Surgery, pre- and postoperative periods lecture for students of the Faculty of Dentistry. Section of the presentation on the topic of surgery Complications of the postoperative period from the respiratory system

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Putting on a surgeon's gown

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Putting on gloves

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Position of the patient on the operating table

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Covering the surgical field

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Treatment of the surgical field

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Stages of surgery

Surgical approach Surgical technique Wound suturing

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STANDARD CONDITIONS OF OPERATIONS

1. Careful handling of tissues - do not apply rough compression to tissues with instruments, or cause hyperextensions and tears of tissues by manually separating them. 2. Careful separation of the constituent anatomical structures, layer-by-layer stitching of organs and tissues. 3. Careful stop of bleeding to prevent the development of anemia, secondary bleeding, purulent-inflammatory diseases in the postoperative period. 4. Prevention of wound infection is achieved by observing the rules of asepsis and antisepsis.

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PATHOPHYSIOLOGICAL CHANGES IN THE BODY IN THE POSTOPERATIVE PERIOD

Catabolic phase: lasts 3-7 days; high consumption of energy and plastic materials (proteins, fats and carbohydrates); is a consequence of activation of the sympathoadrenal system, hypothalamus and pituitary gland. Reverse development phase: lasts 4-6 days; the breakdown of proteins, fats and carbohydrates stops and their active synthesis begins; a balance arises between cata- and anabolic processes. Anabolic phase: lasts 2-5 weeks, on average a month; enhanced synthesis of proteins, fats and carbohydrates; activation of the parasympathetic nervous system.

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MAIN POINTS OF INTENSIVE CARE IN THE POSTOPERATIVE PERIOD

1. Fight pain with narcotic (promedol, omnopon) and non-narcotic (droperedol, fentanyl, diclofenac) analgesics. 2. Prevention and treatment of respiratory failure, prescription of bronchodilators (euphellin, papaverine); oxygen therapy; breathing exercises; percussion chest massage. 3. Normalization of cardiovascular activity by prescribing cardiac glycosides (strophontin, corglucon, digoxin); metabolites (riboxin); potassium preparations (potassium chloride); rheolytics (reopolyglucin, chimes, agapurine); coronary lytics (nitroglycerin, nitrong, sustak).

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4. Prevention of exo- and endogenous infection by prescribing synthetic penicillins (ampicillin, oxycillin); cephalosporins (kefzol, cloforan, cefazolin, cefotaxime); amminoglycosides (gentamicin, sizomycin, dobromycin, methylmecin); fluoroquinolones (pefloxacin, ciprofloxacin). 5. Reducing catabolic processes by prescribing vitamins and anabolic steroids (retabolil). 6. Prevention of thromboembolic complications by prescribing anticoagulants (heparin, fraxiparin, clexane). 7. Infusion therapy to cover functional and pathophysiological fluid losses, hemodynamic blood substitutes (polyglucin, reopoliglucin, gelatinol, refortan); detoxification blood substitutes (hemodesis, polydesis); protein blood substitutes (amino acids, albumin, protein); saline and glucose solutions.

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Homeostasis monitoring

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Blood gas monitoring

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COMPLICATIONS OF THE POSTOPERATIVE PERIOD IN THE ABDOMINAL CAVITY

Failure of gastrointestinal sutures Acute adhesive intestinal obstruction Bleeding into the lumen of the abdominal cavity Bleeding into the lumen of the gastrointestinal tract Abdominal abscesses

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Localization of abdominal abscesses

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POSTOPERATIVE COMPLICATIONS IN THE RESPIRATORY SYSTEM

bronchial conduction disorders; atelectasis; hypostatic pneumonia; pleurisy.

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COMPLICATIONS OF THE POSTOPERATIVE PERIOD IN THE CARDIOVASCULAR SYSTEM

acute cardiovascular failure; acute coronary insufficiency; coronary insufficiency; heart rhythm disturbance.

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Mastering the technology of pain relief Mastering the technology of pain relief In 1846, the American chemist Jackson and the dentist W. Morton used inhalation of ether vapor when removing a tooth. Surgeon Warren removed a neck tumor under ether anesthesia in 1846. In 1847, the English obstetrician J. Simpson used chloroform for anesthesia and achieved loss of consciousness and loss of sensitivity. Antiseptics - a method of fighting infection The English surgeon J. Lister (1827-1912) came to the conclusion that wound infection occurs through the air. Therefore, to combat microbes, they began to spray carbolic acid in the operating room. Before the operation, the surgeon's hands and the surgical field were also irrigated with carbolic acid, and at the end of the operation, the wound was covered with gauze soaked in carbolic acid. Pirogov N.I. (1810-1881) believed that pus could contain “sticky infection” and used antiseptic substances. In 1885, the Russian surgeon M. S. Subbotin sterilized dressing material to perform surgical interventions, which marked the beginning of the aseptic method. Bleeding F. von Esmarch (1823-1908) proposed a hemostatic tourniquet, which was applied to the limb both during an accidental wound and during amputation. In 1901, Karl Landsteiner discovered blood groups. In 1907, J. Jansky developed a blood transfusion technique.

