ERICK GARCIA G 1A

TOPIC - OPERATION, ANESTHESIA.

Operation
Surgical operation is a mechanical effect on tissues and organs for therapeutic
or diagnostic purposes.
Surgical intervention includes:
1) tissue incision in order to detect the affected organ;
2) performing an operation on the organ itself;
3) the connection of tissues, disturbed during the operation.

Types of stages
Analgesia stage (I)
The patient is conscious, but inhibited, asleep, answers questions in
monosyllables. There is no superficial pain sensitivity, but tactile and heat
sensitivity is preserved. During this period, it is possible to perform short-term
interventions (opening phlegmons, abscesses, diagnostic studies). The stage is
short-term, it lasts 3-4 minutes.
Arousal stage (II)
+At this stage, inhibition of the centers of the cerebral cortex occurs, but the
subcortical centers are in a state of excitement: there is no consciousness,
motor and speech excitement is expressed. Patients scream, trying to get up
from the operating table. The skin is hyperemic, the pulse is frequent, the
blood pressure is increased.
Surgical stage (III)
With the onset of this stage of anesthesia, the patient calms down, breathing
becomes even, the pulse rate and blood pressure approach the initial
level. During this period, it is possible to carry out surgical interventions.
Awakening stage (IV)
+As soon as the supply of narcotic substances stops, the concentration of the
anesthetic in the blood decreases, the patient goes through all the stages of
anesthesia in the reverse order, and awakening occurs.
Types of operations
According to the nature and objectives of the operation surgery are divided
into radical and palliative diagnostic..
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Radical operations are surgical interventions in which they seek to

completely eliminate the pathological focus, for example, resection of the
stomach with a tumor, amputation of a limb.
Palliative operations are surgical interventions that are aimed at alleviating
the patient's condition (if it is impossible to remove the affected organ) and at
eliminating life-threatening symptoms.
Diagnostic operations are usually applied to a basic operation to complete
diagnostics (biopsy, puncture et al.).
According to the urgency of the implementation, there are emergency,
urgent and planned operations.
Emergency operations require immediate execution (stopping bleeding,
perforation of the stomach and intestines). Preparation for such operations
lasts no more than 1.5 hours.
Urgent operations are those that are postponed for several days to clarify the
diagnosis and prepare the patient for surgery.
Planned operations are performed after a sufficiently complete examination
and appropriate preparation of the patient for the operation.
In surgery are two main moments that: quick access and quick reception.
Surgical access is the part of the operation that provides the surgeon with
exposure of the organ. Depending on a number of conditions - clinical,
morphological, oncological, the surgeon can approach the same organ from
different approaches.
Surgical reception is the main part of surgical intervention on the affected
organ, the chosen method of eliminating the pathological focus, and the
peculiarities of the technique of this operation.

Anesthesia
State of controlled, temporary loss of sensation or awareness that is induced
for medical purposes. It may include some or all of analgesia (relief from or
prevention of pain), paralysis (muscle relaxation), amnesia (loss of memory),
and unconsciousness.

Types of general and local anesthesia.

General anesthesia
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Artificially induced, deep sleep-like, reversible state in which any (including

pain) sensations are suppressed and the patient's consciousness is turned off,
the muscles of the body are relaxed.
The patient does not remember what happened during the anesthesia. This
condition is maintained by the anesthesiologist during surgery by
administering certain drugs for anesthesia (anesthetics).

General anesthesia can be maintained in a number of ways:

• repeated or continuous administration of drugs through a venous
catheter (intravenous anesthesia).
• with a mask applied to the mouth and nose area (general anesthesia with
a face mask).
• with a laryngeal (laryngeal) mask, which is passed through the mouth,
is located in the pharynx and covers the entrance to the larynx, or
• with a breathing tube that is placed through the mouth into the airway
(trachea) (general anesthesia with mechanical ventilation through a tube
in the trachea).

