Preparing for surgery
As a general rule, do not eat or drink for 6 hours prior to the anaesthetic. However, this should be discussed with your anaesthetist in detail as other rules apply for children and certain types of surgery. As a general rule, no food should be consumed after 22:00 on the evening before the surgery is scheduled to take place.
On the day of the surgery you can wash as normal but please do not use any make-up. If applicable, please remove any nail varnish. Do not wear any contact lenses, hearing aids or dentures. Please remove any jewellery and make sure you leave your glasses on the ward.
If there is anything else you need to do, this will be explained in detail during your pre-operative meeting.
General anaesthesia today is very safe. A mix of anaesthetic drugs is selected for the individual patient and administered to induce a sleep-like state. The patient will be unconscious and will not be able to feel any pain. This type of anaesthesia is suitable for all types of surgery. Nowadays, anaesthesia duration can be planned precisely and adjusted to match that of the surgical procedure itself.
What happens during general anaesthesia:
Before you are moved from the ward to the theatre you will be given a medicine to help you relax. Before you receive the actual anaesthetic you will be moved to the preparation room, where you will be attached to a monitor (blood pressure, ECG, blood oxygen).
Generally, patients will then have an intravenous line ('drip') inserted, through which the anaesthetic will be administered. This process is not unpleasant and you will fall asleep very quickly (approximately 20 seconds). For children and patients with an aversion to needles anaesthesia can be administered by mask before the intravenous line is inserted. Nowadays, anaesthesia can be maintained by continuous administration of anaesthetic drugs via the drip (total intravenous anaesthesia) or by administration of anaesthetic gas. Your vital signs and organ function will be monitored by the anaesthetist who will remain with you throughout your surgery and who can intervene immediately should the need arise. Throughout your operation, all vital statistics and measurements will be processed to produce an anaesthesia record. This process is fully computerised in our Clinic. The anaesthetic will be administered until your surgery is completed. When it is stopped you will start to wake up. You will not return to the ward immediately but remain in the recovery room for a while. This is to ensure that all your major organ systems are working properly and that you do not have any pain before you are moved onto the ward. Depending on the complexity of the surgical procedure and the patient's overall health, the patient may need to spend some time in an intensive care unit, where they can receive the best treatment possible and constant monitoring.
Regional anaesthesia (numbing of a large part of the body)
In regional anaesthesia only part of the body is anaesthetised. In contrast to general anaesthesia, you will remain awake and responsive but you will not feel any pain. Should you prefer not to remain conscious during your surgery, you can be sedated using a mild barbiturate. Due to the smaller doses of drugs required, regional anaesthesia is relatively gentle on the body and is particularly suitable for pregnant women and patients with pre-existing conditions.
The following form part of the group of regional anaesthetic techniques:
A plexus block can block nerve transmission to part of the body (e.g. arm, leg). By injecting a local anaesthetic into a nerve or nerve plexus it is possible to completely block nerve transmission - and thus pain - for a number of hours. For long surgical procedures or pain relief following surgery, a plexus block can be topped up via a very thin catheter in a vein and maintained for a number of hours.
Epidural anaesthesia is a type of neuraxial anaesthesia.
By injecting a local anaesthetic near the spinal cord, nerve transmission - and thus pain - in that part of the body can be blocked. This type of anaesthesia allows large parts of the body to be numbed using only a local anaesthetic, and is suitable for surgical procedures involving the upper body, abdomen, pelvis, lower abdomen and legs. Epidural anaesthesia can be used on its own or in combination with general anaesthesia. One advantage of this procedure is that a thin catheter is used to administer pain medication throughout the procedure, thus minimising the amount of anaesthetic required during surgery. After the operation, the catheter can be used to administer pain medication, thus ensuring that the patient remains almost pain-free even after major surgery.
Spinal anaesthesia is another type of neuraxial anaesthesia. This technique is particularly suitable for surgery on parts of the body below the level of the belly button (legs,pelvic area, lower abdomen). In a process that is similar to epidural anaesthesia, nerve transmission is blocked by injecting a local anaesthetic into the spinal fluid. Spinal anaesthesia requires only a very small amount of anaesthetic, and is particularly suitable for use in pregnancy as the drugs used do not have a direct effect on the baby.
Information on special anaesthesia techniques
The term monitoring describes all types of measures used to check that vital organs are functioning normally.
Anaesthesia monitoring can be divided into basic monitoring and extended monitoring, with basic monitoring comprising the types of checks performed on every patient. These include ECG, blood pressure monitoring and pulse oximetry (measuring blood oxygen levels).
Extended monitoring allows more detailed checks to be performed on specific organs and how they are working and is used in certain types of surgery (e.g. cardiac surgery) or because of increased risk to the patient.
