Any surgical intervention is accompanied by the use of anesthesia. The introduction of potent drugs into the body, especially during deep anesthesia, often entails not the most pleasant manifestations for the body. However, there are situations when their use is contraindicated. This means that general anesthesia is performed only for emergency medical reasons or when the risk to the patient's life is justified by the risk of using anesthetics.

Absolute contraindications

This list is conditional. In some cases, as mentioned above, deep anesthesia is used even if they are present. We list the main contraindications to anesthesia:

• The patient has a disease such as bronchial asthma in severe or progressive form. This condition is directly related to the danger of laryngeal intubation during deep anesthesia. This manipulation can cause closure of the glottis or bronchospasm, which is life-threatening. That is why it is a rather dangerous combination.
• Pneumonia. After surgery, pulmonary edema may develop in this case.
• Serious diseases of the cardiovascular system. These include myocardial infarction suffered earlier than six months, acute heart failure, as well as uncompensated heart failure. The latter is often accompanied by severe sweating, swelling and severe shortness of breath. Atrial fibrillation, in which the heart rate reaches one hundred beats per minute, is also an unacceptable condition.
• Epilepsy, schizophrenia and some other psychiatric and neurological diseases. Contraindications for such diagnoses are associated with an unexpected reaction of the sick person’s body to the use of anesthetics.
• Temporary but absolute contraindications, in which surgery is usually not performed under anesthesia, is a state of alcohol or drug intoxication. The point here is that anesthetics will not work, so this procedure is impossible. Surgical intervention for a patient who is under the influence of alcohol or drugs can only be performed after complete detoxification of the body. Often in this case, the help of a narcologist is necessary. General anesthesia is used for patients under the influence of alcohol or drugs only for emergency medical reasons. However, in this case, large doses of anesthetics and narcotic analgesics are introduced into the body, which can subsequently lead to an unpredictable effect.

In what cases should mask anesthesia not be used?

It is worth noting that there are contraindications to long-term use. First of all, these include the presence of tuberculosis in the patient. It is also prohibited in case of diabetes mellitus and impaired renal function, including unstable functioning of the adrenal glands.

In any case, the decision about which anesthesia will be best for you is made by the anesthesiologist. It takes into account all diseases and possible contraindications. Choose your specialists carefully and be healthy!

I created this project to tell you in simple language about anesthesia and anesthesia. If you received an answer to your question and the site was useful to you, I will be glad to receive support; it will help further develop the project and compensate for the costs of its maintenance.

Questions on the topic

Olga 09.10.2019 05:50

Good afternoon My mother (73 years old) was diagnosed with a giant cystoma of the right ovary. A CT scan was done, all organs were examined, there were no metastases. In the extract, the doctor writes: cystoma? disease of the right ovary (meaning oncology)?, i.e., the diagnosis is unknown. Due to the fact that the cystoma has compressed all organs, disruptions in the functioning of the heart are observed. An operation to remove the cystoma was planned, but after consulting an anesthesiologist, it was postponed. The anesthesiologist said that there was a high risk due to severe tachycardia. Mom never complained about her heart before. I received a referral to donate blood for a tumor marker (I donated it earlier, there was an excess), we will wait for the choice of alternative treatment. It is difficult for her to move, she eats little due to the fact that food simply cannot fit into her compressed stomach, in other words, she loses strength. Should I insist on surgical intervention?

Inna 05/17/2019 09:50

Good afternoon. Tell me, during vertebroplasty, local anesthesia is administered, my FGDS revealed 4 mature gastric erosions, I’ve been undergoing treatment for 3 weeks, and soon I’ll go back to FGDS again. If they are not healed, will the operation be denied? After all, I am still undergoing treatment and I can take stomach medications during the operation. Can local anesthesia cause bleeding?

Yana 02/05/2019 11:57

Hello! A 3-year-old child has congenital hydrocele of the testicles, soon there will be an operation under general anesthesia, the child began to often complain about the knee and we did an ultrasound of the knee joint, in the conclusion we wrote that there was moderate synovitis of the right knee joint with a slight effusion into the cavity, as well as adenoids 2 degrees. Can we undergo surgery under general anesthesia or should we postpone it for now? And what could be the consequences?

Alexander Grigorievich 21.01.2019 16:57

Hello! I am 68 years old. Diagnosis: Chronic polypous rhinosinusitis. The operation was performed using video endoscopic technologies. There is a concomitant diagnosis: Arterial hypertension, grade 3, grade 1, risk 4. Question. How relevant is the use of general anesthesia in this case? Thank you.

Svetlana 05.10.2018 20:03

The gynecologist prescribed an operation; my grandmother had severe uterine prolapse! + the doctor discovered that the bladder seemed to have turned over. My grandmother has epilepsy (she has been drinking benzanal) since she was about 23 years old, she has stones in the bladder, hypertension, and her blood pressure rises very high in the evening and at night, sometimes over 200, she was taken away in an ambulance, 2 times over the summer. I'm very worried about my grandma. What tests need to be taken to check the body’s reaction to anesthesia? Is it worth having surgery at this age?

ANATOLY GRIGORIEVICH 24.07.2018 19:05

HELLO DOCTOR!!! I am 69 years old and have been diagnosed with a benign adenolymphoma of the right parotid salivary gland, so far they have advised me to do the operation under general anesthesia, because of the facial nerve so as not to damage it, but I have concomitant diseases, moderate chronic renal failure, dislocation of the left chambers of the heart, the cavity of the right ventricle, atherosclerosis of the aorta, aortic enlargement 51 cm. signs of ischemic heart disease, stage 2 hypertension, cardiosclerosis. Isn’t general anastasia contraindicated for me? I’m afraid to completely transplant the kidneys and heart. What do you doctor recommend? What type of anesthesia is best for my pain? THANK YOU(((((((

Olga 07.07.2018 15:20

Hello, please tell me whether it is possible to perform an operation to remove a 40mm aneurysm using a shunt installed in 2013. On a leg 37cm long? Dad is 75 years old, has flickering arrhythmia, blood pressure sometimes fluctuates, cancer was discovered on the lung about 60 mm. The doctor says general anesthesia is not allowed, is it possible locally?

Roman 05/28/2018 22:13

Hello. I am 39 years old. A planned ear operation (chronic purulent otitis media, cholesteatoma) was prescribed. One kidney and spleen were removed (hit by a car as a child), and there was a brain contusion. I have heart problems (arrhythmia, tachycardia) - so for many years I have been taking Concor 2.5 mg every day. Plus, they discovered the hepatitis C virus (how long I have had it is unknown), ECG - sinus rhythm, 86 beats, interatrial block; on the only kidney there is 1.9 cm of parenchyma and in the middle segment a hyperechoic formation of 0.8 cm, plus, it seems. liver problems (heterogeneous structure). Is it safe to have surgery? Formally, all the doctors in the local regiment (cardiologist, therapist, urologist, neurologist) gave the go-ahead, but a lot of problems were revealed. Thanks in advance for your answer.

Oleg 05/17/2018 02:14

Hello. Please tell me, a 43-year-old patient is undergoing a planned laparoscopic cholecystectomy. Concomitant diseases include stage 1 hypertension, narrowing of the bifurcation of the carotid artery by 60% on one side with a history of ischemic attacks. How dangerous is general anesthesia in this case and is it possible to use regional anesthesia in this patient. Thank you.

Elena 05/03/2018 18:40

Hello, please tell me, breast plastic surgery is planned, the ECG shows sinus rhythm with a heart rate of 78 beats. per minute Diffuse disturbances of myocardial repolarization, is this not a contraindication to anesthesia? Thank you.

Karlygash 04/08/2018 16:21

Hello, my aunt is 46 years old, they found stones in her kidney, they said we need to have an operation, but in one clinic we were refused to have the operation, they said that she has a weak heart, now we are going to go to another city, I have a question: if she has a very weak heart, is it possible to have an operation and they will be under anesthesia do or what? Will she be okay?

Marina 03/25/2018 22:36

Hello. I would like to know. I have a 4-year-old child who wants to have all his teeth treated at once under general anesthesia. But we recently discovered a pelvis in our right kidney, it is slightly dilated. Can we have such anesthesia?!