Local Anesthesia
The essence of local anesthesia is to block the conduction of nociceptive
impulses from the operation area at different levels. Local anesthesia
captivates with maximum safety, low cost, and no need for sophisticated
equipment.
All methods of local anesthesia can be grouped into three main types:
1. Terminal (surface, contact) anesthesia. Anesthesia is achieved by direct
contact of the anesthetic solution with mucous membranes (drops,
aeration, tampons soaked in anesthetic, etc.). 0.5-1% solutions of
dicaine, 5-10% solutions of novocaine, trimecaine and lidocaine are
used. Anesthesia is applied to the upper respiratory tract, food water,
conjunctiva, urethra.
2. Infiltration anesthesia. It consists in a tight layer-by-layer infiltration
of soft tissues in the area of operation with 0.25-0.5% solutions of
novocaine. It can be used for any surgical intervention in any area of the
human body. The method is simple, but somewhat cumbersome and
violates the topographic relationship of the tissues.
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3. Regional anesthesia. With this type of local anesthesia, the anesthetic

solution is injected not into the operation area, but at a certain distance
from it, so the topography of the operation area is not disturbed.

Intravenous anesthesia
It is performed using tourniquet during operations on the
upper and lower extremities. It consists in intravenous
administration distal to the arterial tourniquet of 0.5-1%
solutions of novocaine, lidocaine in a volume of 20-60
ml.

INTROSOUS ANESTHESIA. It is performed during

operations on the limbs. It consists in the introduction
into the cancellous bone of a 0.5% solution of novocaine
in a volume of 20-60 ml.
ANESTHESIA IN THE REGION OF
HEMATOMA. It is carried out with fractures of the
bones of the extremities, with closed reduction of
fragments. 10-30 ml of a 2% solution of trimecaine or
lidocaine is injected into the hematoma of the bone
fracture area.
CONDUCTOR ANESTHESIA. It is carried out during
surgical interventions on the limbs. Through the
injection needle, a 1-2% solution of local anesthetic in a volume of 10-15 ml /
kg of the patient's body weight is brought to the nerve trunk.
PLEXUS ANESTHESIA. Anesthesia of the cervical and brachial plexuses is
carried out during operations on the upper limb and the upper shoulder girdle
with 1-2% solution of novocaine or lidocaine in a volume of 10-15 ml / kg.
PARAVERTEBRAL ANESTHESIA. Switching off the sensitivity of the
intercostal and lumbar nerves at their exit from the intervertebral
foramen. Each segment is anesthetized separately by injecting 6-10 ml of a
0.5% solution of trimecaine or lidocaine into one point. It is used to relieve
pain in trauma and after operations on the abdominal and chest organs.
PRESACRAL ANESTHESIA. It consists in the blockade of sensory nerves
at the site of their exit from the 5 sacral foramen. The approach to the nerves
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is between the rectum and the anterior surface of the sacrum so that the needle
slides over the bone in the direction of the row of holes. Apply a 0.5%
solution of trimecaine, novocaine, or lidocaine in a volume of 6-10 ml for
each point. Provides good anesthesia for the pelvic organs.
SACRAL (CAUDAL) ANESTHESIA. It is achieved by introducing a 2%
solution of trimecaine or lidocaine in a volume of 10-20 ml through the sacral
fissure into the distal part of the epidural space. Provides anesthesia for the
pelvic organs, perineum and lower extremities.
SPINAL ANESTHESIA. It is achieved by the introduction into the
subarachnoid space by means of spinal puncture of 2% lidocaine solution in a
volume of 3-5 ml. Analgesia, muscle relaxation and sympathetic blockade
develop, sufficient for operations on the lower extremities, pelvic organs, and
abdominal cavity.
EPIDURAL ANESTHESIA. It is achieved by introducing a 1-2% solution of
trimecaine or lidocaine into the epidural space at a dose of 10 mg / kg of body
weight. It is used in operations on the organs of the chest, on the upper and
lower levels of the abdominal cavity, small pelvis, and on the lower
extremities.

Endotracheal anesthesia
✓ The best method for operations on the head and neck and for any other
operation in which there may be a difficulty in controlling the patient's
air-way.
✓ Expiration should be provided for, in endotracheal anaesthesia, either
by means of a second tube or by a tube of calibre sufficient to permit to-
and-fro respiration.
✓ Cocainization of the upper air-passages has decided advantages in
endotracheal anaesthesia.
✓ "Blind" intubation through the nose renders the method possible in
cases where it is impossible to use a speculum.
✓ The insufflation method is not specially indicated in abdominal surgery.
✓ The routine use of endotracheal anaesthesia in teaching-hospitals for
every class of case is detrimental to the production of sound anaesthetic
knowledge in students who are likely to become general practitioners.