- Right heart catheterisation
- Used in intensive care medicine and anaesthesia, this procedure allows close monitoring of heart activity in patients with heart problems as well as being used in cardiac and vascular surgery.
- PICCO monitoring
- Used in intensive care medicine and anaesthesia, this procedure allows close monitoring of heart activity in patients with heart problems as well as being used in cardiac and vascular surgery.
- TOE / TEE
- Transoesophageal echocardiography (TOE, or TEE in US English) produces an ultrasound image of the heart. This technique is used during anaesthesia (e.g. heart valve surgery) as well as in cardiac diagnostics.
- Intraoperative neurophysiological monitoring
- Intraoperative neurophysiological monitoring is used to measure the depth of anaesthesia (BIS, EEG), or for intraoperative monitoring (evoked potential) during carotid or aortic surgery.
Laryngeal mask airway
The laryngeal mask is a particularly gentle device for keeping the patient's airways open during general anaesthesia and is used especially in day case and short surgical procedures.
Total intravenous anaesthesia (TIVA)
Total intravenous anaesthesia is a modern anaesthesia technique which dispenses completely with inhalational agents and instead delivers all anaesthetic agents via an infusion pump. The short-acting nature of the anaesthetic agents involved allows for easy control of the depth and duration of anaesthesia, making it a popular choice for day case surgery.
High-frequency ventilation is a modern ventilation technique that employs a high frequency of small tidal volumes. It is used in the intensive care setting as a lung-protective ventilation technique.
Blood preservation techniques
Special anaesthesia techniques (controlled hypotension) or systems allowing automated blood recovery (Cell Saver) can reduce intraoperative blood loss and reduce the need for blood transfusions.
- Cell Saver®
- Cell Saver is a medical device that recovers and filters the patient's own blood before reinfusing it into the patient.
- Controlled hypotension
- Controlled hypotension is an anaesthetic technique which is used to reduce blood loss by deliberately decreasing blood pressure.
Frequently Asked Questions
Why have I been asked not to eat or drink anything before my operation?
During a general anaesthetic you will be unconscious, i.e. your natural cough, swallowing and gag reflexes are depressed. As a result, there is a risk of stomach contents entering the trachea, with the risk increasing with the volume of food or drink contained within the stomach.
How quickly does an anaesthetic work?
Modern anaesthetics are fast-acting and well tolerated.
Once the anaesthetic has been injected, you will fall asleep within approximately one minute.
Is it possible for me to wake up during surgery?
Throughout your surgery, your anaesthetist will continuously monitor your vital signs, organ function (blood pressure, ECG etc.) and depth of anaesthesia. For the latter we have BIS monitoring equipment available. There is no need for any concern on your part.
When will I wake up following surgery?
Modern anaesthetics make it possible for you to regain consciousness immediately following the end of your surgery. This is why many operations can now be performed on a day case basis. Following major surgery (on the heart, lungs or pancreas), which can take a number of hours, you may need to be moved to intensive care for a while, for monitoring. In this case you will only wake up once you are in the intensive care unit.
Is it possible that I will never wake up?
Advances in anaesthesia have been far more marked than in any other medical speciality. Today's anaesthetics are safer than ever before and complications are extremely rare. The individual patient's risk depends on their medical history and the type of surgery involved.
How much pain will I be in following surgery?
The degree of post-operative pain will depend on the type and extent of your surgery, however, even if a certain degree of pain is unavoidable following surgery, this can be reduced to a level that you find tolerable. We have a dedicated team of pain management specialists who will care for you round the clock. The pain management team have the most up-to-date pain management equipment at their disposal. All patients undergoing major surgery can opt for patient-controlled pain relief using a pain control pump. This pump enables patients to control the level of pain relief administered according to their individual needs. The pumps are small and portable, meaning that patients remain mobile.
Will I feel nauseous or vomit following surgery?
Modern anaesthetics make it far less likely for a patient to feel nauseous or even vomit following surgery but patients differ in the way they react to anaesthetics. Modern anaesthesia techniques mean that post-operative nausea and vomiting can be easily prevented and treated. Developing and improving these techniques continues to be one of our major areas of active research.
When will I be able to eat or drink following surgery?
In order to prevent nausea and vomiting, you should wait at least three hours before having anything to drink and at least six hours before you have any food. Naturally, if your surgery involved abdominal organs you may not be able to eat or drink anything for some time. Should this be the case, you will be fed through a drip.