Svetlana 03/13/2018 13:28

Hello! I have instability of the 5-6-7 cervical vertebrae, and a hernia of the cervical spine, at the moment the pain has worsened, headaches and poor circulation are added to them. Is it possible to perform an operation under general anesthesia in this condition (the operation lasts 1 hour)?

Natalya 02/27/2018 11:50

Is it possible to undergo surgery to remove a hernia if there is a heart block!? (If not, what consequences may there be) (and if so, will this affect the deterioration of heart function)

Larisa 02/03/2018 07:18

Hello! I have a planned operation to remove the gallbladder, but I have heart diseases such as extrasystole and paroxysmal tachycardia. I take Sotahexal 80, magnesium. During treatment with Sotahexal, paroxysmal tachycardia did not occur. Is general anesthesia possible for these problems? And is it possible to take Sotahexal on the day of surgery, before surgery?

Sergey. 29.10.2017 21:25

Hello. I want to remove several teeth under general anesthesia. I take cordarone because I have atrial fibrillation. Does it make sense to contact the dental center with this request? Or will it be refused anyway? Thank you.

Elena 10.26.2017 15:03

Hello! A relative (74 years old) was diagnosed with stomach cancer (early stage). but he has COPD, the oncologist concluded that surgery and chemotherapy cannot be done (he will not withstand anesthesia), is he right?

Marina 10.20.2017 10:42

Hello! Please tell me, my mother’s kidney ultrasound concluded: Ultrasound signs of cystic transformation of the right kidney. Pronounced diffusion changes in the parenchyma and sinus of the left kidney. ICD. Pielita on the left. Left kidney cyst. Cysts of the right ovary, endometrium, uterine fibroids. Can we have spine surgery? and how dangerous is it?

Ekaterina 10/19/2017 22:49

Hello, my daughter is 3 months old. An ultrasound of the brain revealed dilations of the stomachs of the brain. The liquor-containing system is expanded D>S Depth of the anterior horns: right -7.8 mm, left 6.5 mm (N up to 5 mm) And also an open oval window. We are undergoing cosmetic surgery under general anesthesia (removal of capillary malformation). Is it possible to carry out anesthesia for such a diagnosis?

Natalya 10/13/2017 11:14

Hello, please tell me, we are about to have an operation to remove the adenoids under general anesthesia, but the ECG showed sinusoidal arrhythmia (105 beats), the cardiologist did not give permission, he said that the child has bradycardia. Is this a contraindication?

Oksana 10/11/2017 22:35

Hello. Please reply urgently. My friend has stage 3 lung cancer and metastasis in T7 with a pathological fracture of the vertebral body and compression of the spinal cord. At the moment, my legs have failed (sensitivity is preserved), my bladder does not work and I have been constipated for 8 days, an enema does not help. They admitted him to the hospital to install metal rods instead of a vertebra, and during an examination at the hospital they found erosion of the stomach and postponed the operation. The question is, is gastric erosion a contraindication to neurosurgery in such a situation? The condition is getting worse every hour. Symptoms of intoxication from constipation began. Or are doctors afraid of developing pulmonary embolism? How to insist on neurosurgical surgery

Ivan 05.10.2017 11:17

Hello. I have a spring allergy to flowering (April-May), I need to have an operation to remove a herniated disc. Is it possible with such an allergy? Thank you.

Dmitry 09.25.2017 20:02

Good day, dear doctor, I have an umbilical hernia that needs to be sutured, right today. We wanted to have an operation, but the doctor came and said that I could go crazy in simple language. Before he came in the evening, I talked to a girl, an anastasiologist, and told her the whole truth. that I am very much afraid that I have panic attacks when my heart is pounding my heart is pounding for 10 minutes I go wash myself and go to bed, he said that since I was 14 years old I smoke marijuana every day now I’m 19 I haven’t used any other drugs I said she said that I have a very sensitive character, so to speak, when we were sitting I was crying after 30 minutes I had already calmed down and was almost ready for surgery, he told me that I had a diseased gallbladder (biliary dyskinasia and chronic cholecystitis, the gastroeterologist also diagnosed liver steatosis at the moment I have slightly yellowish eyes and skin. I told her that I have gastroudenitis, she suggested spinal anesthesia, an injection in the back after which I will not move my legs for 6 hours (but I have a hernia along the white line of the abdomen above the navel) in general, today I was discharged from the hospital and They said that it was dangerous for me to do anesthesia and, to put it simply, I could go crazy because I was so emotionally excited, I was afraid so that I was shaking all over + I waited until this day for several days and was very afraid, in general, they discharged me from the hospital and told me to come and do it you'll get it in 3 months.

Evgenia 09.20.2017 14:44

Good afternoon An MRI of the brain revealed a 2 mm saccular aneurysm of the anterior communicating artery. Laparoscopy is coming. Are there any contraindications to anesthesia?

Ekaterina 09.16.2017 17:35

Hello, a 6-year-old child has been suffering from asthma for 2 years on basic therapy with Seretide 2 times a day 25/125. and disruption of intraventricular conduction, a slowdown in intraventricular conduction has been noted; surgery to remove grade 2-3 adenoids is pending

Polina 09/12/2017 06:35

Hello! My brother was diagnosed with a pulmonary bulla. He also has inflamed adenoids. They were supposed to have an operation to remove them, but when they found the bulla, they said that it was a contraindication. Is this really true? How then to remove adenoids? Can't you use anesthesia? We also wanted to take him to stem therapy, because... he has ROP of the central nervous system, but he also needs anesthesia (mask). The clinic coordinator said that even with gentle anesthesia, it is unknown how the body will react. What can you do in this situation? Thanks in advance!

Alla 09.10.2017 15:58

Hello, my 4-year-old child had upset stools 2 days before surgery (phimosis), tell me, will the surgery be postponed in this case?

Petimat 09.09.2017 23:13

Hello. I wanted to know that we are having an adenotomy operation in five days. The boy is 8 years old, but yesterday he had a stuffy nose, slight clear snot, no fever, and his throat was slightly red. There is no cough, but I coughed a couple of times at night. Do we have any contraindications for surgery? It’s just that if we are denied surgery, I will no longer wait for recovery. Then I’ll wait until the summer, because as September gets colder, we get sick all the time. Not even 10 days later, we get sick again. Thanks in advance.

Elena 09/05/2017 14:12

Hello. I need to have a laparoscopy in 15 days. I have VSD, I waited a long time for support and was nervous, it got to the point that I wake up at night because it’s stuffy and I start to lose consciousness, when I go out into the fresh air it goes away. The gynecologist also prescribed me lutein hormone 200 for ten days, so that my body could adjust to the date of the operation. Can I have the operation? I wanted to know your opinion, I’ll ask my anesthesiologist, but it’s interesting to know your opinion.

Dmitry 08/17/2017 05:43

Hello! I would like to know if I can undergo anesthesia if I am diagnosed with “Impaired intraventricular conduction, accessory chord in the left ventricle”?

Elena 08/07/2017 11:27

Good afternoon A 7-year-old child is diagnosed with bronchial asthma (mild form) of an allergic nature (to dust mites). We constantly take Singulair and courses of Flexotide. Did the neurologist send you for an MRI of the brain under anesthesia through a mask? Is such anesthesia dangerous for a child with asthma? What is the best way to prepare for anesthesia? Thank you.

Marina 08/03/2017 06:35

Hello, please tell me what kind of anesthesia is possible for my child. I have a 9 year old daughter. A questionable diagnosis of laryngeal papillomatosis was made. She did not allow herself to be examined in a mirror without anesthesia. We were told that they would do the examination under anesthesia. She was diagnosed with LLC. By school the condition had improved and they said it was overgrown. The child is very nervous. Thank you very much for the information.

Daria 07/01/2017 05:40

Hello. The child is 2y 10m. An operation to remove the adenoids is performed under general anesthesia. ECG revealed boadicardia. Pulse rate 80 beats/min. The cardiologist said that the operation would have to be postponed because... With such a pulse, they simply won’t take us on it. Is this true?

Alexandra 06/27/2017 16:42

Hello. A 6-month-old child will undergo surgery for grade 2 vesicoureteral reflux. The child has increased intracranial pressure (moderate) and an enlarged thymus gland (grade 3). Is it possible to use anesthesia?

