Memo to the patient: how to prepare for vein surgery

Operations take place in the first half of the day.

The operation is performed on an empty stomach, you should not drink before the operation (at least 8 hours must pass after the last meal or drink).

The operation is not performed in the period immediately before, during or immediately after menstruation.

Operations are not performed during acute infectious diseases and during exacerbation of chronic diseases.

After discharge from the clinic (after operations) or after some non-surgical corrections, it is not recommended to drive independently.

How to prepare for surgery

Your good physical condition and optimistic attitude are an important factor in the success of the operation. Therefore, we recommend that you approach the preparation for surgery seriously and calmly, and assist the surgeon in achieving the best result. All factors that influence the course of the operation and facilitate rehabilitation must be discussed with your doctor and be sure to follow all his recommendations.

Here are the main factors influencing the success of the operation:

• Your well-being, health status, psychological state;
• It is necessary to postpone plastic surgery if there is the slightest symptom of ARVI until complete recovery and restoration of strength after the disease.
• Bring the surgeon's attention to any infection to which you are susceptible (herpes, infection of the skin, eyes, genitourinary tract).
• If you have chronic diseases, you should consult about the possibility of plastic surgery with your attending physician, and do not undergo surgery during an exacerbation of a chronic disease.
• Do not decide to have surgery when you are stressed or depressed. You should not have plastic surgery during a period of family troubles or divorce proceedings. During the post-rehabilitation period, you will need a calm environment, support and understanding of loved ones.
• Smoking and excessive alcohol consumption can weaken your health. If you are constantly taking medications, hormonal drugs, have been prescribed any other medications, or are undergoing treatment with traditional medicine, you must inform your plastic surgeon and anesthesiologist about this.
• Be sure to tell your anesthesiologist and plastic surgeon if you have any allergies to medications or any other products.
• Together with a plastic surgeon, carefully analyze and evaluate all the structural features of your body: asymmetry of the mammary glands or chest, shoulder position, structural features of the sternum and ribs, skin condition (presence of stretch marks).
• Do not hesitate to ask your plastic surgeon about any questions that remain unclear to you. Achieve complete mutual understanding between you and your doctor. Be sincere and open. If after all the discussions with the doctor you still have at least minimal doubts about the result, do a computer simulation.
• If you are prone to bleeding or bruise frequently or have nosebleeds, tell your surgeon and anesthesiologist.
• The formation of a thin and invisible postoperative scar largely depends on your compliance with your doctor’s recommendations. Excessive stretching and friction of the seam provokes the formation of a rough scar! Follow your plastic surgeon's instructions for suture care exactly and completely. Wear compression garments for as long as prescribed.

Our task is to make your life more beautiful. We do not perform operations for life-saving reasons, but after surgery in our center, your life will change: you will feel beautiful and confident, young and desirable. Be consistent and persistent in achieving your goal, help the plastic surgeon make your dream come true and it will definitely come true.

What you need to know to properly prepare for anesthesia.

• Operations cannot be performed during acute infectious diseases. Common colds and acute respiratory infections are the most common reasons for postponing surgery
• If you have chronic diseases, then before surgery under general anesthesia they should be in a state of stable remission (without exacerbation).
• The anesthesiologist may prescribe additional studies and consultations that are not included in the mandatory list, as well as reschedule and even cancel surgery for your safety.
• It is necessary to remember in advance (make a list) and inform the anesthesiologist about all existing diseases, operations, allergic reactions and medications that you are taking. In this case, no information can be insignificant or superfluous.
• You must remove all jewelry, piercings and contact lenses. It is advisable to keep your fingernails free of false nails and polish, as this may interfere with the operation of some sensors.
• For surgery, it is recommended to wear underwear made of natural cotton (no synthetics).
• You should not drink or eat before surgery. (6 hours before surgery, you must avoid taking any food or drink). The evening before surgery, prepare yourself a light dinner.
• If you are taking any medications, be sure to inform the anesthesiologist in advance, as some medications must be stopped before surgery.

Meeting with an anesthesiologist. What is useful to know before surgery?