The material was prepared by Tatyana Vladimirovna Yapparova, biology teacher at Municipal Educational Institution “Secondary School No. 198”

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Stages of surgical treatment: preparing the patient for surgery, pain relief (anesthesia), surgery. Stages of the operation: surgical access (incision of the skin or mucous membrane), surgical treatment of the organ, restoration of the integrity of tissues damaged during the operation.

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Classification of operations by nature and purpose:

Diagnostic operations allow the surgeon to make a more accurate diagnosis and are, in some cases, the only diagnostically reliable method. Radical operations completely eliminate the pathological process. Palliative operations alleviate the general condition of the patient for a short time. Classification of operations by nature and purpose: Emergency operations require immediate execution (stopping bleeding, tracheotomy, peritonitis, etc.). Urgent operations may be postponed while the diagnosis is clarified and the patient is prepared for surgery. Planned operations are performed after a detailed examination of the patient and the necessary preparation for the operation.

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Features of modern surgery

becomes reconstructive surgery, that is, aimed at restoring or replacing the affected organ: vascular prosthesis, artificial heart valve, strengthening the hernial orifice with a synthetic mesh, etc.; becomes minimally invasive, that is, aimed at minimizing the area of ​​intervention in the body - mini-accesses, laparoscopic techniques, x-ray endovascular surgery. Surgery is associated with such areas as neurosurgery, cardiac surgery, endocrine surgery, traumatology, orthopedics, plastic surgery, transplantology, ophthalmic surgery, maxillofacial surgery, urology, andrology, gynecology, etc.

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Historical information

Renaissance Ambroise Pare (1517-1590) - a French surgeon replaced the technique of amputation and ligation of large vessels. Paracelsus (1493-1541) - a Swiss doctor developed a technique for using astringents to improve the general condition of the wounded. Harvey (1578-1657) - discovered the laws of blood circulation, determined the role of the heart as a pump. In 1667, the French scientist Jean Denis performed the first human blood transfusion. The 19th century is the century of major discoveries in surgery. Topographic anatomy and operative surgery have developed. Pirogov N.I. performed a high section of the bladder in 2 minutes, and amputation of the lower leg in 8 minutes. The surgeon of the army of Napoleon I Larrey performed 200 amputations in one day.

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Mastering the technology of pain relief In 1846, the American chemist Jackson and dentist W. Morton used inhalation of ether vapor when removing a tooth. Surgeon Warren removed a neck tumor under ether anesthesia in 1846. In 1847, the English obstetrician J. Simpson used chloroform for anesthesia and achieved loss of consciousness and loss of sensitivity. Antiseptics - a method of fighting infection The English surgeon J. Lister (1827-1912) came to the conclusion that wound infection occurs through the air. Therefore, to combat microbes, they began to spray carbolic acid in the operating room. Before the operation, the surgeon's hands and the surgical field were also irrigated with carbolic acid, and at the end of the operation, the wound was covered with gauze soaked in carbolic acid. Pirogov N.I. (1810-1881) believed that pus could contain “sticky infection” and used antiseptic substances. In 1885, the Russian surgeon M. S. Subbotin sterilized dressing material to perform surgical interventions, which marked the beginning of the aseptic method. Bleeding F. von Esmarch (1823-1908) proposed a hemostatic tourniquet, which was applied to the limb both during an accidental wound and during amputation. In 1901, Karl Landsteiner discovered blood groups. In 1907, J. Jansky developed a blood transfusion technique.

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Russian surgery

Surgery in Russia began to develop in 1654, when a decree was issued on the opening of chiropractic schools. In 1704, pharmacy business appeared and in the same year the construction of a surgical instruments factory was completed. Until the 18th century, there were practically no surgeons in Russia, and there were no hospitals. The first hospital in Moscow was opened in 1707. In 1716 and 1719 two hospitals are being commissioned in St. Petersburg.

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Regional State Autonomous Educational Institution secondary vocational education "Dobryansky Humanitarian and Technological College them. P.I. Syuzev"

Nursing care in surgery

Teacher: Pishuleva T.V.