Waag 06.26.2017 17:59

Good afternoon. My father must undergo surgery to remove a cervical hernia, and he has a heart aneurysm. Is there a risk of surgery under long-term anesthesia? Thank you.

Alexandra 06/25/2017 08:21

One of these days, my 6-year-old son will undergo surgery to remove adenoids under general anesthesia. An ECG was performed, the conclusion was: sinus rhythm, heart rate = 87 beats/min, s type ECG. Intraventricular conduction is impaired. Can they refuse anesthesia for this result?

Evgeniya 06.16.2017 10:48

Hello! The child is one year and 8 months old and will undergo surgery under mask anesthesia. ECG shows sinus rhythm with heart rate 89-109, with periods of bradycardia. It is not possible to get a consultation with a pediatric cardiologist. The pediatrician has doubts. Please tell me whether it is dangerous to undergo surgery with such ECG data. We'll survive. Thanks in advance.

Irina 06/09/2017 11:26

Good afternoon, my mother was discharged from the hospital on May 31, 2017. diagnosis: Cerebrovascular disease: Brain infarction from 05/11/2017. Coronary heart disease: post-infarction cardiosclerosis. Persistent form of atrial fibrillation. Background disease: Hypertension stage 3, stage III, risk of cardiovascular complications 4. Complication: NC 2A (Strazhenko-Vasilenko) On 06/07/2017 she was taken to the hospital with suspected intestinal hemorrhage. The next day, the coloproctologist said that there was no blood in the stool and most likely the mucous membrane was damaged due to constipation (Mom is bedridden, the right side is paralyzed). Since it is necessary to constantly take anticoagulant therapy, the doctor still advised a colonoscopy under anesthesia. What is the risk? Is it worth carrying out this examination under anesthesia, taking into account the above?

Elena 05/30/2017 00:34

Hello! The child is 1 year 7 months old and needs to undergo FGS under general anesthesia. An ECG examination revealed a diagnosis of 1st degree AV block. Is it possible to do this? How does general anesthesia affect the brain of an actively growing child? Thanks in advance.

Natalya 04/24/2017 08:37

Hello, I am having a planned operation (lipoma) under local anesthesia, I have a sore throat, I am taking Ingoverine, should I cancel the operation or not?

Arthur 04/11/2017 09:26

She is undergoing surgery to remove an inguinal hernia. I am 56 years old, permanent atrial fibrillation. Two years ago, during coronary angiography, there was ventricular febrillation. Now I'm afraid to undergo surgery under general anesthesia. Help with advice, thanks.

Oksana 04/08/2017 12:28

We did a laparoscopy of the ovary, the anesthesiologist said that there were problems with me: a difficult and narrow glottis. What does it mean?

Anastasia 04/04/2017 13:50

Hello. We have a question? We go to the hospital for a CT scan under anesthesia. We have staphylococcus since birth, and later we discovered that we also have adenoids. The bottom line is that we have eternal problems with snot. They never go away. Will they do a CT scan for us under anesthesia if we blow our noses well before doing this?

Tanya 04/02/2017 23:51

Good afternoon An operation is required to remove the placental polyp. I have tachycardia up to 90 beats per minute. Should I worry that it will take me a long time to recover from anesthesia? Isn't it contraindicated for me? I’m currently drinking rose hips to regulate my pulse, does it really help? Thank you!

Oksana 03/19/2017 09:38

Hello, I am undergoing a colpoperineorrhaphy operation under local anesthesia. I am currently treating acute bronchitis. Surgery in a week. Is it possible to perform surgery under such conditions?

Irina Nikolaevna 28.02.2017 13:25

I am contacting you again because I have not found an answer. I need to have a colonoscopy and I would like to do it under anesthesia. Is it possible to do this if I take Lyrica (pregalbin), Zoloft and Spitomin, I’ll also add Sirdalud. I have neuropathy due to stenosis of the lumbosacral spine. Age 67 years. With respect, Irina Nikolaevna.

27.02.2017 14:26

Olga, all the concomitant diseases you listed are not a contraindication to anesthesia. Spinal anesthesia is also possible. This is all at the discretion of your anesthesiologist.

Vyacheslav 02/26/2017 06:35

Hello, my father is 67 years old and has coronary artery disease. He suffered a myocardial infarction 3 years ago and is now suffering from an inguinal hernia. Can he be given anesthesia, if so, what kind in this situation?

Abdurakhman 02/19/2017 22:39

Hello, I have Parkinson's syndrome and I had a bad fall and broke my femoral neck and now I have to undergo surgery to replace the femoral neck, please tell me whether anesthesia is contraindicated for me or not

Olga 02/18/2017 23:45

Hello, what type of anesthesia is used during surgery to remove hygroma of the tendon of the abductor pollicis longus muscle of the wrist joint? Are there any risks? The child is 13 years old.

Olga 02/11/2017 00:09

Hello! Please tell me, I have had VSD for 2 years now and am now pregnant with my 3rd child. Is he afraid of VSD? Thank you!!!

Natalya 02/02/2017 17:57

Hello, I am undergoing surgery to remove a tumor in the posterior part of the mediastinum, my child is 1 year and 1 month old. The child has a runny nose and is teething. Is this a reason not to have surgery at this time?

Olga 01/20/2017 18:56

Thank you. But is it really advisable to put yourself at risk for the sake of some kind of cardiogram? Why in simple cases (which do not require sutures, do not touch muscles, nerves, or blood vessels) not hold the child, secure him with belts (they did this to me, though a long time ago) and use local anesthesia? Sorry for the intrusiveness, this question worries me very much.

Olga 01/19/2017 20:43

Hello. A 3.9-year-old child wants to remove a lipoma (5 mm) on his leg under general anesthesia. A wen on the surface of the skin, under a layer of skin approximately 1 mm thick, the contents are clearly visible to the naked eye, the size of a sunflower seed.. You don’t even have to put stitches. Why do doctors go for general anesthesia without ANY reason other than their own convenience? Why don’t they measure the amount of work and offer other methods (for example, resorption using a drug injection)? Please help, is this not a violation of the patient’s rights?

Andrey 01/19/2017 00:38

Good afternoon My wife is about to give birth, and she has a polyvalent allergy (even to the point of anaphylactic shock). Tell me what drugs for anesthesia are used during childbirth, and whether it is possible to do allergy tests for them in advance. If yes, where? I would also be grateful for any recommendations in such cases.

Sima 12/17/2016 18:23

Hello, my son is 29 years old. He has diangosis - PMD and he needs to have his gallbladder removed. The doctor refused to perform the operation because he cannot be given anesthesia. Tell me what to do? Thanks for the information.

Maria 26.11.2016 21:10

Hello. The patient was prescribed CABG (coronary artery bypass grafting) as planned. During a preliminary examination by specialists, the ophthalmologist diagnosed Suspicion of glaucoma. And he signed that there are no contraindications to the operation. But the cardiac surgery department refused to take the patient in for surgery, since Glaucoma was questionable; they said that the patient needed to find out for sure whether he had glaucoma or not. Since Glaucoma is a contraindication to CABG. Is this true?

Tatyana 11/15/2016 09:28

Thanks a lot!

Tatyana 09.11.2016 10:12

Good afternoon! The patient is 53 years old. The main diagnosis is stage 2 CICM (atherosclerotic, hypertensive). Previously suffered an ischemic stroke in the right side of the anterior spinal cord (cystic transformation in the occipital lobe according to CT scan). Transient ischemic attack in BLSMA a year ago. Concomitant: stage 3 hypertension, degree 3. Hypertensive heart. Atheromatosis of the aortic valve. Risk 4. Mixed nephropathy. BP C2. CHF 1. FC1 Diabetes mellitus 2. Obesity 1st degree. Hyperrumemia. Dyslipidemia. type. Surgical treatment was recommended for atherosclerosis of the vessels of the neck, extracranial section of the bracheocephalic vessels. Occlusion of both ICAs. Stenosis of the proximal segment of the left vertebral artery up to 60%, refused surgery. X-rays later diagnosed COPD. Diffuse pneumosclerosis, pulmonary emphysema. Can we count on surgery now or is this a contraindication?

Ulyana 01.11.2016 12:39

Good afternoon My son is 5.5 years old, the ECG result is a local disturbance of intraventricular conduction, is it possible to do adenotomy under anesthesia?

