Role of the anesthesiologist and initial examination
The anesthesiologist takes a direct part in examining the patient and preparing them for surgery. At this stage, the patient management strategy is formed.
The physician conducts a thorough history taking, focusing on the allergological status and the patient's previous tolerance of anesthesia and surgery. Both the primary disease and comorbid conditions are assessed. If a planned surgery is coming up, preliminary treatment or sanitation of identified concomitant conditions may be required.
Special attention is paid to the anatomical assessment of the patient. The anesthesiologist takes note of:
- Facial shape;
- Neck structure;
- Chest features;
- Severity of subcutaneous adipose tissue (SAT).
These parameters are critical for choosing the correct anesthesia method and successfully performing intubation.
Gastrointestinal tract preparation
A crucial step prior to anesthesia induction is the preparation of the gastrointestinal tract. This is necessary to prevent complications associated with the aspiration of gastric contents.
Standard preparation involves complete cleansing of the GI tract. For this purpose, the patient undergoes gastric lavage and is prescribed cleansing enemas.
Goals and regimen of elective premedication
Pharmacological preparation, or premedication, is performed to reduce psychoemotional stress, suppress reactions of the vagus nerve (n. vagus), potentiate the action of anesthetics, and generally prevent complications.
For elective surgeries, premedication is divided into several stages:
- The night before: The patient is prescribed hypnotics. If the patient has a labile nervous system, tranquilizers (e.g., diazepam) may be prescribed a day before the intervention.
- 40 minutes before surgery: Drugs are administered intramuscularly (IM) or subcutaneously (SC).
- Narcotic analgesics: 1 ml of a 1–2% trimeperidine (Promedol) solution or 2 ml of fentanyl is used.
- Anticholinergics (vagolytics): administer 0.5 ml of 0.1% atropine solution. This is necessary to suppress n. vagus activity and reduce salivation.
- Antihistamines: added to the regimen if the patient has a burdened allergy history.
- Immediately before the intervention: A final oral cavity examination is performed, during which removable dental prostheses are mandatory removed.
Specifics of preparation in emergency interventions
Emergency surgical interventions dictate their own preparation rules since there is no time for lengthy procedures.
Main differences of emergency preparation:
- Mandatory gastric lavage is performed immediately before surgery;
- Premedication is performed right on the operating table;
- The route of drug administration changes — all drugs are administered exclusively intravenously for the fastest possible effect.
Briefly: answers to topical questions
Which specific antihistamines are used for premedication in patients with a burdened allergy history?
In cases of a burdened allergy history and for the prevention of allergic reactions, systemic antihistamines that act as H1-receptor blockers are used as premedication. The following specific drugs are used in clinical practice:
- Clemastine — administered systemically at a dose of 2 mg;
- Suprastin — prescribed as premedication 1 hour before the intervention;
- Claritin — used similarly to suprastin to prevent reactions.
What specific syndromes and complications does gastric cleansing prevent before anesthesia induction?
Gastric cleansing before anesthesia aims to prevent the aspiration of gastric contents and associated complications:
- Aspiration — entry of gastric contents into the trachea and bronchi;
- Mendelson's syndrome — acid aspiration syndrome accompanied by cyanosis, bronchospasm, and tachycardia;
- Severe aspiration pneumonia;
- high risk of mortality.
What tranquilizers and hypnotics, besides diazepam, are prescribed on the eve of elective surgery?
Hypnotics are prescribed on the eve of elective surgery. Tranquilizers and neuroleptics may be used in individual dosages on the evening before surgery, including:
- Lorazepam;
- Bromdihydrochlorphenylbenzodiazepine;
- Thioridazine;
- Sulpiride.
For patients with a labile nervous system, tranquilizers such as diazepam are prescribed a day before surgery.
What are the contraindications to administering atropine as part of premedication?
The administration of atropine as part of premedication has a number of strict contraindications that logically stem from the side effects of this muscarinic receptor blocker. The main contraindications include:
- Glaucoma — the drug increases intraocular pressure;
- Benign prostatic hyperplasia (BPH) — creates a risk of acute urinary retention due to decreased tone of the bladder detrusor;
- Cardiovascular pathologies — presence of tachyarrhythmia in the patient;
- GI pathologies — intestinal atony.
Class and exam questions
Why does the anesthesiologist need to evaluate facial shape and neck structure?
Anatomical features of the face, neck, and chest, as well as the severity of subcutaneous adipose tissue, directly affect the choice of anesthesia method and determine the difficulty of intubation.
Why is atropine included in premedication?
Atropine is a cholinolytic (vagolytic). It is administered to suppress unwanted reactions of the vagus nerve (n. vagus) and significantly reduce salivation during anesthesia.
How does drug administration differ between elective and emergency surgery?
During elective surgery, premedication drugs are administered intramuscularly or subcutaneously 40 minutes before the start. In emergency cases, they are administered only intravenously and directly on the operating table.
What else to study on this topic
- Criteria for difficult intubation based on anatomical examination
- Mechanism of action of vagolytics on the cardiovascular system
- Key considerations for selecting tranquilizers in patients with a labile nervous system
- Prevention of aspiration syndrome in emergency anesthesia
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Other topics in the section "CHAPTER 3. ANESTHESIA"
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