# Surgery --- **Surgery** is when doctors manipulate (i.e. cut into) your body physically move things around to try to fix you. It is often used in conjunction with [[medicine]], which are just chemicals that are trying to fix you. It's spectacular that we have the technology to do this, but it's also very difficult and very risky—even "simple" surgeries require [[general anesthesia]] which in and of itself is dangerous. ## Preoperative Phase The **preoperative phase** of surgery is the first phase, where a patient is prepared for surgery. This can start days to weeks to months prior to surgery. Surgeons want to make sure that the surgery is appropriate for the patient, and that they are healthy enough to handle it. Common preoperative diagnostic tests that may be done prior to surgery include: - fasting [[blood glucose|blood sugar]] - electrolytes - coagulation studies - urinalysis - pulmonary function test - chest x-ray - CBC - liver function - [[blood type]] - EKG - BUN/creatinine - HCG ## Intraoperative Phase The **intraoperative phase** of surgery is the surgery itself. There are a ton of different types of surgeries: - **Diagnostic**: Establishes or confirms a diagnosis; e.g., laparoscopy of abdomen. - **Ablative**: Removes a part of the body that is diseased; e.g., removal of [[gangrene|gangrenous]] toe. - **Constructive**: Restores functioning that has been lost or reduced; e.g. [[cleft lip and cleft palate]] - **Reconstructive/restorative**: Restores function or appearance to traumatized or malnourished tissues; e.g., skin graft for a [[burns|burn]] victim, hand surgery. - **Transplant**: Replaces dysfunctional body part; e.g., heart, kidney. - **Palliative**: Improves comfort, decreases pain or symptoms (doesn't cure); e.g., some types of back surgery (decreases pressure). - **Cosmetic**: Improves personal appearance; e.g., liposuction. ### Laparoscopic Surgery **Laparoscopic surgery** is sometimes called "keyhole" surgery, because it's minimally invasive and the only place where they go into the body is like a little "keyhole" when little incisions are made and the the surgeon goes in with a little robotic arm with cameras and tools and stuff and does the procedure from there. The site where the they go in is called a **trocar**. >[!biology] CO$_2$ in the belly! > When doing abdominal laparoscopic surgery they will puff up the abdominal cavity with a gas in order to have a better view, and allow surgeons to move the tools around more easily. They usually use CO$_2$ because it is non-reactive (won't blow up) and dissolves rapidly in the bloodstream so there is less of a chance of a gas [[embolus]] forming if something goes wrong. After surgery it takes a while for the gas to dissipate, but it is usually harmless (if a little uncomfortable). > For some reason post-op patients ## Postoperative Phase The **postoperative phase** of surgery is the third, recovery phase. This is when [[nursing]] largely takes care of a patient, and they should be keeping an eye out for potential post-op complications. - compromised airway Bleeding Infection (usually occurs at least 48 to 72 hours postoperatively) Clot (PE or DVT) Pneumonia/Atelectasis less common: [[malignant hyperthermia]] dysfunctional IV extended confusion/sedation dehiscence and evisceration. scary complications: - thrombophlebitis (blood clot) = inflammation fo the vein with formation foa thrombus - PE - pneumonia ### ERAS **Enhanced Recovery after Surgery** (ERAS) refers to patient-centered, evidence-based, multidisciplinary team developed pathways for a surgical specialty and facility culture to reduce the patient’s surgical stress response, optimize their physiologic function, and facilitate recovery. These care pathways form an integrated continuum, as the patient moves from home through the pre-hospital / preadmission, preoperative, intraoperative, and postoperative phases of surgery and home again. ![[ERAS pathway.png]] P ## Factors that Affect Surgical Risk - general health - smoking puts a person at risk for reactive airway disease which could lead to complications such as **larynogospasm**, where the [[larynx|laryngeal]] muscle briefly spasms - medications - mental/cognitive ststus - nutrition - need to burn calaories to heal - cardiac disorders - blood coagulation disorders - respiratory disorders - renal disorders - liver disease - diabetes mellitus - previous surgery **Malignant hyperthermia** is a rare inherited disease and potentially life-threatining disease DIVERSITY CONSIDERATIONS Life Span Older adults and children have a greater risk associated with surgery. Culture, Ethnicity, and Religion Cultural influences, beliefs, and practices could influence how a patient responds to surgery and pain. Disability Any disorder that causes extreme anxiety, hinders the ability to understand, interferes with coping with the stress of surgery, and impedes the patient's ability to respond appropriately can increase the risks for surgery and postoperative complications. Morphology Malnutrition can lead to a delay in wound healing, infection, fluid and electrolyte imbalances, and fatigue. Obesity can cause significant mechanical difficulty for the surgeon. ___