Is it possible to have surgery if you have high blood pressure? High blood pressure after anesthesia: what is the cause and how to treat? Video: Reducing blood pressure without drugs

General anesthesia is a temporary inhibition of the functions of the central nervous system, which is accompanied by loss of consciousness, suppression of sensitivity, muscle relaxation, suppression of reflexes and analgesia for surgical intervention. General anesthesia is carried out by suppressing synaptic connections between neurons. There are 4 sequential stages of general anesthesia, each of which is characterized by different indicators:

How does anesthesia affect blood pressure?

The effect on normal blood pressure is presented in table form:

Reaction when high blood pressure

• There may be a large loss of blood during the operation.
• Bleeding in the brain.
• Hypersensitivity of the heart and blood vessels to surgery and narcotic drugs.
• Development of severe heart failure.

Return to contents

At low pressure

• Hypovolemic shock is possible.
• Heart failure.

Return to contents

Why is anesthesia dangerous?

In case of overdose, if the anesthetics have affected the respiratory and vascular-motor centers of the medulla oblongata, the agonal stage begins. Breathing stops and death occurs. In addition to overdose, other complications arise:

• Hypoxic syndrome, which can be caused by obstruction of the airways with vomit, laryngospasm and bronchospasm.
• Hypertensive crisis, hemorrhagic stroke, if hypertension was not treated before the operation. A hypotensive crisis can occur due to blood loss or if anesthesia is administered at low pressure. Rarely, myocardial infarction, pulmonary edema and thrombosis of the pulmonary circulation may occur.
• Anaphylactic shock. Functional adrenal insufficiency.
• After anesthesia, jumps in blood pressure may occur.

Return to contents

Contraindications

• Hormonal pathologies in the stage of decompensation.
• Severe degree of diseases of the cardiovascular system, liver and kidney failure.
• Arrhythmia, extrasystole.
• Severe form of bronchial asthma.
• Previous heart attacks or strokes.

Artificial sleep is dangerous in case of intoxication due to alcohol or drugs.

These contraindications are taken into account if the operation is planned, and their manifestations can still be mitigated. But if urgent surgical intervention is required, then general anesthesia is administered in any case. You should not refuse general anesthesia if the specialist insists on performing the operation. A competent anesthesiologist is able to select the optimal combination of drugs to reduce the risk of complications.

Question to the doctor about blood pressure before surgery

To ensure normal blood pressure during surgery for patients with arterial hypertension, the dose and combination of antihypertensive drugs that would ensure a normal blood pressure level should be selected before surgery. On the day of surgery, you must also take these medications, but no later than 3 hours before surgery.

How to take medications?

To ensure normal blood pressure during surgery for patients with arterial hypertension, the dose and combination of antihypertensive drugs that would ensure a normal blood pressure level should be selected before surgery. On the day of surgery, it is also necessary to take these medications, but no later than 3 hours before surgery.” But is it forbidden to drink water for a certain time before the operation?

How to take medications?

Copyright © 2018 vBulletin Solutions, Inc. All rights reserved.

Arterial hypertension: treatment

Depending on the level of blood pressure, degrees of arterial hypertension are distinguished, which are described in the table below.

Degrees of arterial hypertension:

Degrees of arterial hypertension

Systolic blood pressure mm Hg. Art.

Diastolic blood pressure mm Hg. Art.

Perioperative arterial hypertension

Arterial hypertension is found very often, especially among elderly patients - more than 40%. Hypertension of the first or second degree slightly increases the risk of cardiovascular complications during anesthesia. Higher pressure values ​​indicate that there may be more complications and they are more serious.

In elective patients with grade 3 hypertension (systolic pressure more than 180 mm Hg and/or DBP > 110 mm Hg), delaying intervention should be considered to optimize hypertension therapy.

Medicines used to treat hypertension and anesthetics, when interacting, can lead to the development of resistant hypotension and other intraoperative complications. The criterion for correctly selected drug antihypertensive therapy for planned surgical intervention is the normal age level of blood pressure in a patient with a deviation within ±20%.

TO important conditions The safe administration of anesthesia also includes the time during which blood pressure returns to normal. The patient's body needs a lot of time to adapt to the low blood pressure level. For example, in a patient with third-degree arterial hypertension, using intravenous vasodilators, it is possible to “normalize” the pressure in a few tens of minutes. And if such a patient begins to undergo, for example, epidural anesthesia, then the likelihood of developing a stroke, uncontrolled hypotension, and heart attack will increase rapidly.

Doctors should pay attention that it is unacceptable to carry out forced correction of arterial hypertension of the 2-3rd degree before a planned operation in one or two days. And even more so - in 3-4 hours. It takes at least two to three weeks to find the optimal antihypertensive therapy. We also note that the standards for the treatment of arterial hypertension set aside at least a month (30 days) for these purposes.

