When a child, a teenager or an adult have Hunter Schafer Before 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 before the surgery as such. After the surgery the supporting measures are disconnected in a specific sequence.
All the measures are essentially the same for children and adults, but the psychological preparations will differ for different age groups and the supporting measures will sometimes be more numerous for children.
The following is a nearly complete listing of all measures undertaken by surgery and their typical sequence. All 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 exactly the same way at the place where you have surgery or perhaps work.
Greatest variation is perhaps to be found in the choice between general anesthesia and only regional or local anesthesia, especially for children.
There will always be some initial preparations, of which some often will take place in home before going to hospital.
For surgeries in the stomach area the digestive system often has to be totally empty and clean. This is achieved by instructing the patient to stop eating and only keep on drinking at least one day before surgery. The patient will also be instructed to take in some laxative solution that 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, to avoid content in the stomach ventricle that can be regurgitated and cause breathing problems.
When the patient arrives in hospital a nurse will receive him and he will be instructed to shift to some kind 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 often also get an enema in hospital. This can be given as one or more fillings of the colon through the rectal opening with expulsion at the toilet, or it can be given by repeated flushes through a tube with the patient in laying position.
Then the nurse will take measures of vitals like temperature, blood 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 a further examination to ensure that the patient is fit for surgery, like listening to the heart and lungs, palpating the stomach area, examining the throat and nose and asking about actual symptoms. The anesthetist may also ask the patient if he has certain wishes about the anesthesia and pain control.
The patient 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 some societies consent is assumed if objections are not stated at the initiative of the patient or the parents.
Technically most surgeries, except surgeries in the breast and a few others can be performed with the patient awake and only with regional or local anesthesia. Many hospitals have however a policy of using general anesthesia for most surgeries on adults and all surgeries on children. Some may have a general policy of local anesthesia for certain surgeries to keep down cost. Some will ask the patient which type of anesthesia he prefers and some will switch to another kind of anesthesia than that of the policy if the patient demands it.
When the anesthetist have signaled green light for the surgery to take place, the nurse will give the patient 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 as an injection through the anus.
The purpose of this medication is to make the patient calm and drowsy, to take away worries, to alleviate pain and hinder the patient from memorizing the preparations that follow. The repression of memory is seen as the most important aspect by many medical professionals, 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 is so drowsy that he calms totally down. Then the patient is wheeled into a preparatory room where the induction of anesthesia takes place, or right into the operation room.
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