2020年10月30日星期五

are hemorrhoids hard,Precautions before anesthesia in anorectal department (intravenous anesthesia)

    Hello! Maybe you plan to do anorectal surgery such as hemorrhoids, anal fistula, anal fissure, perianal abscess, etc. Before the operation, you don't know much about the methods of anesthesia and the precautions for anesthesia, and you are afraid or worried about the operation and anesthesia. So let me talk to you about another commonly used anesthesia method in anorectal department-intravenous anesthesia (without intubation).

    Intravenous anesthesia refers to the method of intravenous injection, injecting drugs into the blood circulation, and inhibiting the central nervous system to produce anesthesia. After the anesthesia, the patient felt no pain, as if he was asleep. General intravenous intubation anesthesia is used for short operations or special inspection operations, such as painless gastroscopy, colonoscopy, painless artificial abortion, etc. It is suitable for low requirements for anesthesia, the duration is relatively short, and the pain is relatively small. The recovery time is also relatively fast. During anesthesia, blood pressure, electrocardiogram, blood oxygen and other monitoring, oxygen inhalation are required, and breathing should be controlled if necessary. At the same time, during the operation, the anesthesiologist will also monitor the condition and monitor the vital signs.

    Intravenous anesthesia has certain limitations, such as: poor muscle relaxation effect, large individual differences, metabolism affected by liver and kidney function, controllability is not as good as intravenous inhalation combined anesthesia (tracheal intubation), analgesic effect is not strong, so simple In anorectal surgery under intravenous anesthesia, due to insufficient intraoperative and postoperative analgesia, or because the anal sphincter cannot be completely relaxed, it is often necessary to increase anal local infiltration anesthesia to ensure the smooth progress of the operation. Compared with spinal anesthesia, more drugs are used for anesthesia. Therefore, it is currently mostly used for patients in anorectal department who are not suitable for spinal anesthesia, such as hematological diseases, oral anticoagulant patients, patients after lumbar spine surgery and low back pain.

    If you plan to undergo anorectal surgery assisted by intravenous anesthesia, please read this precaution carefully in advance and refer to it. I hope these contents can help you eliminate your doubts and complete the examination or surgery smoothly.

    Patients who apply for painless treatment or before intravenous anesthesia need to undergo pre-anaesthesia assessment;

    Before the anesthesia, drink for at least 6 hours and fast for 8 hours, accompanied by family members on the day of examination.

    Before anesthesia, the patient or family members should communicate with the anesthesiologist face to face, so that the anesthesiologist can fully understand the patient's medical history, and then have the right to decide whether to perform anesthesia according to the patient's physical condition. For patient safety, please bring your medical records and related examination reports on the day of the examination, and sign an anesthesia consent form.

    Do not conceal the condition (such as blood disease, diabetes, high blood pressure, history of surgery, history of pregnancy, history of unfasted water, vomiting/retention of the stomach, hematemesis, etc.) and actual conditions, otherwise it will cause serious consequences.

    The process of intravenous anesthesia and anorectal surgery: puncture and infusion to establish intravenous access → anesthesia → surgery → wake up → fully awake → sent to the ward, the whole process takes about 1-2 hours. During the whole process, the patient is asked to obey the arrangements of the medical staff to prevent accidents such as falls.

    Discharge criteria: The patient is conscious, has stable vital signs, can walk independently, and has no obvious discomfort. After the anorectal doctor checks the condition and allows him to be discharged, he can leave the hospital with someone accompanied.

    Two hours after the operation, you can drink a moderate amount of water. The principle of no gastrointestinal discomfort should be no more than 50 ml each time; no nausea or vomiting occurs 4 hours after the operation. You can eat general food. If you have other conditions, follow the doctor's advice.

    To leave the hospital, you must be accompanied by your family. Driving or riding a bicycle is prohibited. Please do not drive or perform delicate work within 24 hours after the anesthesia is over. Do not sign legal documents. Please do not drink alcohol on the same day.

    During the operation of the patient, family members are requested to wait in the waiting room so that the doctor and family members can contact at any time.

    I hope that through my introduction, you can dispel your doubts, relax, and cooperate with the anesthesiologist and surgeon to successfully complete the anesthesia and surgery and recover soon!

    Xiyuan Hospital, China Academy of Chinese Medical Sciences

    Anorectal Department Cao Weiwei

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