The question is raised: is it necessary to interrupt the intake of antihypertensive drugs before surgery? There is no consensus among experienced specialists whether it is necessary or not to interrupt medication on the eve of the intervention. For example, some experts believe that patients should continue taking antihypertensive medications as usual for up to an hour surgical treatment. And basically, no special problems arise during anesthesia in connection with such patient management tactics.

But today, more specialists are highlighting a different approach, which, in their opinion, provides better hemodynamic stability of the patient during anesthesia:

• ACE inhibitors or angiotensin II antagonists do not need to be discontinued if patients are receiving this drug because of heart failure or left ventricular dysfunction;
• ACE inhibitors or angiotensin II antagonists prescribed for hypertension should be temporarily discontinued exactly one day before surgery;
• Diuretics are not prescribed on the day of surgery. Patients should continue taking beta-blockers as usual.

Perioperative period in patients with arterial hypertension

The main task is to maintain optimal blood pressure levels during surgery. If there are no special indications, then doctors focus on the “working” level of pressure of the sick patient ± 20%. In patients over 80 years of age, it is advisable not to reduce SBP to less than 150 mmHg. Art.

Blood pressure may fluctuate significantly during anesthesia in patients with hypertension. It can not only rise sharply, but also decline just as sharply. For prevention, there are the following methods:

If controlled ventilation is planned, then 2-3 minutes before intubation it is recommended to administer an increased dose of an analgesic (fentanyl at a dose of 3-5 mcg/kg works well) and carry out induction with a drug that does not increase blood pressure (midazolam, propofol, sodium thiopental, diazepam etc). Increased blood pressure during intubation is a separate anesthetic problem.

When performing intravenous anesthesia, it is worth choosing sodium thiopental, propofol as an anesthetic, because it medications that do not increase blood pressure in humans. There is no need to reduce blood pressure with medication before performing epidural and spinal anesthesia. It is enough to increase sedation (midazolam, propofol, diazepam).

When blocking peripheral nerves, it is recommended to add clonidine to the anesthetic (as an adjuvant), which improves the quality of anesthesia and at the same time slightly reduces the patient’s blood pressure. But, in the vast majority of cases, it is enough to add ataractics to the premedication (diazepam and midazolam have a good effect in this regard).

Intraoperative hypotension in patients with arterial hypertension

A sharp decrease in blood pressure in a patient can lead to various complications that are associated with insufficient blood supply to various organs - myocardial ischemia, stroke, renal failure, etc.

Physicians should remember that against the background of antihypertensive therapy, vasopressors traditionally used to correct hypotension - ephedrine and phenylephrine - may not have the desired effect. In this case, norepinephrine (Norepinephrine), epinephrine (Adrenaline) or vasopressin is used to treat hypotension.

Intraoperative arterial hypertension

It is generally accepted that perioperative arterial hypertension is a condition in a person when systolic blood pressure during surgery and in the recovery room corresponds to one of the following conditions:

• is higher than 200 mmHg. st;
• exceeds the preoperative level by 50 mm Hg. st;
• requires intravenous administration of antihypertensive drugs.

Most common cause perioperative hypertension is activation of the sympathetic nervous system, combined with insufficient depth of blockade of nociceptive stimulation during anesthesia and surgery. That's why traditional method Relief of intraoperative hypertension is called deepening of anesthesia with the help of narcotic analgesics, inhalational anesthetics and benzodiazepines.

It is recommended to take propofol for these purposes (bolus of pomg until the effect is achieved, after which, if necessary, you can switch to continuous administration). The drug acts quickly, has a short half-life, and combines well with almost all drugs that are used for anesthesia.

In many cases, you can prescribe magnesium sulfate to a patient at a dose of 2-5 g per injection; it is administered not immediately, but over a period of minutes. This medicine not only gently lowers blood pressure, but significantly reduces the need for analgesics during surgery and in the early postoperative period, improves the quality of anesthesia. In cases resistant to this therapy, as well as when blood pressure needs to be reduced in a short time, doctors use antihypertensive drugs with a short half-life.

Postoperative hypertension

Doctors must take into account that if the patient has been taking beta-blockers or alpha-adrenergic agonists for a long time, for example clonidine (clonidine), then taking these medications must be continued after the operation, otherwise withdrawal syndrome may develop with a sharp increase in blood pressure.

First of all, attending physicians pay attention to maintaining adequate analgesia. Antihypertensive medications that were effective in patients should be resumed as soon as possible. this person before surgery. When choosing a drug, specialists sometimes use a special table. But doctors do not recommend routine prescription of calcium antagonists, as this is associated with an increased risk of postoperative vascular complications.

Choice of antihypertensive therapy

Low doses of antihypertensive drugs should be used at the initial stage of treatment, starting with the minimum dosage of the drug (the goal is to reduce adverse side effects). If there is a good response to a low dose of this drug, but blood pressure control is still inadequate, it is recommended that the dosage of this drug be increased if it is well tolerated.

Effective combinations of low doses of antihypertensive drugs should be used to reduce blood pressure as much as possible with minimal side effects. This means that if one drug is ineffective, preference is given to adding a small dose of a second drug rather than increasing the dosage of the initially used one.

