Complications after surgery on the intestines in the elderly
The use of anesthesia in the elderly
With the age of a person, the work of almost all organs and systems is disrupted. The body becomes weaker and unprotected. It is much more difficult for him to tolerate general anesthesia. But what if the operation is necessary to save lives, and the contraindications and age of the patient are forbidden to carry out general anesthesia?
Effect of anesthesia on the central nervous system in the elderly
In older people, general anesthesia has a negative effect on the central nervous system. He is dangerous in connection with the possibility of developing such postoperative complications:
- Acute paranoid. This complication most often develops after surgery on the gastrointestinal tract in the elderly. Euphoria and hallucinations can begin in patients. Such people usually do not correctly assess the severity of their condition.
- Depressive syndrome. It is most often observed after gynecological surgeries.
- Acute psychosis. Psychosis develops on day 2-3 after general anesthesia. It
Given the state of health of an elderly person, the type of anesthesia should be selected very carefully
Symptoms of psychosis after general anesthesia include:
- depressive state;
- auditory hallucinations;
- visual hallucinations;
- fear of death;
- olfactory hallucinations;
- taste hallucinations;
- convulsive syndrome.
Very often psychosis is accompanied by impaired memory, consciousness. It is believed that psychosis, developed in humans, in which hallucinations are observed, is the most unfavorable condition. In 90% of cases, psychosis can be coped in the early stages, preventing the development of hallucinations and seizures. After psychosis, for a long time, weakness, lethargy and apathy may persist.
Preparation for anesthesia in elderly patients
To ensure that general anesthesia is not dangerous for an elderly patient, it is necessary to carry out the correct preparation before the operation. Severe complications and consequences of the application of general anesthesia can be avoided by examining the patient's condition prior to choosing the method of anesthesia.
Older people need to undergo a survey to select the type of anesthesia
The mandatory methods of examination include:
- General blood analysis. It is needed to determine the level of hemoglobin and erythrocytes. Their reduced level indicates the presence of anemia, the possible need for blood transfusions, the appointment of drugs with iron. Also, with the help of this analysis, it is possible to detect the presence of a foci of inflammation in the body, which is indicated by an increase in the number of leukocytes and the rate of erythrocyte sedimentation (ESR).
- General urine analysis. This analysis shows the functional capacity of the kidneys. Many drugs for general anesthesia are excreted by the kidneys, so you need to know their performance before choosing the method of anesthesia. The presence of leukocytes and protein in the urine indicates an inflammatory process, sediment means the presence of urolithiasis.
- Electrocardiography. With its help, the heart rate is determined. In the presence of rhythm disturbances, such as atrioventricular blockade, atrial fibrillation, it is necessary to think about the possibility of using local anesthesia instead of general anesthesia.
- Ultrasound examination of the abdominal cavity organs. It is performed to all elderly patients in a planned manner. The doctor evaluates the size and shape of the liver, gall bladder, patency of the bile ducts. If the operation is going on in a planned manner, you must first conduct therapy for the diseases of these organs.
- Blood test for sugar. 40 percent of the elderly have diabetes mellitus of the second type. In this disease, blood vessels primarily suffer. Postoperative wounds very poorly heal if the blood glucose level does not correspond to the norm.
Features of the postoperative period in the elderly
Elderly people, after conducting any surgical intervention under general anesthesia, should be under the round-the-clock supervision of anaesthesiologists in intensive care units. With the help of their equipment, they constantly check the concentration of oxygen and carbon dioxide in the blood, heart rate, blood pressure, an electrocardiogram is performed.
After the operation, the patient needs to observe the doctors
For patients at the age of postoperative treatment includes such basic components:
- Carrying out adequate prevention of purulent complications. After surgery of any complexity it is necessary to carry out antibacterial therapy. Such treatment prevents infection of the operating wound and the development of hospital pneumonia. Older patients are more susceptible to pathogenic microflora, they need to pay sufficient attention to antibacterial treatment.
- Support the level of electrolytes and water in the body. Older people lose the liquid with electrolytes much faster at high temperatures. When the level of potassium, sodium or calcium decreases, heart rhythm disturbances begin, and convulsions may appear.
- Control of body temperature. It is necessary to fear not only an increase, but also a decrease in body temperature. In elderly patients after surgery, severe hypothermia can occur, which requires urgent therapy.
People of advanced age are much more difficult to tolerate general anesthesia. After it is carried out, a violation of the central nervous system is often observed. To prevent these complications, a thorough examination of patients before surgery and proper selection of drugs for anesthesia are necessary.
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How to take care of elderly patients after surgery
Dear visitors! We remind you that self-treatment is sometimes extremely dangerous, especially if you do not know the exact diagnosis. If possible, do not ignore official medicine, especially its diagnostic capabilities. At us with medicine not all so is bad, as sometimes it seems!
The main tasks of postoperative care # 8212; prevent possible complications and facilitate the course of the recovery period.
Complications that can occur after surgery can be divided into general (from the side of the respiratory system, blood circulation, digestion, urination, nervous system, etc.) and local (infection of the operating room wounds).
