja krvi. Prednosti ove vrste anestezije su brojne, a pogotovo se savjetuju pacijentima starije životne dobi, plućnim i većini srčanih bolesnika. Naziv slike Zadovoljstvo pacijenata može se zamijetiti i nakon zahvata, budući da su osjećaj mučnine i nadražaj na povraćanje izuzetno rijetki pa je moguće ubrzo nakon zahvata početi piti i jesti. Važno je istaknuti da pacijenti svojim ponašanjem mogu u mnogo čemu pridonijeti sigurnom tijeku operacije:
  • It is also possible to enjoy the music of his/her choice, using the supplied headphones. If the patient does not want to hear and see what is happening in the operating theatre during the surgery, there is no reason not to take advantage of all the benefits of regional/local anaesthesia.

  • After giving the local anaesthetic, it is possible to put the patient asleep with light sedatives and wake him/her up after the surgical procedure. It should be noted that the injection of a local anaesthetic in most cases is not more painful than the venipuncture for taking a blood sample. There are numerous advantages of this type of anaesthesia and it is especially recommended for elderly patients, pulmonary and most heart patients. Patient satisfaction can be noticed after the procedure, because the feeling of nausea and irritation to vomit are extremely rare and shortly after the procedure, they can start drinking and eating.
 
It is important to point out that patients can contribute to a safe process of the surgery in many ways:
  • before the anaesthesia, they must be on an empty stomach, which means they are not allowed to intake any food or liquid as to avoid the side- effects of stomach contents overflowing into the lungs. Patients are not allowed to eat for, at least, six hours and not allowed to drink at least two hours before surgery. It is recommended not to smoke 1-2 hours before anaesthesia.
  • The drugs they take regularly, they now take in consultation with the anaesthesiologist, but generally the daily drug therapy is not being disrupted. The patients should bring their medication in the original packaging to the hospital.
These instructions are also valid as a rule when the procedure is planned with local or regional anaesthesia.

 
AVOIDING TRANSFUSION OF SOMEBODY ELSE’S BLOOD

Our hospital belongs to those hospitals that keep in mind all the risks and complications, as well as the patient’s fear of receiving someone else’s blood and thus, we pay special attention to avoid such transfusions. Owing to the coordinated work of our entire team, as well as using cutting-edge devices for auto-transfusion (apparatus that prepares the patient’s blood that would be inevitably lost during the surgery, but thanks to this technique, it is restored for the patient when needed), the frequency of transfusing somebody else’s blood in case of a hip replacement is less than 5% in our hospital.
 
WHICH COMPLICATIONS AND SIDE EFFECTS CAN APPEAR DURING ANAESTHESIA?

No medical procedure is absolutely safe. The type and severity of the basic disease, possible concomitant diseases, age, lifestyle habits and other factors determine how high the risk is. Severe complications during anaesthesia are generally seldom, even with severely ill patients. Through the continuous monitoring of the vital functions, the anaesthesiologist can immediately recognize each disorder and start treating it very quickly.

General side effects and complications are:

  • bruises in the area of the intravenous infusion (cannula) and other tubes (catheters) insertion;
  • a disorder of sense as a result of skin nerve injury (the injuries are mostly harmless and last for a short time, or are treated easily);
  • disturbances of skin sensation due to nerve injury (injuries are mostly harmless and current, and are easily cured);
  • infection at the injection site skin (most are successfully treated);
  • damage to the skin and soft tissue (subcutaneous tissue, muscle), irritation of the nerves and veins as a result of injecting drugs before, during and after the procedure (usually successfully treated, and in unfavorable cases can result in long-term problems such as scars and pain);
  • very rarely nerve damage occurs with disturbances of sensation and numbness due to pressure or stretching the position necessary for the procedure (mostly disappear after a while);
  • sometimes nausea or vomiting, mostly after taking pain-killers;
  • danger of spilling of stomach contents into the lungs with subsequent development of pneumonia (particularly pronounced in the case of non-compliance with the preoperative fasting);
  • mild allergic reactions (hypersensitivity) to anesthetics and other medications that are manifested in the form of itching and skin rashes;
  • severe allergic reaction, with the island of mucosa of the larynx, heart failure and circulatory system, breathing difficulties and convulsions are rare but require intensive treatment and can lead to permanent damage due to insufficient blood supply to organs (e.g., brain damage, kidney disease, etc.);
  • extremely rare blood clots or blockage of blood vessels (e.g. pulmonary embolism, stroke, myocardial infarction), which can lead, due to insufficient blood supply, damage to organs. Since in the orthopaedic surgery the risk of blood clots has slightly increased recently, we very often encourage the application of remedies for their prevention, i.e. prevention of thrombosis. Such drugs are administered in the form of extremely thin injection in the abdominal skin.

SPECIAL SIDE EFFECTS AND COMPLICATIONS OF GENERAL ANAESTHESIA (NARCOSIS)
 
  • Disorders of swallowing, hoarseness, vocal cords damage caused by the injury of the larynx or trachea after inserting the tube, which are in most cases temporary and do not require any treatment;
  • Damage to teeth, dental restorations or fixed prostheses to the loss of teeth, especially in loose teeth and/or gum disease;
  • Extremely rare is cardiac arrest, normal blood flow cessation or sudden extreme elevation of body temperature (malignant hyperthermia) due to the applied anaesthetics or intake of other drugs. This can lead to damage of vital organs (e.g. the brain) and requires intensive treatment.

SPECIAL ATTENTION IS NEEDED AFTER ANAESTHESIA

The doctor should be informed immediately, if after the anaesthesia difficulties with breathing or blood circulation occur, unusual disturbances of consciousness, symptoms like cramps or sudden onset of disorders of sensation in the hands or feet.
 
After general anaesthesia, it is absolutely normal to feel tired and sleepy for some time. This condition can, depending on the type of anaesthesia, last for several hours after the patient is being released from the wake-up room and is not a reason to be concerned about.

Our hospital with state-of-the-art equipment has a continuous insight into vital functions of patients throughout their stay providing a very high level of security. After some time, depending on the type of anaesthesia and the surgical procedure, the patient can carefully start drinking liquid and taking small meals. The medical staff introduces the patient with the type of food and the way it should be taken.

In case the patient leaves the hospital within 24 hours after surgery, someone close to him needs to pick him up. It is necessary to provide home care (medical attention at home) for the period recommended by the doctor. Because of the follow-up effects of the used medication or the limited functioning of specific body parts after regional anaesthesia, it is recommended the patient should refrain from actively participating in traffic, driving a vehicle, bicycle or handle factory machines for 24 hours.


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