It is necessary to completely replace one class of drugs with another class of drugs: in case of low effect or poor tolerability, without increasing the dosage or adding another drug.

1. Angiotensin II receptor antagonists + diuretic;

2. Angiotensin II receptor antagonists + calcium antagonist;

3. Angiotensin-converting enzyme inhibitors + diuretic;

4. Angiotensin-converting enzyme inhibitors + calcium antagonist;

5. Calcium antagonist + diuretic.

Emergency conditions for arterial hypertension

All situations in which a rapid decrease in blood pressure is required are divided into 2 large groups:

• The first is a group of diseases and conditions that require an emergency (within 1-2 hours) reduction in blood pressure.

This group also includes a complicated (with damage to target organs) hypertensive crisis - a sudden (several hours) and significant increase in blood pressure relative to the person’s usual level. Increased blood pressure leads to the appearance or worsening of symptoms from target organs:

• myocardial infarction;
• unstable angina;
• about dissecting aortic aneurysm;
• structure of left ventricular failure;
• hemorrhagic stroke;
• eclampsia;
• in case of injury or damage of another origin to the central nervous system;
• swelling of the optic nerve nipple;
• in patients during surgery and in the postoperative period with the threat of bleeding and in some other cases.

To urgently lower blood pressure, parenteral drugs are used such as:

• nitroglycerin (it is preferred for myocardial ischemia in the patient);
• sodium nitropruside (suitable for most cases of resistant hypertension);
• magnesium sulfate (preferred for eclampsia);
• esmolol (it is chosen mainly for lesions of the central nervous system);
• enalapril (preference is given to it if the patient has heart failure);
• furosemide (preferred for hypervolemia, acute LV failure);
• phentolamine (if pheochromocytoma is suspected).

Recommendations. To avoid ischemia of the central nervous system, kidneys and myocardium, there is no need to reduce blood pressure too quickly. Systolic pressure should be reduced by 25% of the initial level in the first two hours, and to 160/100 mmHg. Art. – over the next 2-6 hours. In the first 2 hours after starting antihypertensive treatment, blood pressure should be monitored every minute. Doctors select the dosage of the drug individually. Preference is given to drugs (in the absence of contraindications in each specific case) with a short half-life.

• The second group, where experts include all other cases of increased blood pressure, when it should be normalized within a few hours.

In itself, a sharp increase in blood pressure, without symptoms from other organs, requires mandatory, but not so urgent, intervention. It can be relieved by oral administration of drugs with a relatively rapid action (calcium antagonists (nifedipine), beta-blockers, short-acting ACE inhibitors, clonidine, prazosin, loop diuretics).

It is worth noting that the parenteral route of taking antihypertensive drugs should be the exception rather than the rule. That is, in most cases it is not used.

Oral drugs to urgently lower blood pressure

Examples of assignments in such cases:

• Moxonidine (Physiotens) 0.4 mg should be given to the patient for oral administration. It is effective in increasing blood pressure in patients with high sympathetic activity;
• captoprilmg dabt to the patient orally. Indications: moderate increase in blood pressure in patients without high sympathetic activity;
• nifedipinmg sublingually (allow the patient to chew), if there is no effect, repeat the dose after half an hour. Indicated for moderate increases in blood pressure in patients without high sympathetic activity;
• propranolol 40 mg is taken sublingually (or orally with a glass of warm water). It is used for a combination of arterial hypertension and tachycardia.

Hospitalization for surgery. Part 1 – preoperative preparation.

Hospitalization (the patient's stay in the hospital) usually consists of three main stages. During the first (preoperative) stage, the necessary studies are performed to prepare for the operation, consultations with specialists, as well as preparatory treatment (special nutrition, treatment of concomitant diseases). The second stage is surgery. And the third (postoperative) stage is recovery after surgery and discharge home.

The length of a patient’s stay in the clinic depends on the type of disease and its severity, the number of necessary examinations, the type of operation, as well as the course of the postoperative period.

Due to the desire of clinics to reduce the costs associated with hospital stays in the preoperative period, there is currently a tendency to perform many examinations on an outpatient basis. This means that before surgery, the patient comes to the clinic only to perform prescribed tests, and then returns home. After all the studies have been completed, the doctor sets the day of the operation, and the patient is hospitalized at the clinic the day before (1-2 days before the scheduled date). In many European countries and the United States, patients scheduled for surgery arrive at the clinic early in the morning on the day of surgery, undergo a short preparation in a special preoperative ward, and are sent to the operating room 2-3 hours later. Keeping the patient at home with loved ones until the day of surgery can reduce the stress associated with the need for surgery.

Preoperative examination.

Once a patient is suspected of having colon cancer and surgery is planned, there are several other important tests that need to be done before surgery.