• Patient - a person (individual) who needs and receives nursing care
• Nursing - part of health care, a specific professional activity, science and art aimed at solving existing and potential health problems in the face of environmental change.
• Environment Wednesday- a set of natural, social, psychological and spiritual factors and indicators that are affected by human activity.

Health is a state of physical, spiritual, mental and social well-being and not simply the absence of disease or disability

(WHO 1947)

• Patient care - sanitary hypourgia (Greek) hypourgiai - to help, provide a service) - medical activities for the implementation of clinical hygiene in a hospital, aimed at alleviating the patient’s condition and promoting his recovery.
• Patient care is of particular importance in surgery as an extremely important element in surgical aggression, which mitigates its adverse consequences and largely influences the outcome of treatment.

• "Surgery" literally translated means handicraft, skill (chier - hand; ergon - action)
• Surgery refers to one of the main branches of clinical medicine, studying various diseases and injuries, for the treatment of which methods of influencing tissue are used, accompanied by a violation of the integrity of body tissues to detect and eliminate the pathological focus.

• Surgical care is a medical activity aimed at providing assistance to the patient in satisfying his basic life needs (food, drink, movement, bowel movements, bladder, etc.) and during pathological conditions (vomiting, coughing, breathing problems, bleeding, etc. .).

1. optimization of the patient’s living conditions that contribute to the course of the disease

2. accelerating the patient’s recovery and reducing the number of complications

3. fulfilling doctor's orders

• General surgical care is to organize sanitary - hygienic and medical-protective regimes in the department.
• The sanitary and hygienic regime includes:

Organization of cleaning of premises;

Ensuring patient hygiene;

Prevention of nosocomial infection (the term comes from the Latin nosocomium - hospital and from the Greek. nosokomeo- care for the patient) (HBI)

Creating a favorable environment for the patient;

Providing medications, their correct dosage and use as prescribed by a doctor;

Organization of high-quality nutrition for the patient in accordance with the nature of the pathological process;

Proper manipulation and preparation of the patient for examinations and surgical interventions.

• The causative agents of surgical infection are pyogenic microbes - aerobes (Staphylococcus, Streptococcus, S treptococcus pneumoniae) and anaerobes(gas gangrene stick - Clostridium perfringens , tetanus bacillus - Cltridosium tetani) .
• These pathogens cause a specific or nonspecific infection, acute or chronic.

• A necessary condition for the pathogen to enter the body is the presence entrance gate.
• The portal of entry can vary in size, from a large wound to a bite or injection site.

• Ways of infection entering the wound - the pathogen may enter the surgical wound exogenously, i.e. from the environment, or endogenous- from an inflammatory focus in the body itself (boil, purulent tonsil, carious tooth).

• Exogenous route:

Air - through the air;

Drip - through liquid that gets into the wound;

Contact - through objects in contact with the wound;

Implantation - through objects that must remain in the wound for the required time.

• Endogenous route:
• - hematogenous - with blood flow;
• - lymphogenous - with lymph flow.

Local reaction:

Hyperemia (redness);

Edema (swelling);

Local increase in temperature;

Impaired function.

• Signs general reaction:

Weakness, malaise;

Headache;

Nausea, vomiting;

Increased body temperature, chills;

Changes in blood tests.

• To fight germs in the wound Lister proposed a number of activities and named them antiseptic.
• Bergman chose a different path fight against infection: preventing it from entering the body, and proposed other measures called asepsis.
• Antiseptics is to fight the infection that has already entered the wound, therefore it is a therapeutic method, and asepsis- preventive.

• Asepsis- this is a set of measures to ensure that microbes do not enter the human body, including the surgical wound.

Organizational arrangements (special regime zones);

Physical factors (ventilation, cleaning, ultraviolet radiation);

Chemicals (disinfectants, antiseptics, etc.).

Operating room;

Resuscitation;

Treatment room;

Dressing room.

Limited personnel access;

Compliance with clothing;

Compliance with aseptic standards (room cleaning).

• Asepsis provided disinfection And sterilization.
• Disinfection- this is the destruction of only vegetative forms of pathogenic and opportunistic microbes
• Sterilization- this is the complete destruction of microbes and their spores in the sterilized material
• All objects that come into contact with the wound must be sterile!

• Sterilization is carried out by physical methods(steam, air, in the environment of heated balls) and chemical(chemicals, gases).