The first time a patient meets with an anesthesiologist is after the surgeon proposes and the patient agrees to undergo surgery. At this stage, it is very important to tell the doctor all the information he is interested in. This will help the anesthesiologist determine the plan for the necessary anesthetic examination and the method of anesthesia that should minimize the risk during the proposed operation.

During the second meeting (as a rule, it takes place on the eve of the operation), the anesthesiologist must assess the patient’s level of preparedness, finally decide on the anesthetic management technique and discuss all issues of interest with the patient.

The patient is not just an object for performing an operation, he is a full-fledged participant in the process, whose understanding, determination and help are the key to the success of the upcoming intervention. However, he should not overestimate his capabilities: studying encyclopedias, accessing the Internet and time-limited conversations with doctors are not able to make him an expert in either surgery or anesthesiology.

Nevertheless, the patient has the right to express, and the anesthesiologist, if possible, to take into account the patient’s wishes regarding the proposed method of anesthesia.

! What you need to know from your anesthesiologist before surgery:

• time after which food and liquids are prohibited. Usually the last meal is allowed no later than 18:00 on the eve of surgery; On the morning of the operation, you should not drink anything, including water. This ban is the best prevention of life-threatening complications during anesthesia - vomiting and vomit entering the respiratory tract;
• the time when it is necessary to stop or limit the intake of certain medications (the patient should check their exact list with the anesthesiologist);
• the time it takes to quit smoking.

! Please consult with your anesthesiologist about what restrictions you need to follow. Particular attention should be paid to preparing for anesthesia in children!

! What else is useful to learn from an anesthesiologist?

• The nature of premedication (drugs administered before surgery) and the time of its implementation.

! You should not stop taking sedatives or sleeping pills on the eve of surgery. Any person, no matter how courageous he is, inevitably worries on the eve of surgery. As a result, a persistent focus of excitation may develop in the brain, which will require the use of higher doses of anesthesia drugs and will reduce the rate of post-anesthesia recovery.

• How should you behave during induction of anesthesia?
• What is the expected duration of the operation?
• How long will it take you to come to your senses, how will the awakening process go, when will you be able to see your relatives?

In what case can the operation be cancelled?

Despite the fact that hospitals are equipped with modern high-precision equipment and the anesthesiologist has the necessary medications in his arsenal, surgery and anesthesia still require special attention to the patient’s health. There are conditions that increase the risk of complications of surgery and anesthesia, and in this regard are a contraindication for elective surgery. This can be an acute illness (most often acute respiratory viral infection), an exacerbation of a chronic disease, or an insufficient level of compensation for a concomitant disease.

The situation when a planned surgical intervention is postponed by an anesthesiologist is not a consequence of his reluctance to perform anesthesia, but of concern for your health.

Are there any risks of complications during anesthesia?

There are no medical procedures without risk. Even a carefully selected anesthesia option can lead to undesirable reactions in a particular organism. However, an anesthesiologist has sufficient knowledge, skills and tools to cope with even a complex situation.

Is there a risk of waking up during anesthesia?

Rare cases of intraoperative awakening have been described in the world literature, but nowadays anesthesiologists use modern objective methods of monitoring the level of consciousness, which makes it possible to successfully prevent such episodes even in cases where the patient cannot report it. Thus, the risk of waking up during surgery is almost reduced to zero.

Will it hurt during the operation?

The primary task of the anesthesiologist is to protect the patient from pain. In some cases, due to the characteristics of the body, anesthesia may not completely eliminate pain sensitivity, however, the anesthesiologist always has a number of alternative techniques in his arsenal that will help him cope with any situation and prevent the presence of pain. The anesthesiologist remains close to the patient throughout the operation and has all the necessary knowledge and equipment to provide safe and comfortable anesthesia.

Communication between patient and doctor presupposes a high degree of trust in the professional competence of the anesthesiologist. The patient has the right to express, and the anesthesiologist, if possible, to fulfill wishes about the method of anesthesia. However, it is also important to stop in time; the patient must understand, no matter how unique his case may seem to him, something similar has probably already happened in the anesthesiologist’s practice.

Under no circumstances does the anesthesiologist seek to violate the patient’s prohibition on carrying out certain activities. But, if the patient imposes such a restriction, he must be aware that no doctor approaches him with the desire to harm. Any proposed treatment is aimed at benefit, and a categorical prohibition may prevent the development of complications.