This survey has two main objectives. First, by performing several studies, the stage of the tumor and its extent can be determined. Determining the stage of the tumor in the preoperative period will help you choose the right treatment tactics. Obviously, treatment for colon cancer that has metastasized to the liver will be very different from treatment for a small tumor that does not extend beyond the intestinal wall. Secondly, additional studies will help evaluate overall health and tolerability of surgery. Since surgery is extremely stressful for the body and can worsen existing problems with the lungs, heart, kidneys and other organs, special testing will help identify those patients who are at increased risk for complications in these organs during and after surgery.

Radiography chest. The main purpose of this study is to evaluate the presence of cancer metastases to the lungs. This is a standard test that can determine with fairly high accuracy whether there are tumor nodes in the lungs. Chest X-rays can also look for signs of heart and lung disease. Therefore, this study is performed routinely in all patients before major operations.

Computed tomography (CT) of the abdomen and chest. Using this study, you can evaluate the condition of the liver and abdominal cavity for the presence of foci of tumor metastasis. If a chest CT scan is performed along with an abdominal examination, then a plain chest x-ray is not required.

Magnetic resonance imaging (MRI) of the pelvis. This study allows you to obtain clear images of the pelvic organs, assess the extent of spread of the rectal tumor, damage to the lymph nodes, and involvement of the anal canal muscles in the tumor. Unlike radiography and CT, MRI does not expose patients to ionizing radiation.

Positron emission tomography (PET). This type of examination uses a contrast agent containing a radioactive form of glucose, which helps determine the location in the human body where the tumor is located. Although this method can accurately identify “occult” tumor metastases that cannot be detected using CT or MRI, PET is currently not the method of choice for the preoperative evaluation of patients with colorectal cancer.

Ultrasound examination (ultrasound) of the abdominal cavity. Using this method, you can determine the condition of almost all abdominal organs and suspect the presence of tumor metastases in other organs, most often in the liver. You can also evaluate the condition of the kidneys, pancreas, and gallbladder. If it is not possible to perform a CT scan of the abdominal cavity, this study is the method of choice for assessing the presence or absence of distant metastases.

Transrectal ultrasound (TRUS). This study is performed using a special sensor, which is inserted into the rectum through the anal canal. This method allows you to identify the degree of tumor invasion of the rectal wall, assess the condition of nearby lymph nodes and rectal sphincters. If it is not possible to perform an MRI of the pelvic organs, it is the method of choice for assessing the spread of a rectal tumor.

Blood tests. A standard set of blood tests includes: a complete blood count, a biochemical blood test and a blood clotting test.

IN general analysis blood, the total number of red blood cells (red blood cells), hemoglobin, leukocytes (white blood cells) and platelets is assessed. These cells play a crucial role in the functioning of the body. Red blood cells, with the help of the hemoglobin they contain, are an oxygen carrier and are responsible for supplying oxygen to all tissues and organs. In colorectal cancer, bleeding may occur from the tumor, so the number of red blood cells in such patients may be reduced. In severe cases, a blood transfusion may be required after surgery, and sometimes before surgery. Because platelets play an important role in normal blood clotting (blood clotting), counting these blood cells is a necessary test. If the patient has not had any episodes of abnormal bleeding in their lifetime, such as heavy nosebleeds or bleeding from the gums of teeth, there will likely be no abnormalities in this test. However, studying the platelet count is very important to determine the possible risks of bleeding during surgery.

As part of a biochemical blood test, plasma electrolytes, such as potassium and sodium ions, are assessed. Levels of these ions can be very low or high in patients taking medications for high blood pressure or other medications. Before surgery, it is necessary to restore the normal level of these ions in the blood plasma.

The blood clotting profile evaluates the effectiveness of clotting, which is important to know because blood clotting may be impaired in patients with hemophilia or other clotting factor disorders.

Also mandatory tests that are done to all patients before surgery are the determination of blood group and Rh factor, since these data may be required for blood transfusion, and the determination of markers infectious diseases – viral hepatitis(B and C), syphilis, HIV infection. In the absence of all these tests, the operation is impossible.

Electrocardiography (ECG). This is a simple screening test that can determine heart function. It can help identify signs of atherosclerotic heart disease (narrowing of the arteries of the heart), which is a serious risk during surgery. ECG signs of a previous myocardial infarction or cardiac ischemia (lack of blood supply to certain areas of the heart due to insufficient blood flow) are signs of atherosclerotic damage to the coronary arteries (arteries of the heart). If you receive an abnormal ECG picture, you may need to perform additional tests, which will be prescribed by your doctor or cardiologist.

What to take with you to the hospital.

You should be prepared to stay in the clinic for several days. Be practical and guided common sense. Do not take valuables with you, fashionable clothes or a large amount of money. Bring a small bag with the essentials. You will need leg compression stockings, which help reduce the risk of blood clots during long surgery. This can include elastic bandages or special compression stockings. Immediately after the operation, to protect the sutures of the anterior abdominal wall, you will need to constantly wear a bandage - this is a special wide elastic belt that helps support the muscles of the anterior abdominal wall at times when there is strong pressure on it - when you stand up, cough, sit down or bend over. You will only be in bed for one or two days after surgery, after which you will be encouraged to get up and walk around. You may want to wear a robe or comfortable pajamas and slippers with non-slip soles. After surgery, for some time, a small amount of wound discharge may be released from the sutures, which, even through a sterile dressing, can stain clothing. Therefore, prepare two sets of clothes and do not take expensive or favorite things, as they may get damaged in the hospital.