PHYSICAL STERILIZATION METHOD Air sterilization (dry hot air)

Mode

sterilization

T, o C

Control

Time

Name

sterilization quality

objects

Type of packaging material

• Ascorbic acid
• succinic acid
• Thiourea
• Thermal indicator tape IS-180

Metal and glass products

• Sucrose
• Thermal indicator tape IS-160

kraft package

Silicone rubber products

Optimal mode

sack moisture-resistant paper, Term storage 3 days

Double-layer packaging made of crepe paper for medical purposes

Gentle mode

Term storage 20 days

without packaging

Term storage immediately up to 6 hours under aseptic conditions

Steam sterilization method (autoclaving) )

Mode

T, o C

sterilization

P, atm

Time, min

Control

Name of objects

quality

Type of packaging material

sterilization

• Urea
• Thermal indicator tape IS-132

• Benzoic acid
• Thermal indicator tape IS - 120

• Dressing and suture material;
• Surgical linen;
• Metal and glass products

Products made of rubber, latex, polymer materials

Sterilization box with filter

Double pack of calico

Unimpregnated sack paper

Sack paper, moisture-resistant

Crepe paper for medical purposes (single-layer packaging)

Term storage 3 days

Sterilization box with filter

Crepe paper for medical purposes (double-layer packaging)

Term storage 20 days

Modes are given for specific sterilizers.

Prevention of airborne infection

Wet cleaning of premises;

Ventilation (reduces the number of germs in the air by 30%);

Wearing special clothing and replacement shoes by staff;

UV premises.

Types of operating room cleaning (Order of the Ministry of Health dated July 31, 1978 No. 720)

- preliminary is performed before starting work and consists of wiping horizontal surfaces and turning on a bactericidal lamp to disinfect the air;

- current, carried out during the operation - a fallen ball and a napkin are picked up from the floor, the blood is wiped off;

- intermediate- between operations, all used material is removed and the floor is wiped;

- final, at the end of the day the floor and equipment are washed and aired;

- general- Walls, windows, equipment, floors are washed once a week.

• Wet cleaning is carried out with a disinfectant - this is a complex consisting of 6% hydrogen peroxide and 0.5% detergent or 1% solution of activated chloramine (with the addition of 10% ammonia).
• After cleaning, the bactericidal lamp is turned on for 2 hours.

• Absolute sterility zone - this is the operating room, preoperative and sterilization room of the operating unit.
• High Security Zone - This is a room for putting on overalls, storing anesthesia equipment and processing instruments.
• Restricted Zone - This is a room for storing drugs, instruments, surgical linen, and a room for operating room staff.
• General mode zone - These are the offices of the head of the department of the senior nurse.

Prevention of droplet infection

Wearing masks in the operating room and dressing room.

It is forbidden to conduct unnecessary conversations during surgery and dressing;

People with acute respiratory infections and pustular diseases are prohibited from being in the operating room and dressing room.

Prevention of contact infection

Surgical hand antisepsis;

Sterilization of gloves;

Sterilization of dressings and surgical linen;

Sterilization of surgical instruments;

Treatment of the surgical field.

• mechanical treatment to wash away germs from the surface of the skin and open the pores;
• chemical treatment to destroy microbes remaining on the skin and deep in the pores;
• the use of a chemical substance capable of tanning the leather, i.e. closing the pores.

• It is prohibited to take part in the operation if your hands have cuts, pustules, long nails or nails covered with varnish.
• Spasokukotsky-Kochergin method - wash your hands under running water and soap for 1 minute;
• wash your hands with a sterile gauze napkin for 3 minutes in 2 enamel basins with 0.5% ammonia: in the first basin up to the elbow, in the second – only the hands and wrists;

• wipe the hands with sterile wipes, then the forearms;
• treat hands for 5 minutes with 96% ethyl alcohol, nail beds with 5% alcohol tincture of iodine.
• According to Alfeld – wash hands with 2 sterile brushes for 5 minutes each. under warm running water and soap, dry with sterile wipes, treat hands with 96% ethyl alcohol and 10% iodine solution, nail beds and skin folds.

First treatment of hands (solution C-4, 720 order)

• Preparation of a solution of pervomur for treating the surgeon’s hands: 171 ml of H 2 O 2 33% and 81 ml of 85% formic acid are poured into a glass flask, shaken and refrigerated for 90 minutes (1.5 hours).
• The resulting mixture is diluted with distilled water up to 10 liters .
• The resulting solution within 24 hours can be used to treat hands and the surgical field.

Processing stages:

Wash hands with soap and running water for 1 minute (without brushes), dry with a towel;

Wash your hands in Pervomur solution for 1 minute (30 seconds up to the elbow and 30 seconds only on the hands and lower third of the forearms);

Dry your hands first with a sterile cloth, then your forearms to the elbow of your gloves.