Alina 01.11.2016 00:34

Hello. My 6-year-old child was diagnosed with cicatricial phimosis and surgical treatment was recommended. I am also concerned about the issue of general anesthesia. The fact is that the child suffers from asthma and has MAS. Anomaly of the notochordal apparatus. During examination by a cardiologist, bradycardia was recorded on the ECG. ECHOCG shows MAS. The stress ECG, according to the cardiologist, is normal. This bradycardia is associated with VSD. The operation is coming up in 2 weeks, we are very worried. Can we have general anesthesia?

Marina 10/15/2016 09:02

frequent extrasystole 4 degrees, bigenymia. trigenymia. jogging of gastrointestinal tachycardia, ischemic heart disease. 58 years old, woman. Is it possible to have surgery to remove the gallbladder? What is the risk?

Evgeniy 10/08/2016 11:28

Hello! I want to do chin plastic surgery + SMAS lift. A year ago, I had heart problems due to nervousness; an ECG showed a scar on the back wall of the heart. In the conclusion it is written: “According to Echo-CG, there are signs of atherosclerotic lesions of the aorta, the cusps of the aortic vertae and the mitral valves. Prolance (unintelligible word?!) of the anterior cusp of the mitral valve, stage I, with symptoms of mitral regurgitation, stages I - II. Moderate hypertrophy of the left ventricular myocardium with signs of diastomic dysfunction. Signs of aneurysm of the interatrial septum, right type." Is anesthesia contraindicated for me? I had a heart problem in October 2015. (one year ago), date of the above conclusion: 10/29/2015. Sometimes, once every few days, the heart may tingle quite a bit (2-3 “pricks”), but there are no serious complaints about the heart now. I do not perform heart treatment. Well, what could be the consequences of anesthesia if it is contraindicated for me, and I hide the above from the plastic surgeon?

Aldyn 09.30.2016 12:49

Hello, my grandmother is 70 years old, the cavity of her uterus is filled with purulent-hemorrhagic contents, curettage of the uterus was indicated, but due to the presence of chronic bronchitis it was refused (they said anesthesia may not work). Is this really true? Thanks for the answer.

Natalya 09.21.2016 11:56

Good afternoon. Question about anesthesia. A gynecological operation is coming up to remove a polyp in the uterus. The operation is for the day after tomorrow. I have a fractured wrist, my arm has been in a cast for a month now. Will they accept me for the operation or may they refuse to operate? Thank you.

Daria 09/16/2016 01:09

Hello. Question about anesthesia. I am preparing for gynecological surgery, endometrial curettage. Is general anesthesia suitable for me? Is it possible to minimize the risks? I have type 1 diabetes on insulin with concomitant diseases, chronic pyelonephritis, cholecystitis, anemia, low blood pressure.

Irina 09.13.2016 14:22

My daughter is scheduled for laparoscopy (removal of a cyst on the left ovary), I have hepatitis B, they said general anesthesia... I’m very afraid of contraindications and consequences. I'm interested in your opinion

Valentina 09/08/2016 17:32

Hello. In 2013, I had a caesarean section due to a breech presentation of the fetus under epidural anesthesia. About 5 minutes after the start of the operation, it became very difficult for me to breathe, there was a feeling that half of my lungs were missing, I felt dizzy, it was hard to speak, I felt faint. As the anesthesiologist said: the pressure dropped significantly. After 20 minutes the condition returned to normal. Now I have to deal with it again, I’m very afraid of a repetition of this condition, especially lack of air. By the way, after the first caesarean section, the feeling of lack of air passed only after 2 months. In the anamnesis, IVP, VSD, mitral valve prolapse is not hemodynamically significant, high myopia. During my first pregnancy I had inferior vena cava syndrome, but now I don’t. Age 28 years old. Tell me, what type of anesthesia is still preferable for me and what is the reason for this condition during the first operation? What is the likelihood of such a reaction repeating now? Thank you in advance.

Love 09/02/2016 15:51

Hello! I will have a planned cesarean section at 38 weeks, now I’m 37 weeks and the migraine has worsened again. I have had migraines since 2014 in spring and autumn. During pregnancy, it is not as acute for me (without an aura) as it was before pregnancy. I also have tachycardia, my pulse goes from 100 to 110. I'm afraid of general anesthesia because... Last time my recovery was very difficult (fainting and vomiting). What kind of anesthesia is possible for me?

Elena 08/31/2016 10:45

Hello! We are preparing for the operation, we are undergoing tests and found sand in the child’s kidneys and changes in the urine (protein), and according to the ECG there is a pronounced sinus arrhythmia!, tell me, is this a contraindication for surgery with anesthesia? child 4 years old: the main diagnosis is merosin-negative muscular dystrophy. they said the anesthesia will be inhalation with Sevuran (if I spelled the name correctly)

Natalya 08/28/2016 08:24

Hello. Please tell me whether it is possible to use general anesthesia in my situation. In 2005, the following operations were performed: (first stage) - operation of a right-sided ventriculoperitoneal shunt, and second stage - operation of a right-side paramedian access, removal of a tumor of the left cerebellopontine angle. Currently, the neurologist's diagnosis is: CVD, DE st. complex genesis (hypertensive, atherosclerotic, postoperative), hypertensive-hydrocephalic syndrome, left-sided pyramidal insufficiency, liquorodynamic disorders, moderate vestibulo-atactic, cognitive impairment. Chronic cholecystitis, Gallbladder polyposis. Dyslipidemia. Is it possible in my situation to use general anesthesia - gynecological surgery (endometrial hyperplasia), removal of the gallbladder. What consequences are possible after using general anesthesia on the brain? Are there any contraindications for general anesthesia in my situation?

Natalya 08/18/2016 17:11

Hello. Please tell me, can mental retardation be a reason for refusal to undergo gall bladder surgery? A 63-year-old woman, disabled since childhood, mental retardation and mental retardation. There are complications after the treatment in the form of speech impairment, severe stuttering. Fully capable. She underwent the examination necessary for planned hospitalization. There are no contraindications to the operation. Gallstone disease, constant pain. Periodically nausea, vomiting, diarrhea. She was hospitalized several times by ambulance during an exacerbation period. The gastroenterologist recommended surgical treatment.

18.08.2016 16:32

Yulia, it is not clear from the question whether we are talking about routine vaccination or treatment of the disease. If it’s a vaccination, I can’t be 100% sure, but most likely there’s nothing wrong with it, but it’s still better to reschedule it for after surgery. And if we are talking about a disease, then additional consultations with doctors are needed, an assessment of the risk and the need for surgery.

Anastasia 08/16/2016 20:02

Thank you very much for your answer!

16.08.2016 14:51

Anastasia, if there is no lactation, there are no contraindications, then, of course, you can do it, but I would advise you to delay the operation, let the body recover - after all, pregnancy and childbirth are a strong stress for a woman’s body, especially since there was a cesarean section, which means there was anesthesia, or anesthesia. Now I'll go back to anesthesia again. Of course, it happens that we do several operations and anesthesia in a row and everything goes well, but you need to understand that if there is no urgency, then it is better to postpone it so that at least a year or a year and a half has passed. Good luck to you!

Azat 08/10/2016 11:47

Hello, is it possible to have surgery to remove the gallbladder with angle-closure glaucoma, and what kind of anesthesia is prescribed (anthropine is contraindicated)? What anesthesia is used for the operation, local or general?

Olga 08/03/2016 15:28

Good afternoon On August 11, a reconization of the cervix was prescribed, the diagnosis was grade 2-3 dysplasia, blood sugar was 7.1 mmol, is it possible to have surgery?

Diana 08/02/2016 19:59

Hello! I have a drug allergy to all local anesthetics. Only ultracaine showed 30% (as I understand it is possible, but with tavegil). Please tell me what other anesthesia options may be suitable for me. There was a need to remove a wisdom tooth. And also, for the future, because during childbirth, for example, anesthesia is used.

NATALIA 07/31/2016 15:40

Hello, on August 12, my 7-year-old daughter has her adenoids removed under general anesthesia. Is it possible to get a tetanus vaccination (the time has come) before the operation or is it better to postpone it?

