Preparation for surgery

• For 3 days, stop taking non-steroidal anti-inflammatory drugs that affect blood coagulation (aspirin, analgin, diclofenac, ibuprofen, ketoprofen, naproxen, piroxicam, meloxicam, nimesulide, Plavix), as well as Omega 3 and dietary supplements;
• If you take any oral contraceptives – you cannot stop taking them, but you must inform the surgeon and anesthetist about this;
• 2 weeks before surgery (if it is plastic surgery), it is advisable to stop visiting the gym, because you need the most relaxed muscles. If the muscles are hypertonic, rehabilitation will be more painful and the risk of hematomas will increase;
• It is recommended to abstain from smoking and drinking alcoholic beverages 14 days before surgery (or to reduce consumption by 2 times). For smokers, rehabilitation is always longer, swelling lasts longer than for non-smokers;
• You can use sedatives or sleeping pills on the evening before the operation;

! Do not eat or drink water 6 hours before surgery!

Remember, that the patient’s undisciplined implementation of recommendations during the preparatory period can provoke complications after surgery. Do not neglect factors such as: 

• diet, bad habits, physical or emotional stress on the eve of the operation, taking medication; 
• chronic somatic diseases that can affect the state of the immune system and the general condition of the skin;

What to bring with you to the operation:

• passport, identification code;
• images of MRI, CT, a description of them and other studies made outside the clinic;
• medical records of previous years (certificates from medical institutions, test results, photographs, descriptions);
• in the clinic you will be given a bathrobe, disposable slippers, a towel;
• replaceable underwear;
• personal hygiene items;
• you will be given 0.5-liter non-carbonated water. You can only drink a few hours after leaving anesthesia. The clinic provides meals during the stay in the hospital.
• phone charger, favourite book.

 

N A R C O S I S

Before the operation, an anesthesiologist must be consulted!
Anesthesia methods and their use
         Anesthesia during examinations and surgical interventions can be carried out in various ways or their combination.
General Anesthesia (narcosis)
         Anesthesia is a state of deep sleep that begins after injections of a fast-acting sleeping substance and pain medication (drugs).
      This may be preceded by an injection of a sedative substance (sedation). This state of deep sleep is maintained by the anesthetist during the entire operation (manipulation). At this time, consciousness is turned off and the body’s sensitivity to pain is reduced.
         During surgical interventions, various means can be used: quite often, an injection of a substance for anesthesia in a vein is enough to perform surgery.

For prolonged and complex interventions, such remedy is used:

• Respiratory mask, which is applied to the mouth and/or nose (anesthesia mask) or the larynx J-GeІ / laryngeal mask);
• Intubation / endotracheal tube, which is inserted into the trachea; Oxygen and drugs for inhalation anesthesia are supplied through a mask or endotracheal tube.

      During anesthesia, the anesthesiologist constantly monitors the vital functions of the body: blood pressure, heart rate, respiration, oxygen saturation, etc., monitor the depth of anesthesia.
          At the end of the surgery, the introduction of anesthesia drugs stops and you wake up in the operating room, with the feeling like after a deep sleep.
     In cases of prolonged and / or complex surgical interventions, awakening can take place already in the ward of postoperative observation. After waking up in the operating room, you will be in the recovery room for some time, from where you will be transferred to the hospital ward after your full recovery.
       Under certain conditions (volumetric and prolonged surgical interventions, severe preoperative general condition, the presence of serious concomitant pathology, possible complications during the operation, etc.) you will need treatment in the intensive care unit with continuous monitoring of the main systems and functions of the body.
         Before surgery, you will be informed in detail about the possible options for the course of the postoperative period.

Local and regional anesthesia
        In some cases (small, superficial interventions), the elimination of pain sensitivity in the area of ​​surgical intervention is enough – this is local anesthesia. An anesthetic (local anesthetic) is used, which is injected directly into the area of ​​surgical intervention.
        In the case of regional anesthesia, an anesthetic is administered outside the area of ​​surgical intervention, next to the nerve, which is responsible for pain in the area of ​​operation. In this case, the pain sensation is blocked both for the entire duration of the operation and for a certain postoperative period. You remain conscious and can talk, but do not feel pain during surgery.

Safety and risks
        Thanks to exact planning of anesthesia, the use of the most modern methods of anesthesia, constant monitoring during the operation by a doctor – anesthesiologist of vital signs, in most cases, the anesthesia process is completely safe. However, there are some factors (severe general condition of the patient, large volume of surgical intervention, emergency surgery, concomitant diseases, age of the patient, etc.) that can significantly affect the outcome of treatment or even lead to a condition that threatens the patient’s life. Therefore, one of the main tasks of the anesthetist is not only the early detection and elimination of such conditions, but also the prevention of their occurrence.
         You can be sure that in each case an individual approach will be applied to minimize possible risks.

