Things to do before surgery: preoperative preparation
1.Correct or improve the pathophysiological state
①Make hemoglobin ≥ 80g/L, albumin ≥ 30g/L, correct dehydration, electrolyte disorders and acid-base imbalance;
②People with a history of heart failure, atrial fibrillation or significantly enlarged heart should be treated with digitalis drugs;
③ Pre-operative maintenance treatment with digitalis should be stopped on the day of surgery;
(④) Long-term β-blockers should be stopped 24 to 48 hours before surgery;
(5) Control blood pressure below 180/100mmHg for hypertension;
(6) For combined respiratory diseases, lung function, blood gas and chest X-ray should be checked before surgery, and smoking should be stopped for at least 2 weeks;
(7) Combined with acute and chronic lung infections, apply antibiotics to control infection and promote sputum excretion by nebulized inhalation;
(8) Diabetic patients should control blood sugar not higher than 8.3 mmol/L, urine sugar lower than ++, and negative urine ketone body;
(9) Surgery after correction of acidosis in emergency with ketoacidosis; if immediate surgery is needed, insulin can be supplemented intraoperatively.
2.Psychological preparation
3.Gastrointestinal preparation
① Fasting for 12 hours and drinking for 4 hours before elective surgery.
②Fast food/milk for 4-8 hours and water for 2-3 hours before surgery for pediatric patients;
③Cell stomach and need immediate surgery: consider endotracheal intubation in the awake state of the patient, which is conducive to avoiding and reducing the occurrence of vomiting and misaspiration.
4.Preparation of anesthesia equipment, appliances and drugs
Prepare anesthesia machine, emergency equipment, monitoring equipment, etc.
Preparation and verification of drugs.
Preoperative medication
1.Objectives.
① Eliminate tension, enhance the effect of anesthetic drugs, reduce the amount of anesthetic drugs, and have an amnesic effect on some adverse stimuli.
②Increase the pain threshold.
③Inhibit the secretion of respiratory glands to prevent misaspiration.
④ Eliminate the vagal reflex and other undesirable reflexes, inhibit sympathetic excitation caused by agitation or pain, and maintain hemodynamic stability.
2.Drug selection.
① General anesthesia: sedatives and anticholinergics are the main drugs.
②Lumbar anesthesia: sedative drugs are mainly used.
③Epidural anesthesia: analgesics (greater chance of puncturing the arachnoid membrane and damaging the spinal nerve).
Injected intramuscularly 30-60 minutes before anesthesia.