Lydia 07/26/2016 16:39

Meniscus resection (arthroscopy): which anesthesia to choose? Good afternoon I ask for help with choosing a method of pain relief during knee arthroscopy (the operation will take at least an hour). The surgeon recommends spinal anesthesia. But what stops me is that due to a neglected spine (osteochondrosis, hernia, etc.) this can be difficult. In addition, I heard negative reviews about this method, including from neurologists. There are opinions that the consequences can appear even after six months to a year. General anesthesia - everything is fine, but I have already undergone several operations under general anesthesia and I’m afraid it might be too much. My memory and reaction speed have deteriorated, and I suffer from insomnia. In addition, I have arrhythmia and problems with blood pressure (there were cases when it dropped to 40). Local anesthesia, according to the surgeon, is not an option at all. Conduction anesthesia (regional) remains. I would be very grateful if you express your opinion on this matter. P.S. I haven’t talked to the anesthesiologist yet, but I would like to understand what to ask him for.

Larisa 07/25/2016 21:07

Hello! My sister fell ill a month ago, and an MRI revealed a sequestered hernia of the L4-S1 vertebra. They began to prepare for a neurosurgical operation. An ECG showed that there were changes in the heart. A cardiac examination (ultrasound) was performed, which showed the presence of an aneurysmal deformation of the lower left atrium into the cavity of the left atrium with an interruption of the echo signal of 3.7 mm with a slight pathological discharge of blood. Rhythm disturbance. The thickness of the pancreas PS is 8.2 mm. The conclusion also states that there is a tendency to dilatation of the cavities of both atria. Concentric hypertrophy of the LV myocardium with decreased contractile function. Type 1 diastolic dysfunction Consolidation and mild calcification of the valves of the mitral valve and the aortic root. Mitral insufficiency 1-1.5 degrees. Aortic regurgitation grade 0-1. Tricuspid insufficiency 1.5 degrees. Pulmonary regurgitation stage 1. Myocardial hypertrophy. Moderate pulmonary hypertension. R syst. LA 40 mm/Hg. The neurosurgeon is ready for the operation, but the anesthesiologists twice categorically refused the operation, indicating the presence of a heart defect, which greatly frightened us. We had a consultation with a cardiac surgeon, who said that cardiac surgery in this situation is not indicated and there are no obstacles to performing a neurosurgical operation. Help me figure out whether it’s really impossible to give anesthesia or are anesthesiologists just taking insurance? Is there a real direct threat to life? The operation usually lasts 3-3.5 hours under general anesthesia. I also write that the hospital is a base for training students at a medical university (maybe this is the reason?) located in our city; the operation was to be performed by a high-class neurosurgeon who previously worked in one of the federal centers. I will also say that we found out about the existing heart disease only during the examination. For us, this is a “find”, since there have never been any complaints about the heart.

Egor 07/25/2016 19:29

Hello. Father is 57 years old. After surgery on the carotid artery, progressive signs of stroke were recorded for a year. As a result, the right side of the body became paralyzed. They did an MRI of the brain a year ago and now - a tumor of 4 cm has formed in the brain in a year (I assume a post-stroke cyst), but the doctors do not draw conclusions and simply call it a formation, a tumor (gliastoma). The father walked a little, but fell on his right leg, receiving a displaced subtrochanteric fracture of the femur. Everything would be fine, they wanted to do an operation and install staples on the hip, but the hospital refused to perform the operation, citing the impossibility of anesthesia for such a patient. We went for permission to the Institute of Brain Neurosurgery (Tashkent), where they confirmed to us that no anesthesia could be performed, even during leg surgery. My father has been lying there for two months suffering from a fracture; the bones naturally do not heal on their own. Please tell me, is there really nothing that can be done? Maybe there is a way to numb only the lower part of the body, for example, during surgery on the leg? Thank you.

Hello, doctor! When I was having my teeth treated, the doctor gave me some kind of anesthetic, after which I cried. She asked if I was in pain and why I was crying. At that moment I was not in pain, but crying on its own, I even smiled while answering. She revived me with ammonia, after which she said that she realized that it was an “adrenaline swing.” She said that this was a reaction to adrenaline, and I think she added that I had eaten something sweet before, so this is the reaction. I didn’t consider it necessary to write me the name, since it was not a reaction to the anesthetic, according to her, but I wrote something like “adrianol”, I could be wrong. I have to undergo dental treatment, which will be unbearable without anesthesia, and I’m also breastfeeding, my baby is 1.2 months old, and I’m not going to give up yet. I still have a question about the adrenaline swing and how dangerous it can be? Is it worth taking tests for the use of anesthetics, and if so, which ones, because the prices are terribly high. By the way, after this incident, I was already given anesthesia after childbirth, when the placenta was removed, the general one, but this was probably a different type of anesthesia. She tolerated it well.

Nikolay Valentinovich 06/10/2016 16:06

Hello. My wife was diagnosed with stage 4. bladder cancer. A month ago, my wife (64 years old) made an unsuccessful suicide attempt (phenazepam-30 tablets + 100 g of vodka). She remained alive, but with serious consequences. For the first 10 days after the poisoning, I only slept, didn’t eat, just drank water. Then she regained consciousness, began to eat and drink little by little, recognized her loved ones, spoke poorly, tried to get up and walk on her own, although she did not realize where she was and what had happened to her. But mostly she slept, often turning over on one side, then on the other. In a dream, he often slowly raises his arms and legs, making smooth movements (like in ballet). We thought it would take a week or two and everything would be restored, but every day her condition worsened: she began to speak worse (now she doesn’t speak at all), she doesn’t get up, she walks under herself, she doesn’t respond to our calls, she has to be given water and food in her sleep. Now he sleeps 24 hours a day. Eating has become difficult, she takes food from a spoon into her mouth and sleeps with it, does not chew or swallow, and does not hear our calls. The oncologist asks us to urgently do an MRI of the brain. But since she can raise her leg or arm at any time, this must be done under anesthesia. The question is whether it is possible for my wife in this condition to undergo anesthesia for an MRI examination or in our case this is excluded. And if this is so, then do we have any other option for examining the brain without anesthesia or not? Thank you. Nikolai Valentinovich is a pensioner from Moscow.

Elena 04/14/2016 01:15

Hello. Please tell me how important it is to inform the anesthesiologist about the periodic use of amphetamine for two years, if the last use was a year ago, and the use of marijuana during the last year, if the last use was a month ago?

If general anesthesia is necessary, contraindications to anesthesia must be taken into account first. Every person who is about to undergo surgery should know this. Anesthesia allows surgeons to perform long-term interventions of any complexity without causing physical suffering to the patient.

However, the presence of any diseases in a person that prohibit the use of anesthesia makes its use, and therefore surgical intervention, problematic. In such cases, specialists often postpone the planned operation to a later period and prescribe the patient treatment to stabilize his condition.

In modern medical practice, several types of anesthesia are used: general, epidural, spinal and local. Each of them has its own indications and contraindications for use, which anesthesiologists always take into account before selecting anesthesia for a patient.

General anesthesia and contraindications to it

The use of general anesthesia allows the patient to be immersed in a deep state, during which he will not feel pain from surgical procedures performed by a specialist. This type of anesthesia is used during operations of any complexity on the abdominal organs, heart, brain and spinal cord, large blood vessels, removal of malignant tumors, amputation of limbs, etc. Despite the wide range of applications, this anesthesia has a lot of contraindications.

For adults, the use of general anesthesia during surgical operations is prohibited if they have:

In pediatric practice, during the surgical treatment of children under 1 year of age, there are contraindications to general anesthesia. For young patients, the use of this type of anesthesia is prohibited if:

• hyperthermia of unknown origin;
• viral diseases (rubella, chicken pox, mumps, measles);
• rickets;
• spasmophilic diathesis;
• purulent lesions on the surface of the skin;
• recent vaccination.

Use of general anesthesia if there are contraindications

General anesthesia can hardly be called harmless, since it has a systemic effect on the body and can provoke serious complications in the functioning of the cardiovascular system in a person, causing nausea, headache and other unpleasant symptoms. But there is no need to be afraid of it if the anesthesiologist, despite the presence of contraindications, allowed the patient to undergo surgery.