Intensive Care Medicine
One of the most common reasons for admission to intensive care is impaired respiratory function. If a patient's respiratory function is impaired, or the patient has suffered respiratory failure, the patient will require mechanical ventilation to assist or replace spontaneous breathing. After major surgery artificial ventilation is often required for a number of hours to ensure that the patient receives sufficient oxygen whilst their own respiration remains impaired. It is not unusual for mechanical ventilation to be necessary for a number of days or even weeks. Ventilation is usually via a tube that is inserted into the trachea via the mouth, nose, or directly through a tracheostomy. In order to reduce the level of stress associated with mechanical ventilation, patients receive special sedative medications. Although intubation and sedation will normally make it impossible for the patient to talk, you should always address the patient directly and never talk about them without involving them in the conversation.
A patient whose digestive function is impaired (e.g. after major abdominal surgery or a serious accident) cannot usually receive sufficient nutrition in the normal way. In these cases the patient's normal dietary requirements will be provided in the form of a nutrient solution. As soon as the patient's health allows, intravenous feeding will be stopped and normal digestive processes encouraged. Initially, this may involve a tube which is inserted via the nose and into the stomach (naso-gastric intubation). Following discussion with the doctors and nursing staff, you may be allowed to bring the patient some of the foods and drink they particularly like. Patients often suffer from a loss of appetite. By ensuring the patient has foods available that they particularly like, you will be able to help reduce the likelihood of this becoming a problem.
Artificially induced coma
The majority of intensive care patients are in what is referred to as an artificially induced coma. This is effectively a type of drug-induced anaesthesia that is necessary in the intensive care environment for procedures such as mechanical ventilation.
An artificially induced coma can be maintained for a number of days or even weeks without any harm to the patient. The necessary depth of anaesthesia is determined on a case by case basis. The patient may appear to be in a deep sleep, however, it is possible that they may hear what is going on around them. As a result it is important to always address the patient directly and to talk to them and perhaps even hold their hand when you do.
There may not be any obvious signs that the patient can sense your presence but having a familiar person with them is very important for the patient.
Kidney failure (dialysis)
Impaired renal function is common in critically ill patients. In most cases, this will be a temporary impairment and the patient will recover fully. Dialysis is used to assist the kidneys when renal function is impaired, or it may be used to completely replace renal function.
Being exposed to the intensive care environment is stressful for both the patients and their families. Worries for the patient's health will be compounded by the unfamiliar environment of the intensive care unit and at first it will be difficult to understand some of what you see and hear. However, doctors and nursing staff will always be present so that you will always have the opportunity to ask questions or discuss any concerns in detail. We will do our utmost to help you to better understand and cope with these difficult circumstances.
Information for visitors to the Intensive Care Unit OI 07
Regular visits from loved ones will have significant beneficial effects on a patient's recovery. Access to patients is strictly limited to immediate family members. Visits from children under 12 years of age are discouraged and should be considered the exception.
Visiting hours for the Surgical Intensive Care Unit (OI 07) are strictly limited (14:00 - 15:00 and 18:00 - 19:00 daily). Visits outside these times must be arranged in advance. Set visiting hours are necessary to ensure that medical and nursing care for our patients is not compromised in any way. Even during visiting hours you may be asked to wait in order to allow doctors and nursing staff access to patients as and when this becomes necessary.
Intensivpflege am Klinikum
Im Klinikum Ludwigshafen gibt es drei Intensivstationen verschiedener Fachdisziplinen: Medizinische Intensivstation mit Zusatzbereich Neurologie, Herzchirurgische Intensivstation, Anästhesiologisch-operative Intensivstation. Unsere drei Intensivstationen haben am Klinikum Ludwigshafen – KliLu – einen hohen Stellenwert. Mit einer deutlich älter werdenden Gesellschaft steigt die Zahl und der Schweregrad der Erkrankungen, was eine zunehmend intensivmedizinische Intervention zur Folge hat. Des Weiteren sind die verschiedenen Fachbereiche am Klinikum Ludwigshafen innovativ daran beteiligt im Rahmen des medizinischen Fortschrittes den Patienten die neuesten Behandlungs- und Therapiemöglichkeiten anzubieten. Um von pflegerischer Seite dem hohen Anspruch fachlicher Pflegequalität trotz ansteigender Arbeitsdichte gerecht zu werden, unternimmt das Klinikum Ludwigshafen einige Anstrengungen. Die Intensivstationen wachsen durch flexiblen Personalaustausch immer mehr zusammen. Ein vorhandener Springerpool an Intensivpflegefachkräften hilft mit, Personalausfälle und als Folge entstehende pflegerische Engpässe abzufangen.
Unterstützt werden die Intensivstationen durch das Know-how von Pflegeexperten in Form von Feed-back-Begleitungen, Wundmanagementberatungen, Begleitung von Pflegevisiten, Kinästhetikschulungen zur Förderung der Bewegungskompetenz der Mitarbeiter, Umsetzung der Nationalen Expertenstandards, u. a. m., um den individuellen pflegerischen Erfordernissen der Patienten gerecht zu werden und Pflege auf hohem Niveau zu gestalten.