Don't forget toiletries such as a toothbrush, toothpaste, comb, deodorant, perfume or cologne, they will help you feel like a “human” after surgery. During surgery, patients should not wear contact lenses, so on the day of surgery, do not wear them, instead, it is better to wear glasses, and contact lenses leave for a while after surgery. Before the operation, give valuables and wallet to your family members, leave a small amount of money to pay for television or telephone. You may also find it useful good book, a few magazines or a craft kit to help you pass the time during last days stay in the clinic when you feel better.

If you regularly take any medications (for example, for high blood pressure or diabetes), be sure to take them with you. It is very important that you continue to take these medications until the day of surgery, unless your doctor prescribes something else.

The day before the operation.

Preoperative bowel preparation.

Usually, on the eve of surgery, as before a colonoscopy, it is necessary to completely clear the intestines of stool. Bowel preparation is important to reduce the risk of postoperative complications. As you know, normally the lumen of the colon contains a large number of bacteria. If these bacteria get outside the intestine, such as into the abdominal cavity, during surgery, this can lead to complications. The most common type of infectious complications is suppuration of a skin wound, which can occur in 5-10% of patients. In patients who have completed a complete bowel cleanse before surgery, the risk of wound suppuration is reduced. If, as a result of preparation, for some reason it was not possible to completely cleanse the intestines, the likelihood of problems with the intestinal anastomosis (surgical connection between the two ends of the intestine) increases after the operation, and infectious inflammation may develop in the abdominal cavity. Therefore, take bowel cleansing seriously. If you have problems during preparation, be sure to tell your doctor. If you experience nausea or vomiting while taking the drug, you cannot take the entire dose of the drug, or if the drug does not work, do not wait until the next morning when you are scheduled for surgery, be sure to contact your doctor. Perhaps he will suggest that you use another method of preparation, which is easier to tolerate by patients.

There are many methods of preoperative bowel preparation, from traditional enemas to special medications that have a strong laxative effect. Your doctor will tell you how to prepare your bowels for surgery and describe in detail everything you will need to do. Bowel preparation can take almost the whole day; during this time, patients cannot eat anything solid, only liquid food is allowed (broths, jelly, water, tea).

Medicines that you regularly take.

On the day before surgery, be sure to take all your prescribed medications, even though you are not allowed to eat or even drink liquids during the bowel preparation. But before doing this, be sure to ask your doctor which medications you can take, which you cannot, and how long before surgery you need to stop taking certain medications. Ask your doctor to write you a medication schedule so you don't forget anything and don't rely solely on your memory during this exciting time.

Here are examples of medications you should discuss with your doctor.

Medicines you MUST take before surgery. You may need to take antihypertensive medications (medicines to prevent high blood pressure), including beta blockers, angiotensin-converting enzyme inhibitors, and diuretics, with a small sip of water on the morning of surgery. Antihypertensive medications help stabilize blood pressure during surgery. Beta blockers reduce the risk of heart complications in patients with atherosclerotic heart disease. Diuretics help reduce the risk of a heart attack from too much fluid. Meanwhile, diuretics can cause dehydration if used together with bowel cleansing medications. Therefore, be sure to consult with your doctor whether you should take diuretics on the day of surgery.

Medicines you SHOULD NOT take before surgery. You should stop taking NSAIDs (nonsteroidal anti-inflammatory drugs), which include aspirin and ibuprofen (Nurofen). These medications change platelet function and may cause changes in blood clotting. This effect of NSAIDs lasts for 2 weeks, so these medications should be stopped two weeks before surgery.

Herbal medicines. Although these drugs are not considered drugs, but only food additives Many of these drugs contain registered drugs that can have effects on the body. For example, the drug Ginkgo Biloba affects blood clotting. Be sure to discuss taking all vitamins and herbal medications with your doctor. You will likely need to stop taking these medications the night before your surgery to prevent possible unwanted drug interactions. Also be aware that some non-medicinal herbal products, such as herbal tea, may have unwanted effects. Be sure to check if they may have any potential side effects.

Anticoagulants (warfarin, Plavix). These medications reduce blood clotting and their effects may last for several days, so they should be stopped 4-5 days before surgery. At this time, you may need to switch to other anticoagulants, such as heparin or low molecular weight heparins (Clexane, Fraxiparine, Fragmin). Unlike warfarin, the effect of these drugs lasts for several hours and can be completely eliminated on the eve of surgery. In order to prevent the development life-threatening complications, never stop taking warfarin on your own, be sure to consult your doctor!

