This can be an account of precisely what happens, or you can do, during and around a surgical intervention and sometimes also when complicated examinations are performed.

When a child, a teenager or a grown-up have surgery, more information on preparations are performed. During the surgery the bodily processes of the patient 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 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 become more numerous for children.

The following is really a nearly complete report on all measures undertaken by surgery and their typical sequence. Each 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 will not 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.

Chirurg For surgeries in the stomach area the digestive tract often has to be totally empty and clean. This is achieved by instructing the individual to avoid eating and only keep on drinking at least one day before surgery. The patient may also be instructed to take some laxative solution that will loosen all stomach content and stimulate the intestines to expel this 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, to avoid content in the stomach ventricle which can be regurgitated and cause difficulty in breathing.

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

If the intestines have to be totally clean, the patient will most likely also get an enema in hospital. This can be given as one or even more fillings of the colon through the anal opening with expulsion at the bathroom ., or it usually is given by repeated flushes by way of a tube with the patient 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 will have a talk with the anesthetist that explains particularities of the coming procedure and performs an additional examination to ensure the individual is fit for surgery, like listening to the heart and lungs, palpating the abdominal area, examining the throat and nose and asking about actual symptoms. The anesthetist may also ask the individual if he has certain wishes about 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 patient or the parents.

Technically most surgeries, except surgeries in the breast and some others can be carried out with the patient 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 a general policy of local anesthesia for certain surgeries to help keep down cost. Some will ask the patient which type 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 occur, the nurse gives the individual a premedication, typically a type of benzodiazepine like midazolam (versed). The premedication is usually administered as a fluid to drink. Children will sometimes get it as drops in the nose or being an injection through the anus.

The objective of this medication is to make the patient calm and drowsy, to take away worries, to ease pain and hinder the individual from memorizing the preparations that follow. The repression of memory is seen as the main aspect by many doctors, but this repression will never be totally effective so that blurred or confused memories can remain.

The patient, 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 that he calms totally down. Then your patient is wheeled right into a preparatory room where in fact the induction of anesthesia occurs, or directly into the operation room.

MEASURES PERFORMED RIGHT BEFORE ANESTHESIA

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

The patient will receive 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 circulation 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. Several electrodes with wires are also placed at the chest or the shoulders to monitor his heart activity.

Before proceeding the anesthetist will once more check all the vitals of the patient to ensure that all parts of the body work in a way that allows the surgery to occur or even to detect abnormalities that want special measures during surgery.

Right before the definite anesthesia the anesthetist may provides patient a new dose of sedative medication, often propofol, through the IV line. This dose gives further relaxation, depresses memory, and often makes the individual 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.

Once the patient is dormant, we will always get gas blended with a high 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 will not move any areas of the body. Then the anesthetist or a helper will give a dose of medication through the IV line that paralyzes all muscles within the body, including the respiration, except the heart.

Then your anesthetist will start the mouth of the patient and insert a laryngeal tube through his mouth and at night vocal cords. There exists a cuff around the end of the laryngeal tube that is inflated to keep it in place. The anesthetist will aid the insertion with a laryngoscope, a musical instrument with a probe that is inserted down the trout that allows him to look into the airways and also guides the laryngeal tube during insertion.