Anesthesiology and Perioperative Medicine

Department of Anesthesiology and Perioperative Medicine staff members are a highly integrated, collaborative group of adult and pediatric anesthesiologists committed to providing the best possible care to adult patients requiring anesthesia and intensive care as well as to pediatric patients.

To guarantee you a comfortable and safe experience in our hospital and the success of the intended surgery, it is very important that you are introduced to the ways of preparing for the surgery, the basic procedures of anesthesia and monitoring during and after surgery, and the possible complications as well.

PREOPERATIVE PREPARATION

Starts with talking to our physician when the patient makes a decision about the operating procedure, agrees to the terms of the operation and receives all the information required for high-quality preoperative preparation.

Depending on the type of surgery, the patient is given instructions on the necessary laboratory and diagnostic tests that have to be done prior to the scheduled surgery and have to be done within 30 days before the surgery.

The patient completes the "pre-anesthesia questionnaire" in which he/she fills out the data on the current health status, possible allergies and medications that he/she takes. On the basis of this data the anesthesiologist decides if any additional specialist examinations and diagnostic or laboratory tests are required.

EXAMINATIONS BY THE ANESTHESIOLOGIST

Before admittance of the patient to the hospital, the anesthesiologist performs preoperative anesthetic examination. Based on the patient's state of health, laboratory and other findings, the doctor determines the patient’s readiness for the upcoming operating procedure. In addition, he introduces patients to the types of anesthesia and possible risks, and selects optimal way of anesthesia that the patient approves.

ANESTHESIA CAN BE:

1. General anesthesia

Type of anesthesia that induces the body to a dream-like state, in which the patient does not feel pain or other external stimuli, is called a general anesthesia.

General anesthesia begins by introduction of an intravenous cannula and application of fast-acting drug for induction of sleep and continues by application of strong painkillers and other necessary medicines or anesthetics. This state is maintained throughout the surgery. Additional tools that ensure the flow of oxygen and anesthetic gases are: anesthesia mask placed over the nose and mouth, laryngeal mask placed in front of the entrance to the trachea, or tube that is inserted into the trachea itself.

Anesthesia is terminated after the end of surgery and the patient wakes up. The patient is then placed in ‘the waking room’ under the supervision of professional staff, where he/she stays until his/her vital functions are back to physiological values and anesthesiologist decides everything is okay and he/she can return to his/her room on the ward.

2. Local or regional anesthesia

Local anesthesia is a type of anesthesia in which local anesthetic is given directly into the operating field or near the nerves that innervate this area. This way pain sensation is eliminated and the administration of other drugs into the blood stream and their possible impact on the functioning of the whole organism is avoided. The patient is awake during the whole operation, and he is able to communicate with the operator and make decisions about situations that could not be predicted before surgery.

The patient under local anesthesia can get a mild sedative to help him fall asleep if he doesn’t want to see or hear what is going on in the operating room. This type of anesthesia is particularly recommended for older patients and lung and heart patients.

The advantages of this type of anesthesia are numerous. Sickness and vomiting occur very rarely so patients can begin to eat and drink soon after the surgery.

Patients wi can significantly contribute with their behavior to the safety of ongoing operation and postoperative recovery:

Prior to the scheduled surgery the patients must come to hospital on an empty stomach. They must not eat anything for at least six hours before the procedure and liquids should not be consumed for at least two hours.

It is recommended not to smoke 1-2 hours before the procedure.

Drugs that the patient was taking before being admitted to the hospital, during the hospitalization are taken in consultation with the anesthesiologist or physician on duty. Daily therapy is usually adjusted to the patient's current condition. It is recommended to bring your own medication, in the original packaging, to the hospital.

These instructions apply equally to the general and regional / local type of anesthesia

Blood transfusions

In our institution, special attention is paid to the risks and complications in the application of blood transfusion. Additionally, patients are often concerned about receiving someone else's blood, and this is being avoided as much as possible, with the possibility of application of autologous perioperative or postoperative transfusion, where patient’s blood can be drawn a month before the agreed date of the operation at the Institute for transfusion, which he/she will get through transfusion after an operative procedure, or the blood will be collected during surgery using a special machine that allows subsequent transfusion.

What are the most frequent complications and accompanying side effects of anesthesia?

Every medical procedure is accompanied by certain risks which are determined by the type and severity of the underlying disease, age-associated diseases, lifestyle habits and a number of other factors to which the patient was informed and that were explained during preoperative anesthesiological exam. Severe complications during anesthesia rarely occur, and by permanent monitoring of vital functions during anesthesia and surgery each disorder can be diagnosed and treated on time.

General side effects and complications during anesthesia can be:

* hematoma at thesite of induction of intravenous cannula and other catheter

* altered sensation to the skin due to injury of the nerve (which are short and are easily cured)

* skin infection at the injection site (mostly successfully treated and cured)

* damage to the soft tissue (subcutaneous tissue, muscle), irritation of nerves or veins by the use of drugs before, during and after surgery (most often successfully treated)

* injury of the nerve with sensory symptoms and outburst occurred due to pressure or stretching because of the forced position necessary for the procedure (mainly pass spontaneously after a while)

* nausea and vomiting during application of anesthetics and analgesics

* possibility of aspiration of gastric contents into the lungs, which is why the compliance with the prohibition of eating and drinking before surgery is important

* mild allergic reactions in the form of itching and rashes

* evere allergic reaction with swelling of the airways, heart failure and circulatory system, are very rare and require intensive care

* blood clots and blockage of blood vessels (pulmonary embolism, cerebral infarction, heart attack). In orthopedic surgery the possibility of clot formation is increased, which is why in our institution we apply medicines for thromboprophylaxis (low molecular weight heparin preparations) applied under the skin.

Special caution is necessary after anesthesia, and it is immediately necessary to inform the physician!

After the general anesthesia it is normal to feel dazed, sleepy and tired. This state, depending on the length and type of anesthesia can take up to a few hours after waking up and it is not a reason for worrying. After two or three hours, if vomiting doesn’t occur, the patient may start slowly drinking liquid, and then start with taking the liquid or pureed food. The medical staff will inform the patient about the liquid and food intake pattern.

Our hospital is equipped with modern appliances and central monitoring for continuous monitoring of vital signs of patients in early stages of post-operative rehabilitation, and if necessary throughout the stay for the safety of patients.

If the patient is scheduled for surgery, or leaves the hospital after 24 hours, an escort is required to provide a ride home, and home care could be required if recommended by the physician.

For subsequent effects of applied drugs, or due to limited functions of certain parts of the body as a result of regional anesthesia / analgesia, it is recommended that the patient doesn’t drive in the first 24 hours after the surgery.

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