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

When a child, a teenager or an adult have surgery, a long list of preparations are performed. During the surgery the bodily functions of the patient is supported and monitored by the means already prepared prior to the surgery as such. After the surgery the supporting measures are disconnected in a specific sequence.

All of the measures are fundamentally the same for children and adults, however the psychological preparations will differ for different age groups and the supporting measures will sometimes be more numerous for children.

The following is really a nearly complete listing of all measures undertaken by surgery and their typical sequence. All of the measures aren’t necessarily present during every surgery and there’s also cultural differences in the routines from institution to institution and at diverse geographical regions. Therefore everything won’t necessarily happen in a similar 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, of which some often will need place in home before going to hospital.

For surgeries in the stomach area the digestive tract often must be totally empty and clean. This is achieved by instructing the patient to stop eating and only keep on drinking a minumum of one day before surgery. The patient will also be instructed to take in some laxative solution which will loosen all stomach content and stimulate the intestines to expel the content effectively during toilet visits.

All patients will be instructed to stop eating and drinking some hours before surgery, also when a total stomach cleanse is not necessary, in order to avoid content in the stomach ventricle that can be regurgitated and cause breathing problems.

Once the patient arrives in hospital a nurse will receive him and he’ll be instructed to shift for some kind of hospital dressing, which will typically be a gown and underpants, or perhaps a sort of pajama.

If the intestines must be totally clean, the individual will most likely 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 could be given by repeated flushes through a tube with the individual in laying position.

Then the nurse will need 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 undoubtedly be inserted at a later stage.

Then the patient and in addition his family members will have a talk to the anesthetist that explains particularities of the coming procedure and performs a further examination to make certain the patient is fit for surgery, like hearing the center and lungs, palpating the abdominal area, examining the throat and nose and asking about actual symptoms. The anesthetist could also ask the patient if he has certain wishes concerning the anesthesia and pain control.

The individual 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 a few societies consent is assumed if objections aren’t stated at the initiative of the individual or the parents.

Technically most surgeries, except surgeries in the breast and some others can be performed with the patient awake and only with regional or local anesthesia. Many hospitals have however an insurance plan of using general anesthesia for most surgeries on adults and all surgeries on children. Chirurg Some may have a general policy of local anesthesia for certain surgeries to keep down cost. Some will ask the individual which type of anesthesia he prefers and some will switch to some other sort of anesthesia than that of the policy if the individual demands it.

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

The purpose of this medication is to make the patient calm and drowsy, to take away worries, to ease pain and hinder the patient from memorizing the preparations that follow. The repression of memory is seen as the most important aspect by many doctors, but this repression will never be totally effective so 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 right into a preparatory room where the induction of anesthesia takes place, or directly into the operation room.

MEASURES PERFORMED RIGHT BEFORE ANESTHESIA

Before anesthesia is initiated the patient will be linked to several devices that may stay during surgery and some time after.

The patient will get a sensor at a finger tip or at a toe connected to a unit that will monitor the oxygen saturation in the blood (pulse oximeter) and a cuff around an arm or perhaps a leg to measure blood circulation pressure. He will also get a syringe or a tube called intravenous line (IV) right into a blood vessel, typically a vein in the arm. Several 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 ensure that all areas of the body work in a way that allows the surgery to occur or to detect abnormalities that require special measures during surgery.

Right before the definite anesthesia the anesthetist may provides patient a fresh dose of sedative medication, often propofol, through the IV line. This dose gives further relaxation, depresses memory, and frequently makes the patient totally unconscious already at this time.

INDUCTION OF GENERAL ANESTHESIA

The anesthetist will start the general anesthesia by giving gas blended with oxygen by way of a mask. It can alternatively be started with further medication through the intravenous syringe or through drippings in to the rectum and continued with gas.

After the patient is dormant, we will always get gas blended with a high concentration of oxygen for a few while to ensure an excellent oxygen saturation in the blood.

By many surgeries the staff wants the patient to be totally paralyzed so that he will not move any areas of the body. Then the anesthetist or perhaps a helper gives a dose of medication through the IV line that paralyzes all muscles within the body, including the respiration, except the heart.

Then the anesthetist will open up the mouth of the individual and insert a laryngeal tube through his mouth and at night vocal cords. You will find a cuff around the end of the laryngeal tube that’s inflated to help keep it set up. The anesthetist will aid the insertion with a laryngoscope, a musical instrument with a probe that is inserted down the trout that enables him to look down into the airways and also guides the laryngeal tube during insertion.