How to prepare for surgery?

To ensure a pleasant and safe stay at our hospital and a successful surgical procedure, it is extremely important to inform you about the pre-operative preparations, basic anesthesiology procedures, and supervision during and after the surgery, as well as potential complications.

PREOPERATIVE PREPARATIONS

They begin by talking to the physician from our hospital when the patient is making a decision about a surgical procedure, making a surgical appointment, and is getting all the information necessary for a quality preoperative preparation.

Depending on the surgical procedure, the patient gets the instructions about the required laboratory and diagnostic procedures which must be done before the surgery and which cannot be older than 30 days.

The patient fills out a „ Pre-anesthesia questionnaire“ which the patient puts data about his or her medical history, possible allergies and drugs he or she is taking. On that basis, the anesthesiologist makes a decision about potential additional specialist examinations, as well as diagnostic and laboratory procedures.

ANESTHESIOLOGICAL EXAMINATION

Prior to the patient hospitalization in the anesthesiologic clinic, the anesthesiologist does a operative anesthesiologic examination on the basis of the patient's health status, laboratory and other tests and makes a decision about the patients readiness for surgery. Furthermore, the anesthesiologist informs the patient about the types of anesthesia and their potential risks. Then, the anesthesiologist chooses the optimal anesthesia which the patient has to agree to.

ANESTHESIA

The main goal of the anesthesiologic procedures is to remove pain and discomfort which some diagnostic and therapeutic procedures can cause. This is done by the application of the various anesthesiologic methods and by the use of modern anesthesiologic equipment with which the anesthesiologist gets a good insight into the functioning of all the vital organs. This way, optimal working conditions for the surgeon are achieved and risks of anesthesia are significantly reduced.

There are two main types of anesthesia: local and general.

GENERAL ANESTHESIA

General anesthesia is the type of anesthesia which puts the body in a state similar to sleep in which the patient does not feel pain or any other external stimuli.

General anesthesia begins by introducing an intravenous cannula and applying a fast-acting drug to put the patient to sleep, followed by giving strong analgesics and other necessary drugs, i.e. anesthetics. This state is maintained during the whole surgery. Additional equipment which ensures oxygen flow and anesthesiologic gases to the patient is: anesthesiologic mask over the nose and mouth, laryngeal mask in front of the entrance to the trachea or a tube is put in the trachea itself.

Anesthesia is stopped at the end of surgery and the patient wakes up. The patient is then transported to a room to wake up under supervision of our educated personnel. The anesthesiologist makes a decision to return the patient to his or her room at the ward if all the vital functions are stabilized.

LOCAL OR REGIONAL ANESTHESIA

Local anesthesia is the type of anesthesia where the local anesthetic is applied directly in the surgical field or next to nerves that innervate the region. This way, the patient is relieved of pain and other drugs in the bloodstream which can cause disruption in the functioning of the whole body. While in local anesthesia, the patient is awake and available for communication with the surgeon about making decisions on potentially newly formed situations which could not be predicted prior to surgery. 

In local anesthesia, the patient can be given mild sedation to put him or her to sleep if he or she does not want to see or hear what is happening in the surgical room. This type of anesthesia is recommended to patients o folder age and with the lung and heart problems.

The advantages of such anesthesia are multiple. Nausea and vomiting happen very rarely so the patients can eat and drink very soon after the surgery is done.

Patients can significantly add to the safe course of surgery and postoperative recovery with their behavior:

For the schedule surgery they have to be on an empty stomach at least 6 hours before surgery and must not during anything at least 2 hours prior to it.

It is advisable not to smoke one or two hours before the surgery.

They take drugs during hospitalizations in agreement with the anesthesiologist and physician on duty. Everyday therapy does not stop in general, but is modified according to the patient's present state. We recommend the patient brings all the drugs in original packaging to the hospital.

These instructions are valid both for general and regional/local anesthesia.

BLOOD TRANSFUSION

At our hospital, special attention is given to risks and complications when doing blood transfusions. We respect the fear of patients when given someone else's blood and this procedure is avoided. Autologous perioperative or postoperative autotransfusion is recommended more when the patient collect his or her own blood in the Institute for transfusion medicine a month prior to surgery. This blood will be given to the patient after the surgery. Otherwise, the blood can be collected during the surgery with help of special equipment.

WHAT ARE THE MOST COMMON COMPLICATIONS AND ADVERSE REACTIONS OF ANESTHESIA?

Every medical procedure has its risks which are determined by the type and severity of disease, patient age, lifestyle, and other factors about which the patient is warned and informed while doing the anesthesiologic examination. More severe complications during anesthesia are generally rare, and every disorder can be timely prevented and treated by constantly monitoring vital functions during the surgery.

• General adverse reactions and complications during anesthesia can be the following:
• Hematoma on the place of application of intravenous cannula and other catheters
• Altered sensation if skin nerves are damaged (which are short and easily treated)
• Skin infections (mostly successfully treated)
• Soft tissue injury (subcutaneous tissue, muscle), nerve or vein irritation as a consequence of drug application prior, during o rafter surgery (mostly successfully treated)
• Nerve damage with altered or impaired sensation occurring during pressure or stretching because of the necessary position of the body during surgery (mostly go away spontaneously)
• Nausea and vomiting when applying and anesthetics and analgesics
• Possibility of aspiration of stomach contents in the lungs because of which it is very important not to take food or drinks prior to operation
• Mild reactions in the form of itching and rash
• We are allergic reactions with airway edema, heart failure, hematologic shock are very rare and require intensive treatment
• Forming of blood clots and clogging of blood vessels (pulmonary embolism, stroke, myocardial infarction).

During orthopedic procedures, there is a higher possibility of blood clots forming because of which at our hospital we give
thromboprophylactic drugs (low molecular weight heparin). They are applied subcutaneously.

SPECIFIC ADVERSE REACTIONS AND COMPLICATIONS OF GENERAL ANESTHESIA

• Swallowing problems
• hoarseness
• Vocal cord damage during application of the tube (mostly do not require treatment and go away spontaneously)
• Teeth and denture damage, loss of teeth
• Heart failure, shock, hyperthermia when applying anesthetics and other drugs – happen very rarely and requires intensive treatment
• Trouble with breathing, consciousness alterations, muscle twitches or altered sensation in the arms and legs

SPECIAL ATTENTION IS REQUIRED AFTER ANESTHESIA AND IT IS MANDATORY TO INFORM THE PHYSICIAN WITHOUT DELAY!

After general anesthesia, it is normal for the patient to feel „dazed“, sleepy and tired. This state, depending on the length and type of anesthesia can last a few hours after waking up and does not present a reason to worry. After 2 to 3 hours, if there is no nausea or vomiting, the patient can start slowly drinking and eating liquid or mushy food. The medical personnel informed the patient about food and fluid intake.

Our hospital is equipped with modern equipment for monitoring continuously vital patient functions in the early postoperative phase and, if required, during the whole hospitalization because of patient safety.

If the patient is scheduled for surgery in the daily hospital or who's the hospital after 24 hours, the patient's escort is required to ensure transportation the the patient's home and home care for the time the physician recommended it.

Because of subsequent action of applied drugs, i.e. limited function of some parts of the body under regional anesthesia/analgesia, it is recommended for the patient not to drive a motorized vehicle within 24 hours after surgery.