An experienced doctor can minimize the harm from the effects of general anesthesia on the body, so the patient can and should trust him and not worry about anything. Refusal to undergo surgery can lead to more disastrous consequences than the effects of anesthesia.

The above restrictions on the use of general anesthesia do not apply to emergency cases when a person’s life depends on a timely operation. In such a situation, surgery using general anesthesia is carried out regardless of whether the patient has contraindications to it or not.

Regional types of anesthesia

In addition to general anesthesia, surgical treatment today is carried out using spinal and epidural anesthesia. Both the first and second types of pain relief refer to.

During spinal anesthesia, a specialist uses a long needle to inject the patient with an anesthetic drug into the spinal cavity filled with cerebrospinal fluid, located between the soft and arachnoid membranes of the brain and spinal cord.

With epidural anesthesia, an anesthetic is injected through a catheter into the epidural space of the spine. provides complete relaxation of the patient's muscles, loss of pain sensitivity and makes surgical intervention possible.

Epidural or spinal anesthesia can be used both as an independent method of pain relief (for example, during cesarean section or childbirth), and in combination with general anesthesia (for laparotomy and hysterectomy). The main advantage of pain relief methods is that severe complications after them occur much less frequently than after general anesthesia. Despite this, they have many prohibitions on their use.

Absolute contraindications include:

• severe cardiovascular diseases (complete atrioventricular block, aortic stenosis, atrial fibrillation);
• pathologies accompanied by blood clotting disorders;
• anticoagulant therapy during the last 12 hours;
• arterial hypotension;
• history of severe allergic reactions;
• infectious process in the area of ​​​​injection of the anesthetic.

In addition to absolute prohibitions on the use of epidural and spinal anesthesia, there are relative contraindications, in which the use of these types of anesthesia is allowed only in extreme cases, when the patient’s life is at stake.

During surgery using spinal or epidural anesthesia, the patient is conscious and aware of what is happening to him. If he is afraid of such a surgical intervention, he has the right to refuse. In this situation, the operation will be performed under general anesthesia.

When prescribing to a patient, the anesthesiologist must warn him about the possible consequences of such an operation. The most common complications after using such a procedure are headache and the formation of hematomas at the site of injection of the anesthetic. Sometimes pain medications do not provide the patient with a complete nerve block. This leads to the fact that during the operation the person will feel pain from surgical manipulations.

In what cases is local anesthesia prohibited?

Local anesthesia is another type of pain relief used during surgery. It consists of local injection of an anesthetic drug into the area of ​​the intended surgical intervention in order to reduce its sensitivity. The patient remains fully conscious after the administration of the anesthetic drug.

Local anesthesia rarely causes complications, so it is considered the least dangerous among all types of pain relief existing today. It is widely used for short-term and small-volume operations. Local anesthesia is also used in persons for whom any other methods of pain relief are strictly contraindicated.

The use of local anesthesia during surgical interventions is prohibited if the patient has:

• hypersensitivity to local anesthetics (Lidocaine, Bupivacaine, Benzocaine, Ultracaine, etc.);
• mental disorders;
• state of emotional lability;
• respiratory dysfunction.

In early childhood, the use of local anesthesia is impossible due to the fact that a small child does not know how to remain motionless for a long time. After using local anesthetics, a person may experience complications in the form of allergic reactions (urticaria, itching, Quincke's edema), loss of consciousness, and the occurrence of an inflammatory process at the site of injection of the drug under the skin.

Before any surgical intervention, specialists conduct a thorough examination of the sick person, based on the results of which they decide on the possibility of using one or another type of anesthesia. This approach allows them to perform successful operations with minimal risk to the patient’s health.

Name surgery consists of the name of the organ on which it is performed and the term that denotes the surgical technique being performed.

The following terms are used:

Tomia– dissection, incision, opening;

ectomia– excision;

extirpatio– isolating, peeling;

resectio– partial excision;

amputatio– removal of the peripheral part of the organ;

stomia– creation of an artificial fistula;

centes- puncture

This is where the following names come from:

• rumenotomy(rumen - scar, tomia - dissection) - dissection of the scar;
• enterectomy(enteron - intestine, ectomia - excision) - excision of the intestine.
• urethrostomy(urethra - urethra, stomia - creation of an artificial fistula) - creation of an artificial fistula of the urethra.

Indications and contraindications for operations

Each surgery preceded by a diagnosis based on clinical, laboratory or radiological examination.

After that surgery justified by relevant evidence. In all difficult and doubtful cases of determining the indications for surgery, it is necessary to resort to a consultation.

« A deftly performed surgical operation does not give the right to the title of an experienced clinician. Only a doctor with good clinical training can be a good surgeon».

Indications for surgery– these are cases where surgical operations are necessary or can be performed.

Indications may be:

• absolute(indicatio vitalis) – those cases in which there is no other way to cure the animal (malignant neoplasms, bleeding, suffocation, pneumothorax, rumen tympany, prolapse of internal organs);
• relative– those cases in which surgery can be omitted without causing significant damage to the health and productivity of the animal, or when surgery is not the only method of treatment (benign tumor, non-strangulated hernia).

NB! You should not resort to surgery when the animal can be cured in an easier and safer way, but you should not neglect surgery when it is the only method of treatment.

Contraindications to surgery– these are cases when the operation cannot or is undesirable to perform.

They are divided into:

Contraindications due to the severe condition of the animal:

In case of exhaustion, old age, exacerbation of the inflammatory process, fever, infectious disease, large volume of damage, the second half of pregnancy, sexual heat in females.

The exception is emergency operations (strangulated hernia, cellulitis, malignant tumor). In these cases, the full risk must be explained to the animal owner.

Contraindications due to economic and organizational factors:

• when imposing quarantine due to an infectious disease characteristic of a given animal species (erysipelas, plague, horse washing, Siberian flu);
• before moving and regrouping animals;
• 2 weeks before and within 2 weeks after preventive vaccination;
• in the absence of appropriate sanitary conditions for postoperative keeping of animals.

The exception is emergency cases that require emergency intervention, in which the operation must be performed in compliance with all rules for self-protection and prevention of further spread of the disease.

Mass operations cannot be carried out on farms that do not have adequate conditions for post-operative housing of animals (calves cannot be castrated if they are kept knee-deep in slurry).

Any surgical operation involving a risk to the life of an animal must be performed only with the written consent of the legal owner of the animal or his representative (head of the farm, private owner of the animal).

If we are talking about an animal that is state property, then the doctor, who understands the necessity of the operation, must insist on its performance, and, if necessary, operate without waiting for consent.

Any surgical operation has a relative degree of risk.

Grade 1 – mild.

The risk is negligible. The existing disorders do not affect the general condition and do not cause disturbances in other organs and tissues. This group also includes planned operations.

2nd degree – moderate severity.

This applies to emergency operations that cannot be postponed, and the animal has moderate cardiac or respiratory failure.

Grade 3 – severe.

The sick animal had local lesions of vital organs (myocardial infarction, acute respiratory failure, diabetes).

Childbirth is the most natural and most unpredictable process. Even a woman who is not becoming a mother for the first time cannot predict exactly how her child will be born. There are many cases when a woman, despite the doctors’ plans, gave birth safely on her own, but it happens that a seemingly successful birth ended in an emergency caesarean section. Let's find out what are the indications (and contraindications) for a cesarean section.

Elective caesarean section

There is a division into absolute and relative indications for this operation.

Absolute indications for elective caesarean section

Absolute indications for a cesarean section include reasons when natural childbirth is impossible or poses a very high risk to the health of the mother or fetus.

Narrow pelvis

Sometimes the anatomical structure of a woman does not allow the child to pass through the pelvic ring: the size of the mother’s pelvis is smaller than the presenting part (usually the head) of the child. There are criteria for the size of a normal and narrow pelvis based on the degree of narrowing.

With an anatomically very narrow pelvis:

• Grade III-IV surgery will be performed as planned;
• II degree of narrowing, the decision will be made during childbirth;
• I degree birth will take place naturally in the absence of other indications.

Mechanical obstacles preventing natural childbirth

This may be uterine fibroids in the isthmus region (i.e., the area where the uterus meets the cervix), ovarian tumors, tumors and deformities of the pelvic bones.