Antiglycemic drugs (against diabetes). If you have diabetes, you will need to take the medicine you usually take the day before your surgery. Since you will not eat anything on the day of surgery, you will not need to take anti-glycemic tablets or inject insulin on the morning of surgery, as this can cause your blood glucose levels to drop significantly. If you have severe diabetes, you may need to take a small dose of insulin on the morning of surgery, but this must be discussed with your doctor.

Consultation with an anesthesiologist.

On the day before the operation, an anesthesiologist or his assistant will talk to you, who will assess your condition and explain what type of anesthesia will be chosen for the operation. Be sure to answer all the anesthesiologist's questions completely and honestly, this will help avoid possible complications. Also be sure to ask any questions you have about your upcoming anesthesia. The anesthesiologist will prescribe special medications that you will receive the evening before the operation; they will help you reduce anxiety before the operation and prepare your body for anesthesia.

Consent for surgery and anesthesia.

Before the operation, you will need to sign informed consents for the operation and anesthesia, as well as for blood transfusions.

Anesthesia drugs slightly reduce blood pressure, slow down the pulse and breathing rate. But this is provided that during anesthesia the pressure readings were within normal limits. Low or high blood pressure in combination with anesthesia can cause serious complications, so specialists strive to regulate all indicators before surgery.

General information

General anesthesia is a temporary inhibition of the functions of the central nervous system, which is accompanied by loss of consciousness, suppression of sensitivity, muscle relaxation, suppression of reflexes and analgesia for surgical intervention. General anesthesia is carried out by suppressing synaptic connections between neurons. There are 4 sequential stages of general anesthesia, each of which is characterized by different indicators:

Enter your pressure

Move the sliders

• BP—blood pressure;
• HR—heart rate;
• RR - respiratory rate.

How does anesthesia affect blood pressure?

The effect on normal blood pressure is presented in table form:

Reaction when high blood pressure

• There may be a large loss of blood during the operation.
• Bleeding in the brain.
• Hypersensitivity of the heart and blood vessels to surgery and narcotic drugs.
• Development of severe heart failure.

At low pressure

• Hypovolemic shock is possible.
• Heart failure.

Why is anesthesia dangerous?

Overdose can be fatal.

In case of overdose, if the anesthetics have affected the respiratory and vascular-motor centers of the medulla oblongata, the agonal stage begins. Breathing stops and death occurs. In addition to overdose, other complications arise:

• Hypoxic syndrome, which can be caused by obstruction of the airways with vomit, laryngospasm and bronchospasm.
• Hypertensive crisis, hemorrhagic stroke, if hypertension was not treated before the operation. A hypotensive crisis can occur due to blood loss or if anesthesia is administered at low pressure. Rarely, myocardial infarction, pulmonary edema and thrombosis of the pulmonary circulation may occur.
• Anaphylactic shock. Functional adrenal insufficiency.
• After anesthesia, jumps in blood pressure may occur.

Contraindications

• Hormonal pathologies in the stage of decompensation.
• Severe degree of diseases of the cardiovascular system, liver and kidney failure.
• Arrhythmia, extrasystole.
• Severe form of bronchial asthma.
• Previous heart attacks or strokes.

Artificial sleep is dangerous in case of intoxication due to alcohol or drugs.

These contraindications are taken into account if the operation is planned, and their manifestations can still be mitigated. But if urgent surgical intervention is required, then general anesthesia is administered in any case. You should not refuse general anesthesia if the specialist insists on performing the operation. A competent anesthesiologist is able to select the optimal combination of drugs to reduce the risk of complications.

Enter your pressure

Move the sliders

Preparation for surgery is a very significant stage and requires a serious approach from the patient. Based on preliminary examinations, test results, the lifestyle that a person leads immediately before the operation, his psychological mood, the anesthesiologist chooses the method of anesthesia and drugs, and the surgeon builds a strategy and determines the procedure for performing the operation. And preparatory measures should be taken very carefully and responsibly.

How to properly prepare for surgery

• Lifestyle

A person for whom surgery is a planned event will have to make adjustments to his lifestyle and give up, at least temporarily, some habits long before the day of surgery appointed by the surgeon.

About three to four weeks before the target date, you should quit smoking or at least minimize the number of cigarettes you smoke per day. The limitation is due to the fact that the risk of complications from respiratory system(bronchitis, pneumonia) after surgery in smokers the disease is much higher and more severe than in non-smokers.

You should also be careful with alcohol. You should give up strong drinks at least two weeks in advance to eliminate the effect of alcohol on the functioning of the liver and heart. Alcohol interferes with the normal functioning of the liver and reduces its ability to neutralize toxic substances and remove them from the body. On the part of the heart and vascular system, unstable heart function and pressure surges may be observed. Alcohol changes the functioning of the blood coagulation system: blood clots can form or, conversely, bleeding can be provoked.