Side effects and complications
       There may be subcutaneous hemorrhage at the injection sites or discomfort that goes away after a while or is easily amenable to therapy. Injection sites can cause inflammation, which, in most cases, are easily eliminated. In extremely rare cases, against the background of reduced immunity, bacteria can enter the bloodstream and lead to a septic state, which requires intensive treatment. There is a low probability of infection with the hepatitis virus, human immunodeficiency, herpes, etc. during the use of blood products.
         Damage to nerve trunks with impaired function of sensitivity and movements is quite rare due to prolonged forced position of the patient in a stationary state during surgery, usually, these complications are temporary and do not require specific therapy.
           Sickness and vomiting may occur as an individual reaction to narcotic drugs (opioids).
          At the same time, there is a danger of the contents of the stomach getting into the respiratory tract, with the possible development of respiratory failure, pneumonia. The risk increases if the patient took alcohol and smoked the day before.
         Sometimes individual allergic reactions occur with increased sensitivity to medications, which may be accompanied by itching, rash, sickness, etc. In most cases, such reactions go away on their own or are easily treatable.
        Severe allergic reactions are rare enough with swelling of the mucous membrane of the larynx and bronchi, respiratory failure and convulsions, cardiac failure and blood circulation. Such complications require intensive treatment and may be accompanied by a violation of the brain, various internal organs and systems (acute renal failure, arterial hypotension, pulmonary oedema, etc.).
         A special place is occupied by complications associated with the formation of blood clots in the middle of the vessels, which can clog them and lead to thrombophlebitis, pulmonary embolism, heart attack, stroke, etc.
        In case of blood coagulation disorders (as a result of a disease or taking drugs that prevent thrombosis), there is a risk of bleeding. Rarely, that respiratory arrest, heart failure, blood circulation, impaired consciousness up to a coma, or a sharp increase in temperature (malignant hyperthermia) develop as a reaction to the use of narcotic drugs and other medicines.

When using local/regional anesthesia techniques, the following symptoms may occur:

– numbness, weakness, restoration of pain in the anesthesia zone;

– post-puncture headache;

– insufficient block during regional anesthesia (may require changes in anesthetic management – conversion to general anesthesia);

– epidural hematoma;

– chronic pain;

– anxiety during regional anesthesia;

– erectile dysfunction, priapism.

When using general anesthesia techniques, the following symptoms may occur:

– unpleasant sensations when swallowing, hoarseness, slight sore throat due to the introduction of an endotracheal tube or a laryngeal mask that quickly pass and usually do not require specific treatment;

– during intubation (insertion of the endotracheal tube), damage to teeth and dentures is possible and even their loss. This is especially true for damaged, untreated and rickety teeth;

– damage to the nose, lips, vocal ligaments, eyes;

– unpredictable recovery of elements of consciousness during anesthesia;

– cognitive impairment, memory impairment, amnesia;

Preparing for pain relief
        Any anesthesia is performed on an empty stomach. In case that there were no other appointments, you should not eat, drink, chew gum, suck candy or smoke from 00.00 hours, or at least 6 hours before surgery. Medicines that you take constantly can be taken only by agreement with your doctor.
        You should inform your doctor about the use of dentures (dental plaques, braces), glasses, contact lenses, hearing aids, jewellery and wigs and leave them in the ward. In some cases (for example, a hearing aid), the doctor may ask you to keep it with you during the operation. It is forbidden to use any cosmetics, apply nail polish, use nail overlays. During the surgical intervention, everything possible will be done so that you can transfer it easily and painlessly. Anesthetist constantly monitors your condition.

   What to expect after applying pain relief?

         At the end of general anesthesia (narcosis), pay attention to the following:
       If after anesthesia you feel breathlessness, pain in the heart, giddiness, cramping in the throat after anesthesia, inform your doctor about these symptoms.
        It is normal if after general anesthesia you will feel sluggish and sleepy. This condition, depending on the type of anesthesia, the volume of surgical intervention, individual characteristics, can last up to several hours and does not give cause to excitement.
       Usually, you can start drinking and eating in small portions no earlier than 2 hours after the end of the operation, but in each case, as directed by the doctor, this time may vary. It is necessary to consult your doctor before taking any food or drink. Smoking and drinking alcohol during the first 24 hours after anesthesia is prohibited.

 

Сontraindications for operations

• Serious somatic diseases of the heart, kidneys, liver and other organs
• Hemophilia. Coagulation failure.
• Pregnancy.
• Lactation period.
• Abnormal tests.
• Drug allergy.
• The tendency of the skin to the appearance of keloid scars.
• Diabetes mellitus (if glycated hemoglobin and glucose profile are normal, then surgical intervention is possible).
• The presence of respiratory diseases (SARS, etc.)