Threat of uterine rupture

It most often occurs when there is a scar on the uterus, for example due to a previous cesarean section, as well as due to numerous previous births, when the walls of the uterus are very thin. The health of the scar is determined by ultrasound and its condition before and during childbirth.

Placenta previa

Sometimes the placenta is attached in the lower third and even directly above the cervix, blocking the exit of the fetus. This is fraught with severe bleeding, which is dangerous for the mother and baby and can lead to placental abruption. Diagnosed by ultrasound, surgery is scheduled for 33 weeks of pregnancy or earlier if bleeding is detected, indicating placental abruption.

In these cases, it is necessary to carry out surgical delivery using a cesarean section, regardless of all other conditions and possible contraindications.

Relative indications for surgery

Chronic diseases of the mother

Cardiovascular diseases, kidney diseases, eye diseases, nervous system diseases, diabetes mellitus, cancer - in a word, any pathologies that can worsen during contractions and pushing. Such conditions also include exacerbation of diseases of the genital tract (for example, genital herpes) - although childbirth in this case does not significantly aggravate the woman’s condition, when passing through the birth canal the disease can be transmitted to the child.

Some complications of pregnancy that threaten the life of the mother or child.

The possibility of delivery through cesarean section is offered in severe forms of gestosis with dysfunction of vital organs, especially the cardiovascular system.

Recently, pregnancy after long-term infertility or occurring after an in vitro fertilization procedure has also become a relative indication for delivery via cesarean section. Women carrying a long-awaited child are sometimes so worried about the fear of losing him that, in the absence of physical disorders, they cannot “tune in” to the process of childbirth.

Malposition

History of anal sphincter rupture

Large fruit

A child whose weight at birth is 4 kilograms or more is considered large, and if its weight is more than five kilograms, then the fetus is considered gigantic.

Emergency caesarean section

Sometimes the impossibility of spontaneous childbirth becomes known only at the moment of contractions. Also, during pregnancy, situations may arise when the life of the mother and the unborn child is at risk. In these cases, emergency delivery is performed by caesarean section.

Persistent weakness of labor

If natural childbirth continues for a long time without progress, despite the use of medications that enhance labor, then a decision is made to have a caesarean section.

Premature placental abruption

Separation of the placenta from the uterus before or during childbirth. This is dangerous for both the mother (massive bleeding) and the child (acute hypoxia). An emergency caesarean section is performed.

Presentation and prolapse of umbilical cord loops

Sometimes (especially when the baby is breech), the umbilical cord or its loops fall out before the widest part of the baby is born - the head. In this case, the umbilical cord is pinched and, in fact, the child is temporarily deprived of blood supply, which threatens his health and even life.

Clinically narrow pelvis

Sometimes, with normal pelvic sizes at the time of birth, it turns out that the internal ones still do not correspond to the size of the fetal head. This becomes clear when there are good contractions, there is dilation of the cervix, but the head, with good labor and pushing, does not move along the birth canal. In such cases, wait about an hour and, if the baby’s head does not move, surgery is recommended.

Premature (before the onset of contractions) rupture of amniotic fluid in the absence of effect from cervical stimulation

With the release of water, regular labor may begin, but sometimes contractions do not begin. In this case, intravenous stimulation of labor with special drugs prostaglandins and oxytocin is used. If there is no progress, then a caesarean section is performed.

Abnormalities of labor that are not amenable to medication

Surgery has to be resorted to if the strength of the contractions is insufficient, and they themselves are very short.

Acute fetal hypoxia

During childbirth, the child's condition is monitored by heartbeat (the norm is 140-160 beats per minute, during contractions - up to 180 beats per minute). Worsening heartbeat indicates hypoxia, that is, lack of oxygen. An emergency caesarean section is required to prevent intrauterine death of the baby.

Previously undiagnosed threat of uterine rupture

The contractions are frequent and painful, the pain in the lower abdomen is constant, the uterus does not relax between contractions. When the uterus ruptures, the mother and child show signs of acute blood loss.

Contraindications for cesarean section

There are no absolute contraindications to a cesarean section; nevertheless, this is often the only way to preserve the health and life of a woman and her child.

However, there are contraindications in which a cesarean section is undesirable.

Fetal health problems

If it becomes clear that it is impossible to save the child (intrauterine death of the fetus, extreme prematurity, developmental defects leading to early postnatal death of the child, severe or long-term fetal hypoxia), then the choice is made in favor of the health of the mother, and natural delivery as opposed to traumatic surgery.

High risk of developing purulent-septic complications in the postoperative period

These include infections of the birth canal, purulent diseases of the abdominal wall; amnionitis (inflammation of the membranes of an infectious nature).

Only the doctor observing her can judge whether a pregnant woman needs a cesarean section!

In any case, remember, no matter how your baby was born, naturally or through a cesarean section, it is important that both he and his mother are healthy!

MILITARY MEDICAL ACADEMY

Department of Military Traumatology and Orthopedics

"APPROVED"

Head of the Department

Military traumatology and orthopedics

Professor Major General of Medical Service

V. SHAPOVALOV

"___" ____________ 2003

Senior Lecturer at the Department of Military Traumatology and Orthopedics
Candidate of Medical Sciences
Colonel of the Medical Service N. LESKOV

LECTURE No.

in military traumatology and orthopedics

On the topic: “Plasty of bone cavities and tissue defects

For osteomyelitis"

for clinical residents, students of faculties I and VI

Discussed and approved at a department meeting

"_____" ____________ 2003

Protocol No._____

LITERATURE

a) Used in preparing the text of the lecture:

1. Akzhigitov G.N., Galeev M.A. and others. Osteomyelitis. M, 1986.

2. Aryev T.Ya., Nikitin G.D. Muscle plasticity of bone cavities. M, 1955.

3. Bryusov P.G., Shapovalov V.M., Artemyev A.A., Dulaev A.K., Gololobov V.G. Combat injuries to limbs. M, 1996, p. 89-100.

4. Vovchenko V.I. Treatment of wounded with gunshot fractures of the femur and tibia, complicated by defects. dis. Ph.D. honey. Sciences, St. Petersburg, 1995, 246 p.

5. Gaidukov V.M. Modern methods of treating false joints. Author's abstract. doc. dis. L, 1988, 30 p.

6. Grinev M.V. Osteomyelitis. L., 1977, 152 p.

7. Diagnosis and treatment of wounds. Ed. SOUTH. Shaposhnikova, M., 1984.

8. Kaplan A.V., Makhson N.E., Melnikova V.M. Purulent traumatology of bones and joints, M., 1985.

9. Kurbangaleev S.M. Purulent infection in surgery. M.: Medicine. M., 1985.

10. Treatment of open bone fractures and their consequences. Mater. conf. dedicated to the 100th birthday of N.N. Pirogov. M., 1985.

11. Melnikova V.M. Chemotherapy of wound infections in traumatology and orthopedics. M., 1975.

12. Moussa M. Plastic surgery of osteomyelitic cavities with some biological and synthetic materials. dis. Ph.D. honey. Sci. L, 1977.

13. Nikitin G.D. Chronic osteomyelitis. L., 1982.

14. Nikitin G.D., Rak A.V., Linnik S.A. and others. Surgical treatment of osteomyelitis. St. Petersburg, 2000.

15. Nikitin G.D., Rak A.V., Linnik S.A. and others. Bone and musculoskeletal plastic surgery in the treatment of chronic osteomyelitis and purulent false joints. St. Petersburg, 2002.

16. Popkirov S. Purulent-septic surgery. Sofia, 1977.

17. Experience of Soviet medicine in the Great Patriotic War of 1941-1954. M., 1951, vol. 2, pp. 276-488.

18. Wounds and wound infection. Ed. M.I.Kuzina and B.M.Kostyuchenko. M.. 1990.

19. Struchkov V.I., Gostishchev V.K., Struchkov Yu.V. Guide to purulent surgery. M.: Medicine, 1984.

20. Tkachenko S.S. Military traumatology and orthopedics. Textbook. M., 1977.

21. Tkachenko S.S. Transosseous osteosynthesis. Uch. allowance. L.: VMedA im. S.M.Kirova, 1983.

22. Chronic osteomyelitis. Sat. scientific works Len. sanitary and hygienic honey Institute. Ed. prof. G.D.Nikitina. L., 1982, t. 143.