• Nutrition

Two to three weeks before the planned operation, and if possible even earlier, you need to give up strict diets and create a diet in such a way that low-fat meat dishes, fish, fruits and vegetables predominate on the table. A few days before surgery, you need to exclude high-calorie, difficult-to-digest fatty foods, smoked foods, pickles and marinades. Fast food and alcohol are also prohibited before surgery. Before surgery, you should not experiment with unfamiliar foods or exotic fruits- this may cause allergic reactions, and the operation will have to be postponed.

On the eve of the operation, dinner should be no later than 19:00, after which you should not eat or drink any water.

• Physical form

A balanced diet helps the body mobilize resources for normal recovery after surgery. But it is important, if possible, to strengthen the immune system and normalize metabolism, which will help increase the body’s resistance and accelerate tissue regeneration. In addition to a balanced diet, the patient needs to include regular, feasible physical activity in his daily routine. There is no point in exhausting yourself with training in a stuffy gym; an hour-long walk at a fast pace in the park will bring much greater health benefits. But even regular daily exercise will help bring the body into full combat readiness before a significant test. Patients with increased weight should be especially attentive to their physical fitness. Losing weight will have a positive effect on the outcome of the operation, reduce the load on the heart and help you go through the rehabilitation period faster and easier.

• Taking medications

During the consultation, the patient must tell the doctor about all the medications he is taking. In no case should you stop taking previously prescribed medications on your own initiative or, conversely, uncontrollably drink anti-inflammatory, antipyretic medications (such as ibuprofen, analgin, diclofenac; drugs containing aspirin).

Only after consulting with the doctor, the patient will firmly know which medications to continue to take according to the usual regimen, and which ones will have to be abandoned. For example, aspirin can affect blood clotting and affect the effect of anesthetics, and if you stop taking antihypertensive drugs prescribed before surgery, a jump in blood pressure may occur.

It is very important that the anesthesiologist, who will choose the type of anesthesia and drugs, knows whether the patient is allergic to drugs. The doctor may consider it necessary to prescribe antihistamines three to four days before surgery.

In some cases, a day or two before the intervention, doctors recommend taking sedatives at night.

• Hygiene and appearance

Preparation for surgery includes a number of general hygiene measures.

• Before the operation, you need to take a shower, preferably wash your hair.
• To ensure that the stomach and intestines are empty during the operation, the doctor may prescribe tablets to cleanse the intestines the day before. Immediately before abdominal surgery, an enema is performed in the clinic.
• It is necessary to remove contact lenses, all jewelry, and remove makeup.
• You should not use any cosmetics on the day of surgery. Nail polish must be removed.
• Even if clothing is provided at the clinic during hospitalization, comfortable underwear, soft, easy-to-put-on shoes, and shoes for showering should be provided.
• If the operation is performed on a part of the body where there is hair, it must be removed on the eve of the operation (shaved).

Important:

• On the day of surgery, no food or liquid is allowed.
• No jewelry should be left on the body during surgical procedures; nail polish and makeup must be removed.
• On the eve of the planned planned operation, it is necessary to rest well and get enough sleep, and also try to avoid nervous and physical stress.

• Psychological attitude

A state of excitement or anxiety before a surgical procedure is a normal human condition. Even planned in advance, long-awaited Plastic surgery, on the result of which the patient places great hopes, is associated with natural experiences. And it is very important to come to her in good psychological shape, without unnecessary emotions and fears. After all, internal balance and calmness significantly improve the results of the operation, and the rehabilitation period is faster and easier.

The more the patient learns about the upcoming intervention, the more adequate the reaction to the event will be.

Since the operation is planned and the person himself is looking forward to it, sometimes for several years, it will not be difficult to gradually collect information from competent sources. A rational approach and knowledge of information about exactly how the operation is carried out and the period of initial postoperative recovery, what types of anesthesia are possible, what painkillers will be given in case of discomfort at the end of the procedure, helps to get rid of worries, and the body will definitely react with increased resistance to the phenomena of the rehabilitation period .

If you feel increased anxiety, you must tell your doctor about it so that he can clarify any questions or doubts that arise, and, if necessary, prescribe sedatives or advise you to talk with a psychologist at the medical center.

The foundation of a calm attitude towards upcoming changes and control over the situation and one’s own emotions is trust in the doctor and the understanding that after surgery, additional life opportunities will open up for the patient, a sense of self-confidence will be strengthened and a sense of inner harmony will appear.

• Organizational aspects

If an inpatient stay is expected medical center, it is best to prepare a list ahead of time and, after coordinating it with the medical institution, take your time to collect the necessary things.

The clinic will need:

• Passport or other identification documents. You should check with your doctor in advance whether a medical insurance is necessary.
• Results of medical examinations and tests.
• Personal hygiene products and items ( Toothbrush, paste, comb, manicure accessories, shampoo, soap, etc.).
• If the patient wears contact lenses, a container and solution will be needed to store them.
• Notepad or notebook, pen.
• Mobile phone and Charger to him.