The conversation between the patient and the anesthesiologist ends with the signing of a document called “Patient Informed Consent for Anesthesia,” which records the results of the conversation, including information about which treatment methods the patient considers unacceptable. Both the patient and the anesthesiologist must understand that any expression of the patient’s will does not relieve the doctor from moral and legal responsibility for the patient’s life.

The material was prepared with the support of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”.

You will need to refrain from eating and drinking if you are going to:

• General anesthesia. This type of anesthesia turns off the patient's consciousness. You see nothing, hear nothing, feel no pain, your muscles completely relax, and after the operation there are no memories of it. Some types of general anesthesia are given intravenously, sometimes it is a gas that you are given to inhale.
• Regional anesthesia. This type of anesthesia numbs any part of the patient's body, for example, a leg, arm, or lower half of the body. Typically, the numbing agent is given through a catheter or injection.
• Sedation. These are sedatives, after which a person relaxes and can fall asleep. Sedatives are injected into a vein using an injection or catheter.

Indications for general anesthesia

Some cases in practical surgery and dentistry are a direct indication for the use of general anesthesia during therapeutic procedures. However, even if they are available, the use of anesthesia raises many doubts and questions about the general health of the patient, which may have contraindications. To eliminate all risks, the patient undergoes a certain examination of the body, based on the results of which the doctor decides on the advisability of this type of anesthesia.

The following types of dental treatment can be performed under sedation or general anesthesia:

• extraction of 3 molars, which are located in the jaw bone in an extremely complex manner, which involves drilling and crushing tooth tissues and roots, which have a complex and tangled structure;
• bone grafting with immediate implantation;
• the need for prosthetics or implantation of several dental units;
• one-stage removal of several teeth;
• elimination and treatment of a large volume of carious lesions on the dental surface;
• injuries of the maxillofacial apparatus, requiring a large scale of restoration work;
• treatment of advanced forms of pulpitis or widespread periodontitis;
• surgeries on the temporomandibular joint;
• a burdened allergy history, which does not allow treatment with local anesthetics;
• the patient has a pronounced gag reflex;
• insurmountable fear of dental procedures, accompanied by characteristic sounds, smells and tactile sensations;
• the patient has severe mental illness (schizophrenia, mental retardation);
• children under 3 years of age, which is due to inadequate patient contact and the presence of a large volume of dental work;
• genetic pathologies (autism, Down syndrome);
• patients with somatic pathologies in a compensated state to prevent exacerbation, for example, hypertension or neurasthenia;
• epilepsy.

In cases of treatment in government institutions with a hospital, you will always be persuaded to undergo treatment under anesthesia followed by hospitalization, since this is strictly regulated by the internal regulations of hospitals.

In paid non-state clinics, all these types of treatment will be carried out only under sedation and without hospitalization, since there is no need to extend the stay and duration of treatment.

The list of indications is quite large, but it may have limitations. Whether it is possible to treat teeth under anesthesia in a particular case will be determined only by an experienced anesthesiologist, who must be on the staff of specialists in a modern dental clinic that provides comfortable and effective service.

Nervous system. Brain

Smoking forms an addiction to the process; nicotine affects receptors, and through them neurons. Apparently, it is the interference of nicotine in neural connections that leads to the fact that in smokers:

• the reaction to preoperative premedication (drug preparation) is weakly expressed, and this complicates the course of the preoperative period and the early stage of induction of anesthesia;
• the pain sensitivity threshold is higher, which worsens the course of the postoperative period;
• The period of pre-anesthesia preparation and the anesthesia itself (mostly intubation) is more difficult.

Another effect of nicotine on VSN is the activation of adrenaline production, which leads to bright or smoothed signs of a panic attack, and over time causes disturbances in the physiology of the central nervous system and vascular tone, leading to the formation of arterial hypertension

But the cells of the vomiting center “trained” by smoking facilitate the course of the postoperative period by reacting weaker or not at all to the vomiting-stimulating effect of anesthesia drugs.

What questions should you ask before vein removal?