It is necessary to take care in advance that the bed was warmed by several heaters. Then they are put to the feet of the patient (not forgetting the possibility of burns from heaters, as the patient, being in a state of anesthesia, is not able to feel the pain in time).
After the operation, the patient is laid on a hard bed. The position with the raised leg of the bed is necessary for large blood loss during the operation, the state of traumatic or postoperative shock, with drainage in the abdominal cavity. After surgery, limbs are placed on a limb in a comfortable elevated position, as this improves circulation, heart and lung function.
At any position, even the most optimal, for the prevention of various postoperative complications (pneumonia, pressure ulcers, thrombosis, etc.) it is necessary to change the pose as often as possible. Frequent replacement of the forced postoperative posture raises the general tone of the patient, improves blood circulation, stimulates the functions of important organs, especially the gastrointestinal tract and urinary system. A weak, depleted patient to prevent pressure sores under the sacral area is put a special rubber circle.
Compensatory capacity of the body decreases with age, and this affects the course of the postoperative period. Elderly people are more likely to suffer an operational trauma, are particularly sensitive to certain pharmacological agents, are prone to various complications. In elderly people there are more pronounced changes from the side of the cardiovascular system with the phenomena of circulatory insufficiency, chronic pneumosclerosis. After the operation, the volume of breathing and the vital capacity of the lungs are often reduced, secretion is delayed, and pneumonia often occurs.
In the prevention of pulmonary complications, special attention is paid to respiratory gymnastics. The nurse even before the operation teaches patients simple gymnastic exercises in bed and explains their important preventive value in congestive pneumonia.
Elderly people are difficult to adapt to changes in ambient temperature. Therefore, it is necessary to prevent both cooling and overheating.
In the elderly, constipation often occurs after an operation due to lack of intestinal tone. Multi-day stool delays adversely affect the general condition of the patient, lead to disruption of the heart. With propensity to constipation, it is necessary to prescribe an appropriate diet, stimulate the motor function of the intestine up to high siphon enemas.
In elderly men, urination is often difficult due to prostatic hypertrophy. The tone of the intestine and bladder is significantly improved if the operated person rises from bed as early as possible, so elderly patients should be encouraged to actively move. The nurse from the first day after the operation should turn the patient from side to side, put the jar, remind of respiratory gymnastics.
Elderly people are very sensitive to oxygen starvation, so in the postoperative period they are often injected with moistened oxygen in the respiratory tract. In cases of severe respiratory failure, elderly patients are given a tracheostomy that improves gas exchange conditions, and patients spend less effort in breathing and expectoration of phlegm.
After relatively small surgical interventions, the elderly need to measure blood pressure within the first 2-3 days after operations daily, and after severe operations it is measured several times a day and indicators are recorded in the medical history and in the temperature sheet.
After surgery on the gastrointestinal tract, to compensate for the lack of fluid, electrolytes, proteins, patients are prescribed parenteral infusions or nutritional droplet enemas.
In the elderly due to increased blood viscosity, reduced blood flow velocity, changes in the walls of blood vessels, there is a risk of thrombus formation. Therefore, after surgery to prevent this complication, the doctor allows you to get out of bed and appoints the procedure for bandaging your legs with elastic bandages.
Operational wounds require special care. Pain sensitivity at this age is usually reduced, so it is much more common in the elderly to have suppuration in the wound without noticeable subjective sensations. Sutures are removed no earlier than on the 12th day after surgery.
To prevent mumps and stomatitis, which often occur in elderly patients, special attention should be paid to oral hygiene.
Insufficient control of the skin, bed can lead to the formation of pressure sores and complicate postoperative healing. Bedsores are hard to treat, so to prevent this serious complication, you should wipe the patient's skin with camphor alcohol daily, bed linen was always dry, without folds, more often to turn the patients on their side, to make them move more in bed, showing patience and mercy.
Published on: 18.02. | | Posted by: admin | Rubric: News
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Surgical treatment of aneurysms
What is the surgical treatment of aneurysms?
VASCULAR SURGERY - EURODOCTOR.RU - 2007
Surgical treatment of the aortic aneurysm is understood as excising it and replacing the removed (aneurysmatic) aortic site with a synthetic prosthesis. An aneurysm is a special saccular widening of the wall of the aorta that results from the thinning of its wall. This occurs when the walls of the aorta are affected by some kind of inflammatory process or atherosclerosis. An aneurysm is a serious problem, as with the increase in its growth, the risk of its most formidable complication, the rupture, also increases. In addition to this complication, with aortic aneurysm, there is also a phenomenon such as the formation of thrombi and their introduction into various organs and tissues, where the occlusion of the vessel occurs. Fortunately, aneurysms are treatable. There are several methods for treating aortic aneurysm, so that if one method is not suitable for you, then it is quite possible that another one will do. These are methods such as open method (or surgical) and endovascular (stenting method). The choice of an aneurysm treatment method depends on many factors, such as the size, location and shape of the aneurysm, as well as the general condition of the patient.
