Pre-surgical preparation is closely related to the priority and scope of the patient’s surgery as well as the patient’s physiological condition. Surgery for patients can be divided into three types.
(1) Elective surgery: such as major gastrectomy for gastric and duodenal ulcer disease.
(2) Surgery of limited duration: such as surgery for malignant tumors.
(3) Emergency surgery: such as appendectomy in acute appendicitis. Various potential factors that may affect a patient’s ability to tolerate surgery include heart, lung, liver, kidney, endocrine, blood, immune system function, and nutritional and metabolic status. Accordingly, patients can be divided into those with good surgical tolerance and those with poor surgical tolerance.
Pre-operative preparation is a two-pronged and indispensable process for both the surgeon and the patient. It includes psychological preparation and physiological preparation.
1.Psychological preparation
The patient’s heart is very active before surgery, and there are many changes and contradictions in the heart, which often lead to anxiety, and the common reasons are.
(1) Worries about the effect of surgery: mainly about the regression of the disease, survival and quality of life.
(2) lack of understanding of anesthesia and surgery: mainly concerns about anesthesia, surgical accidents, complications, etc.
(3) Influence of previous surgical experience:: The painful surgical experience makes patients ambivalent and worried about the occurrence of such situations.
Pre-operative anxiety is a normal phenomenon. Mild anxiety is beneficial for the patient and the medical staff to cooperate and successfully pass the perioperative period and cure the disease. Those without anxiety are not prepared for the difficulties and dangers of surgery, and once they encounter difficulties, they can hardly bear it in their hearts, which will affect the treatment effect more than those with severe anxiety. For this reason, patients should do the following.
(1) Establish a good doctor-patient relationship: mutual respect and understanding are the cornerstones of a good relationship; do not misrepresent without believing, but see what you see and communicate frankly.
(2) Understand the condition and treatment plan: The doctor should give a detailed description of the condition and treatment plan to the patient, and the patient should trust and cooperate with the doctor, do all kinds of examinations and prepare for the surgery.
(3) Detailed understanding of possible intraoperative and postoperative conditions: Preoperative talk and signature is an important platform for doctor-patient communication. Patients and family members should fully understand the intraoperative and postoperative complications written by the doctor before signing. Otherwise, once there is easy to cause fear of prevention and even unnecessary misunderstanding, affecting the next step of treatment.
2.Physiological preparation
The purpose of physiological preparation is to enable the patient to maintain a good physiological state in order to safely survive the surgery. The main points are as follows.
(1) Exercises to adapt to the changes after surgery: for example, practicing bed urination and defecation, practicing the correct method of coughing and sputum production, stopping smoking from 2 weeks before surgery, etc.
(2) Blood preparation and rehydration: correct the preoperative imbalance of water, electrolyte metabolism and acid-base balance and anemia, do blood type identification and cross-matching test before surgery, prepare a certain amount of blood products, and pre-collect autologous blood for patients with conditions.
(3) Prevention of infection: patients should be included to avoid cross-infection, medical personnel should pay attention to the principle of asepsis and gentle intraoperative operation to reduce tissue damage. Indications for prophylactic use of antibiotics are: surgery involving infected lesions or incisions close to infected areas; gastrointestinal surgery; major surgery with long operation time; contaminated trauma with long clearing time or difficult to clear completely; cancer surgery and vascular surgery.
(4) Gastrointestinal preparation: mainly for gastrointestinal surgery, the patient should start a liquid diet 1 to 2 days before surgery, and if gastric surgery is performed, the stomach should be cleaned and washed before surgery. If colorectal surgery is performed, a clean enema should be administered and oral intestinal antiseptic drugs should be started 2 to 3 days before surgery to reduce the chance of postoperative infection. For other surgeries, patients should fast from 12 hours before surgery and from 4 hours before surgery, to prevent aspiration, asphyxia or aspiration pneumonia caused by anesthesia or vomiting during surgery.
(5) Calories, proteins and vitamins: Elective surgery is best performed about 1 week before surgery, with adequate calories, proteins and vitamins provided orally or intravenously to facilitate postoperative tissue repair and wound healing and to improve the ability to defend against infection.
(6) Others: check the patient once a day before or in the morning of the operation, if there is fever or the female patient has menstrual flow, the operation date should be delayed; give sedatives the night before the operation to ensure the patient’s adequate sleep; empty the urine before entering the operation room and leave the catheter in place if necessary; remove the denture before the operation to prevent accidental swallowing, etc.