Hand treatment with chlorhexidine bigluconate (hibitan)

• The working solution of chlorhexidine digluconate is prepared by diluting the original 20% solution of chlorhexidine digluconate with 70% ethyl alcohol in a ratio of 1:40.

Processing stages:

Wash hands with running water and soap, dry with sterile wipes;

Treat your hands with several gauze balls, moistened with 0.5% alcohol solution of chlorhexidine bigluconate no less 3 minutes first to the elbow, then to the wrist and hand;

Dry with a sterile cloth;

Wear sterile rubber gloves.

• The treatment is carried out in basins for 5-7 minutes, after which the hands are dried with a sterile cloth.
• The disadvantage of this method is the processing time.
• Synthetic film coating of the surgeon's hands with Zerigel is carefully applied to the skin of the hands for 2-3 minutes to form a film.
• Brun's method, which consists of treating hands with 96% ethyl alcohol for 10 minutes.

• Stepping- hands are processed in a certain sequence - from the fingertips to the elbow bend, and cleaner skin should not touch the less clean area during the treatment process.
• Punctuality(wash according to the scheme)
• Symmetry

Sterilization of surgical linen and dressings

• Sterilization of surgical linen and dressings is carried out by autoclaving. Sterilization mode - 2 atm., 132 °C, 20 min.

Terms of maintaining sterility:

Bix without filter: unopened - 3 days; opened - 6 hours;

Bix with filter: unopened - 20 days; opened - 6 hours

Stages of processing surgical instruments (OST 42-21-2-85 and Order of the Ministry of Health dated July 12, 1989 No. 408)

Stage 1 - disinfection

• physically - this is boiling in distilled water for 30 minutes or in a 2% soda solution for 15 minutes;
• chemical antiseptics -3% chloramine 60 min, 6% peroxide 60 min or with 0.5% detergent 60 min

Stage 2 - pre-sterilization cleaning

Stage 3 - sterilization

• Dry heat method
• Autoclaving

• Chemical method

Hydrogen peroxide 6% for 180 min. (3 hours) at 50 °C; 18 °C – 360 min. (6 hours)

Dezoxon1 1%, 18% for 45 min at 20 °C;

Sidex 2% 4-10 hours.

Rinse in 2 containers with sterile water for 5 minutes in each;

Wrap in a sterile sheet and store in a sterile container.

Can be used within 3 days.

• on the eve of the operation, the patient takes a bath or shower for the purpose of hygienic preparation of the skin;
• Immediately before the operation, the skin of both planned and emergency patients is treated with an antiseptic, dried, dry shaving, and then treated with alcohol.

Widely and sequentially (from the center to the periphery), the entire operation area is processed twice, and not just the site of the future incision;

Then the area limited by sterile sheets is treated;

The area must be treated at the end of the operation before suturing and after suturing.

• The source of such infection can be suture material, drainages, catheters, endoprostheses, transplanted organs and multiple metal structures used in traumatology and orthopedics.
• All implants must be sterile, otherwise they will become a source of purulent-septic processes.

• Threads of artificial or natural origin are used as suture material.
• For example: silk, nylon, lavsan, cotton thread, polyester, horsehair, etc.
• Factory methods for sterilizing suture material are the best - this is radiation sterilization with gamma rays or gas mixtures. These methods are used both for threads of natural origin and for artificial threads.

• Nylon and fine silk are sterilized in formic acid for 10 minutes, then rinsed 3 times in distilled water and stored in 96% alcohol. The alcohol changes every 10 days.
• According to Sitkovsky - skeins of catgut are dipped in ether for 24 hours, then wiped and dipped in a 2% solution of potassium iodide
• According to Kocher, the suture material is degreased in ether for 12 hours, then it is transferred to 70% alcohol for 12 hours, then transferred to a solution of mercury dichloride 1: 1,000 and boiled in this solution for 10 minutes. Store in 96% alcohol until use.

Prevention of endogenous infection

The patient enters the hospital having already had the required minimum of examinations (fluorography, blood and urine tests, ECG, a report from a dentist, gynecologist, etc.);

If the source of infection is found, the planned operation is postponed until it is eliminated;

If the patient has had an acute respiratory infection, the operation is postponed for at least 2 weeks. from the moment of recovery.

• Active is the subcutaneous administration of staphylococcal toxoid: from a dose of 0.1 ml/day it is increased by 0.2 ml, bringing it to 1 ml, and then reduced in the reverse order to 0.1 ml/day;
• Passive - hyperimmune antistaphylococcal serum is administered before surgery.