• Medical examinations and tests

Before the patient arrives at the clinic for surgery, he must undergo a medical examination in accordance with the list given by the doctor and collect tests. The list of tests depends on the method of anesthesia, and they can be prepared in the district clinic to which the patient is assigned, or in a specialized laboratory.

For surgical intervention using general anesthesia

• HIV (HIV)
• RW (syphilis)
• Hepatitis B, hepatitis C
• Blood test (biochemical)
• Total protein
• Total bilirubin
• Prothrombin
• APTT.

For surgical intervention With using local anesthesia the patient needs to prepare:

• Blood test (general clinical)
• HIV (HIV)
• RW (syphilis)
• Hepatitis B, hepatitis C.

In addition to the mandatory tests listed, the surgeon or anesthesiologist may prescribe additional ones. Most often, the patient is recommended to have an ECG with a transcript to assess the functioning of the heart, and a coagulogram, with the help of which disorders of blood clotting are detected.

The clinic doctor will tell you in detail about how to prepare for the operation at the preliminary consultation. It is important for the patient to remember that strict adherence to the instructions of the surgeon and anesthesiologist, adherence to the daily routine required before medical procedures and an optimistic attitude are the key to a successful result of the work of the medical center’s specialists.

So, you are about to undergo surgery. You have already faced the thought of this difficult test and now you want to prepare for it as best as possible. And rightly so, because the correct approach to surgery, as well as subsequent compliance with the rules and regulations of the postoperative regimen, plays a very important role in the patient’s recovery and maintaining his health. In fact, preparation for planned surgical intervention begins long before the patient’s planned hospitalization.

If you have planned surgery...

It includes not only a whole list of important activities aimed at improving health, preparing personal hygiene products, necessary clothing and items to fill free time. You also need to take care of developing a certain psychological attitude that allows you to calmly, correctly, soberly and balancedly approach the upcoming medical manipulations.

To your health

Before elective surgery, you need to ensure that your body is as healthy as possible. If you have any chronic ailments, care should be taken to achieve their stable remission. Your GP will help you with this.

About a month and a half before the proposed intervention, stop smoking. This way you can significantly reduce the likelihood of developing any respiratory complications after recovery from anesthesia. If you just can’t quit smoking, you shouldn’t pick up a cigarette at least on the day of surgery.

If you are overweight, do everything possible to get rid of at least a couple of extra pounds. This will avoid many different complications and problems after surgery.

If you have loose teeth or crowns, take the time to visit your dentist and get the appropriate treatment. During surgery, there is a significant risk of losing such teeth while the anesthesiologist installs special equipment to ensure airway patency.

In addition, you should prepare all the medications you need in advance and take them with you to the hospital.

Remove all jewelry and jewelery from yourself. If you cannot do this for some reason, wrap them with duct tape before surgery. This will help avoid damaging them and also prevent them from accidentally injuring your skin.

Remember that the clothes you take to the hospital can become very dirty, so give preference to those things that you don’t mind throwing away. In the majority medical institutions Before the operation, the patient is recommended to change into special hospital clothes.

Fasting mode

Unless you have received any special advice from your surgeon or anesthesiologist, remember that the day before surgery you are allowed to drink and eat your usual food until midnight. However, in the morning of the day of surgery, you should not consume anything. Your stomach should not contain the slightest amount of water and food, as otherwise the safety of anesthesia may significantly decrease, creating a real threat to life and health.

For the children's age group, slightly different rules apply. So, until the age of six months, the last meal should be taken no later than four to six hours before anesthesia. For children aged six to thirty-six months, this period is at least six hours. It is not recommended to drink for at least two to three hours before surgery. All these instructions remain valid unless the anesthesiologist gives any other recommendations.

Hygiene measures

In the evening, on the day before the operation, take a shower or bath, unless you have received a prohibition from your doctor. This procedure will cleanse your body of small invisible contaminants, which will significantly reduce the risk of infection during surgery.

Be sure to brush your teeth in the morning or at least rinse your mouth thoroughly.

Before surgery

Remove existing foreign objects from the oral cavity: piercings, dentures, candy and chewing gum. All of the items listed can cause breathing problems after you are put under anesthesia.
You should also remove your hearing aids and contact lenses.

Nails should be cut short and free of manicure polish. The applied varnish will interfere with assessing your condition based on the color of the nail plate, and may also prevent a special device that reads information about the breathing rhythm and is attached to one of the fingers from working properly.

Taking medications

If you need to take any other medications on the morning of surgery, and your anesthesiologist has nothing against it, try to swallow the tablets without water. If this is not possible, the amount of fluid should be minimal; in addition, it is recommended to shift the intake of drugs to the earliest possible time in the morning.

Viagra is considered a particularly dangerous drug before surgery, since in combination with anesthesia it causes a strong drop in blood pressure, which leads to damage to the kidneys, brain and heart. You should not take Viagra for at least a day before surgery.

As mentioned above, proper preparation for surgery also includes a psychological attitude. Trust your doctor, believe that the intervention will be easy and successful, and it will actually be that way.