Preoperative Preparation

Prehospital stage and psychological support

The onset of preoperative preparation coincides with the patient's first contact with an emergency doctor or polyclinic physician. At this stage, preliminary indications for surgery are determined, and intensive therapy for vital function disorders is initiated immediately (anti-shock measures, hemorrhage arrest). This therapy is continued during transportation.

An essential role is played by psychological support. The doctor must reassure the patient and gain their trust. This is particularly relevant when patients refuse emergency surgery due to underestimating the severity of their condition. In acute life-threatening conditions (strangulated hernia, acute appendicitis, perforated ulcer, internal hemorrhage), the risks of delay—such as the development of peritonitis or fatal blood loss—must be explained with solid reasoning.

Features of emergency preparation and shock management

Emergency preparation is aimed at the rapid restoration of vital functions.

• Acute blood loss: Once bleeding is stopped, blood volume is restored (plasma, dextrans, albumin). If bleeding continues, transfusion is performed simultaneously through multiple veins, and the patient is urgently transported to the operating room.
• Shock management: As a general rule, a shock state is a contraindication to surgical intervention. First, the shock-inducing factor (pain, intoxication) is eliminated, and circulating blood volume and vascular tone are restored. Surgery is initiated only after systolic blood pressure stabilizes at a level no lower than 90 mm Hg.

Exception: Hemorrhagic shock in the setting of ongoing internal hemorrhage. In this case, the patient is operated on immediately, as the cause of shock can only be eliminated surgically.

Specialized preparation of organs and systems

Preparation tactics depend on the localization of the pathological process:

1. Colon: To reduce the risk of infection and suture failure, a low-residue diet, laxatives, cleansing enemas, and oral antibiotics are prescribed 2–3 days before the intervention.
2. Gastric antral stenosis: Daily gastric lavage via a tube until "clear return" is required.
3. Purulent pulmonary pathologies: Bronchial tree clearance is performed via inhalations, endobronchial administration of antibiotics, and mucolytics.
4. Diabetes mellitus: Metabolic acidosis is corrected in patients, and those receiving long-acting insulin formulations must be switched to regular insulin.

General procedures: gastric lavage, catheterization, and skin preparation

Basic cleansing procedures are frequently required during preparation:

• Gastric lavage: Used to prevent regurgitation during anesthesia or in intestinal obstruction. The tube is inserted 50 cm (to the cardia) and washed using the siphon principle in 0.5–1 L portions until clear water returns.
• Urinary bladder catheterization: Necessary for emptying before surgery. A soft rubber catheter is used. The use of a metal catheter requires special skills due to the high risk of urethral injury.
• Preparation of the surgical field: The day before, the patient takes a shower and changes clothes. In the morning, hair is shaved dry. If an open wound is present, the skin is treated with an antiseptic and shaved strictly away from the wound to prevent introducing infection.

Class and exam questions

What else to study on this topic

• Technique of siphon enema placement and criteria for its efficacy
• Methods of detoxification therapy: hemadsorption, plasmapheresis, limfosorption
• Features of nutritional support in surgical patients (enteral and parenteral nutrition)
• Types of premedication and the pre-anesthetic evaluation on the eve of surgery

Other topics in "CHAPTER 8. SURGICAL OPERATION"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.