2, 3, 4, 6, 13, 14, 15, 20.

VISUAL AIDS

1. Multimedia presentation

TECHNICAL TRAINING TOOLS

1. Computer, software and multimedia.

Introduction

The problem of osteomyelitis cannot currently be considered completely resolved. The reasons for this are largely determined by the special properties of bone tissue - its rigidity, tendency to necrosis when exposed, poor circulation and infection (formation of bone sequestration), cellular structure (formation of closed purulent foci, which themselves are a source of infection), a state of unstable equilibrium in the “macroorganism-microbe” system, changes in the body’s immunoreactivity.

The long course (years and tens of years) of all forms of chronic osteomyelitis, the occurrence of exacerbations after periods of calm, severe complications (amyloidosis, kidney stone disease, allergization of the body, deformities, contractures and ankylosis of joints in a vicious position of the limb) - all this gave rise to the near In the past, osteomyelitis was considered an incurable disease. The development by domestic authors of the pathology and treatment system for acute and chronic osteomyelitis made it possible to refute this statement. The successful use of antibiotics in the post-war period and the introduction of radical plastic surgery into practice made it possible to obtain a lasting recovery in 80-90% of operated patients.

Currently, due to the evolution of purulent infection and changes in the human body's resistance to it, there is an increase in the number of unsuccessful treatment outcomes for osteomyelitis, an increase in the number of late relapses of the disease, and the manifestation of generalization of the infection. Osteomyelitis, like other purulent diseases and complications, becomes a social and sanitary-hygienic problem.

Over the past decades, open fractures and their adverse consequences have attracted increasing attention from surgeons, traumatologists, immunologists, microbiologists and doctors of other specialties. This is explained primarily by the worsening nature of the injuries due to an increase in the number of multiple and combined injuries, as well as a high percentage of suppurative processes in patients with open bone fractures. Despite the noticeable progress of medicine, the frequency of suppuration in open fractures reaches 45%, and osteomyelitis - from 12 to 33% (Goryachev A.N., 1985).

A significant increase in surgical activity in the treatment of injuries, their consequences and orthopedic diseases, expansion of indications for immersion osteosynthesis, an increase in the proportion of elderly patients among those operated on, and the presence of immunodeficiency of various origins in patients lead to an increase in the number of suppurations and osteomyelitis.

This lecture will discuss the issues of surgical treatment of osteomyelitis depending on the phase of the wound process and the size of the secondary bone defect formed as a result of surgical treatment: direct and cross muscle, free and non-free bone grafting.

Many domestic and foreign scientists have dealt with the diagnosis and treatment of purulent osteomyelitis. Of particular importance were the works of the Finnish surgeon M. Schulten, who first used muscle plastics in 1897 to treat bone cavities in chronic purulent osteomyelitis, and the Bulgarian surgeon S. Popkirov, who in 1958 showed the effectiveness of surgical treatment of bone cavities in osteomyelitis using the method of bone autoplasty.

The principles of treatment of osteomyelitis were developed back in 1925 by T.P. Krasnobaev. They include: influence on the body in order to reduce intoxication, normalize homeostasis indicators; medicinal effect on pathogens; surgical treatment of the disease focus.

Surgical treatment of osteomyelitis is of decisive importance; all methods of general and local influence on the body, aimed at optimizing the wound process, are only of additional importance; all of them are not effective enough without rational surgical tactics.

In case of exacerbation of the osteomyelitic process, opening and drainage of the purulent focus is indicated, necrosis - sequestrectomy. Reconstructive and plastic surgeries are performed after acute inflammatory phenomena have subsided. During surgery, a radical sequestrectomy is performed, resulting in the formation of a secondary bone cavity or bone defect along the length.

Elimination of the defect and stabilization of the bone are necessary conditions for the treatment of osteomyelitis.

Surgical treatment methods for bone defects in chronic osteomyelitis can be divided into two main groups: conservative and radical in relation to the resulting secondary cavity.

Conservative methods include isolated local treatment with antibiotics for all forms of osteomyelitis, the use of trepanation and bone treatment (flattening of lesions, the use of fillings, most of which are only of historical significance).

If the cavity is small (up to 3 cm), it can be treated under a blood clot (Schede’s technique); larger cavities require replacement. For this purpose, in some cases, fillings are used.

In medicine, fillings mean organic and inorganic substances introduced into cavities with hard walls to cure caries and chronic osteomyelitis. A distinctive feature of all types of fillings is the absence of biological connections with the body, primarily vascular and nervous. That is why it is incorrect to call plastic surgery for chronic osteomyelitis “biological filling.”

There are three types of fillings: those designed to be rejected or removed in the future; designed for resorption and biopolymer materials.

There are more than 50 types of fillings. The most serious research on the use of fillings was carried out by M. Mussa (1977), who used biopolymer compositions containing antibiotics in the treatment of chronic osteomyelitis. Currently, the drug “Kollapan” is used to replace bone cavities.

Regardless of the material, all fillings, all compositions are allogeneic biological tissues, which, when introduced into the bone cavity, become foreign bodies. This violates the basic principles of surgical treatment of wounds - removal, and not the introduction of foreign bodies into it (Grinev M.V., 1977). Therefore, the percentage of positive treatment results in general among various authors who used fillings does not exceed 70-75%.

Modern research indicates that most types of fillings are fundamentally unacceptable when used in surgical practice.

The most acceptable currently is to replace the cavity with blood-supplied muscle or bone tissue.

The initially existing bone defect, which is expanded through necrosequestrectomy and radical clearance, remains the main treatment problem. It cannot resolve on its own; it exists for many months and years, turning into a bed of a chronic purulent process that maintains fistulas and further damages and destroys bone tissue. Such a wound is not capable of self-healing (Ivanov V.A., 1963). The task becomes even more difficult when a bone defect causes instability or when its continuity is disrupted.

Indications and contraindications for surgical treatment

The existence of a fistula supported by a bone cavity is, in the vast majority of cases, an absolute indication for surgical treatment. Fistulaless forms of osteomyelitis, including Brody's abscess, which are usually almost asymptomatic, as well as more superficial defects of soft tissue and bone, called osteomyelitic ulcers, are also subject to surgery. In most cases, it is very difficult to establish what is the main reason preventing the healing of an ulcer or fistula - sequesters, granulations, scars, foreign bodies or a cavity, therefore, the most correct and mandatory is the removal of all pathological tissues that form a purulent focus in the form of a cavity or surface defect fabrics. Patients who underwent repeated surgical interventions did not receive healing only because the final stage of the operation was not carried out - the elimination of the resulting secondary cavity or bone defect. In 46.7% of cases, the cavity itself is the main cause of a non-healing fistula or ulcer; in 2% of cases, independently or after surgery on the site of osteomyelitis, the fistula is supported by detached bone sequestra (Nikitin G.D. et al., 2000).

Thus, the indications for surgical treatment of osteomyelitis are:

1. The presence of non-healing fistulas or ulcers that correspond to the X-ray picture of osteomyelitis;

2. A form of osteomyelitis that occurs with periodic exacerbations;

3. Fistulaless forms of osteomyelitis, confirmed x-ray;

4. Rare forms of chronic osteomyelitis, complicated by tuberculosis, syphilis, tumors of the skeletal system.

Contraindications to surgical treatment are identical to those before any other operation. The most serious obstacle to plastic surgery is acute inflammation in or near the site of osteomyelitis. In these cases, opening and drainage of the abscess, expansion of the fistula tract, sometimes trephination of the bone, removal of sequesters and antibacterial therapy must first be applied. Temporary contraindications may arise in case of extensive bone lesions in relatively fresh cases of hematogenous osteomyelitis, where topical diagnosis of osteomyelitis is difficult, since the boundaries of the lesion have not been determined, or a pathological fracture is possible due to weakening of the bone. In these cases, it is advisable to postpone the operation for 2-3 months, so that during this period the acute inflammatory process subsides, the bone becomes stronger and the focus begins to demarcate.

Contraindications to surgery may also arise in cases where there are technical difficulties for its implementation: a significant size of the bone cavity with a corresponding lack of soft tissue in the affected area and the impossibility of obtaining them on the other limb. This forces one to resort to transplantation of free musculocutaneous flaps using microvascular techniques.