Before you go on the operating table, do not hesitate to ask the doctor anything that concerns you. You must fully understand what the essence of the operation is, what the risks are, how long it will take to recover after surgery, what restrictions phlebectomy imposes, and whether you will be able to fully perform your usual activities. Find out all the details regarding preoperative preparation during the consultation. Usually the doctor issues a special reminder, but it would be useful to clarify.

Tell us about allergies, concomitant diseases, experience of previous operations, medications, vitamins, hormonal contraceptives that you take. All this is important when deciding on the method of treatment and anesthesia.

Why can’t you eat or drink before surgery?

Sometimes you should not eat or drink before surgery or other medical procedures.
It depends on what kind of surgery you are having and what kind of anesthesia you will need. Before elective surgery or other medical procedures, your doctor or nurse will ask you not to eat or drink anything. If you are undergoing local anesthesia, you will most likely not need to fast from food. Local anesthesia numbs a small area of ​​the body and can be used as an ointment, spray, gel or injection.

How anesthesia and anesthesia work: myths, fears, side effects

An alternative to spinal anesthesia can be epidural, when a local anesthetic is injected into the epidural space located in the spine through a special catheter. Depending on the type of operation (chest, abdominal cavity), the anesthesiologist determines the place of its introduction. In this case, the doctor can inject not only a local anesthetic into the epidural space, but also opioid painkillers that enhance the effect. Sometimes the epidural catheter may be left in place temporarily to provide pain relief as required by the patient (called an extended epidural).

More complex and serious interventions are always associated with lengthy preparation on the part of the anesthesiologist - installation of a central venous catheter, administration of infusion therapy, correction of blood coagulation parameters and other important parameters. It is also important to consider whether the operation is an emergency or a planned one.

Can you tell me more about the difference between spinal and epidural pain relief?

During spinal anesthesia, the drug is injected at the lumbar level into the subarachnoid space (into the cavity between the pia mater and the arachnoid mater of the spinal cord, filled with cerebrospinal fluid). Usually everything is limited to a couple of injections. In this way, the soft tissues above the injection site are anesthetized and the drug is directly administered under the dura mater. This anesthesia lasts from two to six hours and is technically easier to administer.

During epidural anesthesia, the drug is injected into the space between the dura mater of the spinal cord and the periosteum of the vertebrae, which contains connective tissue and venous plexuses. It is located closer to the skin compared to the spinal one. Anesthesia is given at any level of the spinal column. It is considered a technically more complex manipulation.

I've read that epidurals can cause paralysis.

This is a common fear, but anesthesiologists say that today it is practically impossible. Such a complication could arise after surgery due to improper care of the catheter, as a result of which the patient developed purulent epiduritis, which caused neurological symptoms with loss of function of the lower extremities. Or due to incorrect actions of the anesthesiologist, when puncture of the epidural space occurs at high levels (there is a risk of unintentional damage to the spinal cord). But in most cases, epidural anesthesia does not threaten anything other than a headache for several days after surgery.

Can everyone have anesthesia?

In life-threatening situations when a person needs surgery, doctors almost always use anesthesia. For example, if there is a victim of an accident on the couch who urgently needs surgery, the risk of having it performed with anesthesia for any health condition will be less than the risk of refusing it.

If a patient comes for a planned operation, then the anesthesiologist is obliged, after collecting an anamnesis, to select the appropriate type of anesthesia taking into account the patient’s health. Doctors are guided by the rule: the volume and risk of anesthesia should not exceed the risks on the part of the surgeon. The patient's age cannot be a contraindication. Specialists take into account all severe chronic diseases that complicate the state of health, and allergic reactions to anesthesia components.

Is there a difference between old and new drugs?

Yes there is: in their consumption, efficiency and safety of use. However, it is invisible to patients; To appreciate the difference, you have to be an anesthesiologist.

How to prepare for anesthesia and how to survive recovery from it?

Preparation depends directly on the type of anesthesia and surgical intervention. The doctor will tell you what and how best to do before the operation. Just build a trusting relationship with your treating doctors, it will be much calmer.

Each patient experiences recovery from anesthesia individually; not everyone feels bad, but many feel nausea and drowsiness, and muscle tremors. It all depends on the characteristics of the body and the drugs that were administered during the operation. After waking up, it is important to listen to your body and report any deviations to your doctors.