Regardless of the anesthetic to be given, patients require certain preparations for their anesthetic as well as for the operation itself. In major cases the preparations must include hospitalization of the patient several hours before the anticipated operation, unless of course it is an emergency procedure.
In some cases it may be necessary to have the patient in the hospital several days before operation, but usually the patient is admitted to the hospital the day before the elective operation. This permits the patient to become adjusted to hospital routine before the operation. It also provides a period of evaluation of the patient. The necessary laboratory tests are done, and an accurate account of the temperature, pulse, and respirations is kept. This is particularly important when general anesthesia is contemplated, for the variations in these readings are important signs while a person is anesthetized. Likewise, the basal blood pressure levels may be learned. The surgeon, the anesthetist, or a hospital physician will make the necessary physical examinations during this period, to make certain that there has been no significant change in the operative indications and no superimposed illnesses since the surgery was scheduled. Operative and anesthetic complications could be due to a concurrent illness, such as a cold or infectious disease, but can be obviated when the surgical team is aware of such. The extra day spent in the hospital before operation may save many days in the postoperative period. It is a false economy to avoid this pre- operative hospitalization period.
One of the more distressing occurrences while the patient is under general anesthesia, and often while he is recovering from the anesthetic, is vomiting. This is particularly to be avoided while the patient is anesthetized because of the likelihood of aspirating (sucking) some of the vomitus into the lungs; while reacting from the anesthetic it is of concern for the patient’s comfort. For these reasons it is important that the patient take absolutely nothing by mouth for a few hours before general anesthesia. This means absolutely nothing to eat or drink, except as specifically given to the patient, such as a pill with a small amount of water or other necessary exception, by one of the hospital nurses. This is actually sufficient reason in itself to admit the surgical patient several hours before the scheduled operation. The anesthetist must know that there has been absolutely nothing eaten or drunk before the anesthetic is given.
It is important for patients who are to undergo major anesthesia and major surgery to have a period of rest. This is best provided in the hospital by having the patient enter the day before. Usually a sedative is given the evening before to assure an adequate night’s sleep. Well-meaning visitors will be asked to leave early the night before operation to assure adequate rest and allow time for the necessary tests and examinations. Only a brief visit with the closest relative will be allowed on the morning of operation, if at all. This is to allay apprehension and mental unrest.
One of the first steps in the production of anesthesia is the administration of the preanesthetic medication. This is given by hypodermic injection and is often referred to as the “preop hypo.” Proper anesthesia is contingent upon this medication; and drug, dosage, and time are chosen very specifically according to the surgical procedure, the anesthetic, and the individual patient. The selected drugs produce definite useful effects, and the safety and effectiveness of the anesthesia are influenced by the preanesthetic medication. This is ordered by the surgeon or the physician anesthetist. The hypo may be given anywhere from one half hour to several hours prior to the operation, and often more than one is given.
The premedication has several functions. To be sure, a patient contemplating an operation and exposed to all the strange sights, sounds, and aromas of the operating room will become apprehensive. This state of apprehension and actual fear can be minimized by the sedative effects of the medication given beforehand. When local anesthesia is to be used, the patient can more easily remain calm and co-operative. The memories of the operation are more pleasant.
The sedative action of the medication also reduces the amount of the agents needed to produce adequate anesthesia, and thereby increase the safety of the anesthesia. This is brought about by the lowering of all the body metabolisms, i.e. slowing the chemical actions of the body, so that less of the anesthetic is required to depress the proper parts of the nervous system to a state of anesthesia. The slowing of body processes also makes elimination and neutralization of the anesthetic agents take place more slowly so that the effects will last longer. This is true for both local and general anesthesia. Also, when local anesthesia is to be employed, the patient is not nearly so susceptible to pain after the premedication, so less of the anesthetic drug is needed.
The preanesthetic medication also is used to counteract some of the undesirable effects during anesthesia. With general anesthesia it is necessary to minimize the amount of nose and throat secretions so that they will not collect to hinder the airway. When such “drying” drugs are used the patient’s mouth may feel dry and “cottony,” but this is to be desired. Likewise any other specific actions may be depressed by preoperative drugs.
The entire preoperative and preanesthetic preparation of the surgical patient is an important phase of the treatment plan. Understanding the various steps will help you realize their significance and import. Anesthesia can be no haphazard or spur-of-the-moment decision. It must be planned.