 In the presence of symptoms such as cough, runny nose, aching joints, temperature (up to 37.2) and the period immediately after the SARS is a contraindication to surgery.

The implementation of surgical intervention in this condition can lead to serious postoperative complications and a long recovery period.

• Mental illness.

 

Rehabilitation

          After the operation, it is necessary to follow the appointments and recommendations of the surgeon, as this largely affects the recovery process and the rehabilitation period. The patient must arrive on time for dressing, removal of sutures and postoperative consultation, which is appointed within a month after the operation. The date of such a consultation depends on the type and complexity of the surgery. The patient is advised not to violate the recommendations of the attending doctor. Rehabilitation in each patient takes place individually, depending on the complexity and volume of the operation, the characteristics of the body, the presence of chronic diseases, compliance with the rules of postoperative care and regimen.

General recommendations after surgery:

• At first, you will have discomfort in the seam area and in general with active movement. Itching, a feeling of stiffness a postoperative wound, sensitivity are normal after surgery. You should not have pain similar to those that you experienced before the operation. Before discharge, you will be recommended pain management medications and anti-inflammatory drugs;
• Patients after abdominal surgery should perform breathing exercises;
• For patients of general surgical profile, a special gentle diet is indicated, especially if the operation was performed on the gastrointestinal tract. Patients should wear supportive underwear and bandages, this will help the muscles quickly restore tone. After interventions on the spine, wearing a corset is also recommended;
• Avoid physical exertion that causes pain and leads to stretching of the joints in the area of ​​the operation, not less than 14 days after the operation, in some operations not earlier than 30 days;
• You must eat healthy foods and observe a water regime, and this will help you recover faster. If you need a special diet, your doctor will let you know. This is normal if you have a reduced appetite after surgery. This is an extra reason to eat more often, but in small portions;
• Oedema in the area of ​​operation is a standard reaction of the body to the intervention. In plastic surgery, otorhinolaryngology surgery maximal oedema is observed 1-3 days after surgery. Oedema and possible hemorrhages (bruises) in the operation area will disappear within 14 days;
• It is recommended to give up alcohol and smoking;
• Keep the site of suture clean and dry;
• Avoid thermal procedures (bath, sauna), water procedures (swimming), bathing, up to 30 days;
• It is allowed on the 7th day taking a quick shower (up to 10 minutes) if the seam heals and is dry, or using a special waterproof dressing on the wound;
• You will need to take medication after surgery. Your doctor will tell you how long you have to take the drugs. Make sure you understand the names of the drugs, what they are for, and how often you should take them. Take only those drugs that have been prescribed to you. Talk with your doctor about the need for the drugs you took before surgery. Without consulting a doctor, DO NOT take new drugs (food additives, pain management medications, cold-relief medicine) and do not increase the dosages of old ones;
• Your doctor will tell you when you can return to driving. Until that moment, you can be a passenger as much as you want;
• It is necessary to avoid lifting weights over 5 kg for patients after neurosurgical, traumatological and general surgical operations within 1-2 months after surgery;
• You must have enough rest to avoid overwork. Consult a doctor if lack of sleep affects your behavior or normal sleep patterns do not normalize;
•  After discharge from the hospital, regularly perform the exercises recommended by the physiotherapist and conduct classes to adapt to normal physical activity (ergotherapy);
• After the first stage of restoration, the strengthening of the muscles of the limbs, back, abdominals and restoration of the normal movement pattern come to the fore. At this stage, in addition to physical education, methods of mechanotherapy, classes on simulators, massage, reflexology are used. Physiotherapy is prescribed, in particular, UHF therapy, laser therapy, magnetotherapy, diadynamic therapy, electrophoresis;

Is home rehabilitation possible?

       Perhaps, it is difficult at home to organize all the necessary events. The patient can perform the simplest exercises without the supervision of a physiotherapist, but for a quick recovery, an integrated approach with physiotherapeutic procedures, trainings, massage, psychological support is required.

           At home patients often forget about the need for systematic rehabilitation. Therefore, restoration should be carried out in a specialized centre. We invite everyone to take a rehabilitation course with our physiotherapists, who will select the best course for you at a convenient time with a discount of up to 25%.

These symptoms should be reported to the doctor

• increase in oedema on 4-5 days after surgery;
• increasing pain;
• the appearance of blood or fluid accumulation on the surgical site;
• the appearance of a profuse rash;
• increased discharge from the wound;
• the edges of the wound parted;
• redness and swelling appeared in the seam area;
• increase in body temperature (above 38 degrees Celsius);
• if you have diabetes and your sugar level is much higher than usual.