Mitarbeiter der stationsübergreifenden Arbeitsgruppen AG Wunden, AG Kinästhetik, AG Standard und AG Dokumentation aller drei Intensivstationen treffen sich jeweils zusammen mit der zuständigen Pflegeexpertin turnusmäßig während der Dienstüberlappungszeit zu einem praktischen fachlichen Austausch mit dem Ziel, spezielles Wissen und Fertigkeiten zu erwerben, zu festigen, weiterzuentwickeln und im Arbeitsalltag an die Kollegen weiterzugeben. In Zusammenarbeit mit der Pflegeexpertin leisten sie somit einen wichtigen Beitrag zur Durchdringung und Nachhaltigkeit einzelner Pflegekonzepte und helfen mit, speziell für die Intensivstationen einheitliche Arbeitsabläufe zu entwickeln und umzusetzen. Dies hat auch zum Ziel, ein bedarfsgerechtes Personalmanagements auf den Intensivstationen zu erleichtern und trägt wesentlich sowohl zur Patientensicherheit als auch zur Arbeitssicherheit und Arbeitszufriedenheit der Mitarbeiter bei.
Ein großer Schwerpunkt am Klinikum Ludwigshafen liegt weiterhin in der konstruktiven Zusammenarbeit in den therapeutischen Teams.
Neue Mitarbeiter erfahren nach einigen Wochen der Einarbeitung eine Praktische Begleitung durch die Pflegeexpertin der Intensivstationen und erhalten so die Möglichkeit, ihr pflegerisches Handeln zu reflektieren. Ebenso erlauben regelmäßige Präsenzzeiten der Pflegeexpertin vor Ort den Mitarbeitern, zeitnah Pflegeprobleme im Dialog zu lösen und konkrete pflegerische Unterstützung in Anspruch zu nehmen.
Im Bereich der Intensivstationen wird die Einarbeitung durch verschiedene Angebote ergänzt. So bekommen die neuen Mitarbeiter u.a. die Möglichkeit, auf den anderen Stationen zu hospitieren.
Mit einem regelmäßigen Angebot an Fortbildungen erleichtern wir allen Mitarbeitern auf unseren 3 Intensivstationen und der Anästhesie den Einstieg in diese spannenden Arbeitsfelder.
Insbesondere die Einführungstage für neue Mitarbeiter im Intensivbereich und der Anästhesie haben sich hierbei als wertvolles Instrument erwiesen. Seit Ende 2009 findet diese Veranstaltung turnusmäßig statt. Noch während der Einarbeitung auf den Stationen werden neue Kollegen an 6 Tagen mit den theoretischen Aspekten ihres neuen Tätigkeitsfeldes vertraut gemacht. Durch verschiedene Unterrichtseinheiten, die allesamt von erfahrenen Mitarbeiterinnen des KliLu gestaltet werden, gelingt eine exzellente Ergänzung der im Stationsalltag erworbenen Handlungskompetenz mit theoretischen Inhalten:
- Grundlagen der Beatmung
- Grundlagen der Hämodynamik
- innerklinische Transporte
- Grundlagen der Schrittmachertherapie
- kreislaufwirksame Medikamente
- verschiedene Dialyseverfahren
- Grundlagen EKG & Monitoring
Alle Unterrichtseinheiten finden in Schulungsräumen am KliLu statt. Selbstverständlich sind die Mitarbeiter an diesen Tagen vom Dienst auf den Stationen freigestellt. Ergänzt werden die Einführungstage durch geplante wöchentliche, stationsübergreifende Fortbildungen. Referenten aus allen Berufsgruppen des therapeutischen Teams schulen hier umfassend alle interessierten Mitarbeiter aus den verschiedenen Bereichen - arbeitszeitneutral während der Überlappungszeit!
Mit diesem Konzept der Zusammenführung und Vernetzung pflegerischen Wissens streben die Intensivpflegekräfte am Klinikum Ludwigshafen danach, ihren pflegerischen Auftrag in seinen verschiedenen Facetten leistungsstark, innovativ, partnerschaftlich, umsorgend und kompetent - gemäß dem Leitbild des Klinikums - zu leben.
For further information on anaesthesia and intensive care medicine (stakeholder groups and professional organisations) please click on the following external links:
- Berufsverband Deutscher Anästhesisten e.V.
- Deutsche Gesellschaft für Anästhesie und Intensivmedizin e.V.
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin
- Bundesvereinigung der Arbeitsgemeinschaften der Notärzte Deutschlands BAND e.V.
- Arbeitsgemeinschaft der Südwestdeutschen Notärzte e.V.