Aneurysm can be located in arteries of any caliber, but most often they are found in the aorta. Depending on the aortic department, where the aneurysm is located, it is called the aneurysm of the abdominal aorta or thoracic aorta. In addition, aneurysms can be located in the arteries of the hip, knee, spleen, liver, kidney or stomach. But the most common type of aneurysm is an aneurysm of the abdominal aorta.
Not all aneurysms require immediate treatment. If the aneurysm is small, the doctor can offer a wait-and-see tactic.
When the aneurysm reaches life-threatening dimensions, the doctor can offer you surgical treatment. An aneurysm operation is performed under anesthesia. As it was said, the treatment can consist either in replacing the affected area of the aorta with a prosthesis or in the stent installation. Sometimes an aneurysm operation involves a so-called clipping, that is, when an aneurysm protrudes like a sack from one side of the aorta, it is pinched at its base by a special clip.
Preparing for an operation for an aortic aneurysmBefore the operation, the doctor usually collects all the necessary data about the course of the patient's illness. This is his complaint, when they arise, for how long they disturb the patient. In addition, the doctor conducts a survey, which consists of careful feeling of the aneurysm site and listening with phonendoscopes. It is mandatory before the operation to conduct additional research methods, such as:
- ultrasound scanning
- CT scan
- magnetic resonance angiography
Before the operation, the doctor will recommend that you do not eat for 8 hours. Also, if you are taking any medications, you need to discuss with the surgeon about their further admission before and after the operation.
When is it necessary to treat aortic aneurysm?
Treatment for an aneurysm of the aorta can be either planned or emergency, according to vital indications. Planned treatment is performed when the aortic aneurysm reaches certain sizes, depending on the location of the aneurysm, or if it grows rapidly. Less often, planned treatment of aneurysms is necessary provided that it disrupts the blood flow in the legs.
Emergency treatment of the aortic aneurysm is required for life-threatening conditions, for example, if it is threatened with rupture or stratification, or if a gap occurs. Also, emergency treatment can be performed if there are severe pains in the abdomen or in the back, which indicates the stratification of the aneurysm.
Is there any risk during surgery for an aortic aneurysm?Serious health problems, which are especially common in elderly patients, can increase the risk of complications during surgery for an aortic aneurysm. In the absence of concomitant diseases, the elderly patient's age is not a contraindication to the operation. The risk of complications during surgery is increased with the following concomitant diseases:
- congestive heart failure
- chronic obstructive pulmonary disease, when there are violations of pulmonary ventilation
- angina pectoris
The physician should assess the presence of these risk factors before surgery.
How is an operation performed for aortic aneurysm?
Usually, the operation is performed under general anesthesia. Depending on the location of the aneurysm (aorta, knee artery, etc.), the incision may be in the abdomen, limb or other area.
Once the surgeon reaches the aneurysm site, he clamps the upper portion of the artery or aorta so that blood does not flow into the aneurysm. So, the surgeon can either remove the altered portion of the aorta and replace it with a synthetic prosthesis, or sew it into the lumen of the aneurysm prosthesis, or to excise an aneurysm, having preliminary put on its basis a clip (in case of the form of an aneurysm in the form of lateral protrusion).
In some cases, when an aneurysm is located in the area of small arteries, for example, in the artery of the leg, the surgeon can remove the artery and replace it with a vein site.
Less often, when the surgeon can not clone the aneurysm due to its location, the so-called sealing with metal or plastic is performed. This type of operation is performed using a catheter inserted into the vessel. The filling fills the lumen of the aneurysm and prevents its filling with blood.
After the operation, depending on its volume, the patient needs a rehabilitation period, for a period of 7 to 10 days.
Complications after surgery for aneurysm of the aortaAs with any surgical intervention, there may be complications after surgery for an aortic aneurysm. They include:
- complications from the heart
- complications of the lungs
- kidney complications
- complications from the intestine
In addition, there may be infectious complications from the operating wound, infection of the urinary tract and lungs. Very rarely due to the spread of blood clots through the vessels from the site of surgery, there may be strokes and paralysis. Also, there is such a complication as retrograde ejaculation (in men), when the sperm along the seminal duct goes back to the seminal vesicles. It is worth noting that all these complications are mainly related to emergency interventions for an aneurysm.
Prevention of aneurysmTo achieve maximum results after surgery for aortic aneurysm, you should change your lifestyle. First of all, it is necessary to achieve normalization of the blood pressure and cholesterol level in the blood, as they are the main risk factors for the occurrence of aneurysms. Activities aimed at this:
- food intake with low cholesterol
- to give up smoking
- normalization of body weight
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Sources: http://narkozzz.ru/anesthesia/oslozhnenija-posle-narkoza-u-pozhilyh.html, http://krollik.ru//02/18/kak-uxazhivat-za-pozhilymi-pacientami-posle-operacii/, http://vascularsurgery.eurodoctor.ru/aneurismsurgicaltreatment/
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