Identification of Types

Surgical Intervention

LIC. AIDÉ DINORAH FLORES MORA

 Surgical intervention

Concept: from the Greek cherios: hands and ergon, work. Branch of medicine that is dedicated to curing
"diseases."

Its purpose is to manipulate the structures of the body for diagnostic, preventive, and curative purposes.

Aim:

> Diagnosis
> Palliative
> Eliminator
> Reconstructive
> Transplant.
Historical background:

These are the surgical techniques used to treat wounds and trauma caused during life or exposure.
► Rudimentary methods of suturing, amputations, drainage or cauterization of wounds with hot instruments.
► Bloodletting or phlebotomy, attested with numerous societies throughout history using cutting instruments
or leeches
► Archaeological finds of skulls with obvious signs of trepanation, dated around the year 300 BC
► -Mesopotamia: the health-illness model among the Sumerians is based on a supernatural conception of
illness; This was a divine punishment imposed by different demons after breaking some taboo.

Historical background:

► -Egypt: the Ebers papyrus is considered one of the oldest known medical treatises. Edwin Smith is
a manual of traumatic surgery.
► -China and India: China developed, in exchange, a discipline halfway between medicine and
 surgery called acupuncture. The Hindu develops specific plastic surgery techniques: from repairs to
deformities of the auricle.
► -Pre-Columbian America: demonstrates the practice of trepanation throughout the American
continent, the use of coca, yagé, yopo, 'perica, tobacco, yoco or curare as an anesthetic agent can
be highlighted.

► 1.- Scientific knowledge of the blood coagulation and fibrinolysis process

will later help to inhibit bleeding from small caliber vessels
► 2.- the discovery of blood groups will provide the basis for the therapeutic act of
blood transfusion
► 3.- The authentic revolution in the fight against pain does not come until anesthesia
ethereal inhalation, introduced in Surgery by WG Morston (1819-1868) Boston dentist and assistant
to C. Warren. Subsequently, less toxic anesthetics appear, while devices with closed circuits are
designed to deliver them.
► 4.- In 1871, a transcendental event in the history of Anesthesia was constituted by the
introduction of endotracheal intubation, which, pioneered by Trendenlenburg

► 5 in the 20th century, the use of curatives (1942) as muscle relaxants will allow,
by analogy, then develop methods that free the organism from its physiology for a certain period of time,
which will expand the possibilities of surgical action.
► 6.- The great creator of Digestive Surgery, and who represents the beginning of the development of other
surgical specialties, was Th. Billroth (1829-1894). Professor from Vienna, great researcher and one of the
first surgeons
► 7.- Starting from the path traced by J. Hunter, of Bichat's thought and of the practice of
Dupuytren gradually established a Surgical Pathology with his clinic, based on Pathological Anatomy.
This will fully justify the therapeutic action based on making the the injury by removing or restoring it,
using a surgical technique
appropriate.
► 8.- Semmelweiss' work in 1861 on the "etiology, concept and prophylaxis of fever
puerperal" marks the beginning of the antiseptic principle, which was later expanded by J. Lister with the
sprays of a. carbolic and E. von Bergmann with the introduction of steam sterilization.
► 9.- Mickuliz contributes to the development of aseptic surgery with the systematic use of caps
and mask, as well as cotton gloves, later replaced by rubber ones by Halstedt.
► 10.- Sauerbruch with its hypopressure chamber to counteract negative pressure
intrathoracic surgery began.
 • Classification based on its objective

► -Diagnosis: allows obtaining a tissue sample to identify a process

specific and establish a diagnosis.
► -Palliative: surgery is used to relieve suffering even if it is unlikely
healing, is relieved by sectioning the nerves that are affected by the tumor.
► -Eliminator: extraction of a piece, organ and/or limb to avoid
complications.
► -Reconstructive: deals with the surgical correction of any congenital, aching, or tumor process that
requires repair or replacement of superficial structures that affect body form and function.
► -Transplant: change and/or replacement of an organ for therapeutic purposes.
• Classification based on the urgency or need to
preserve life.

► -Urgent: is responsible for caring for patients who require immediate attention.
► -Scheduled: Procedure that you choose to have, which is not necessarily essential to continue your life
in optimal conditions.
Classification based on the degree of risk for the
patient.

HANDLE CHARACTERISTICS MORTALITY RATE

Yo Normal and healthy patient. 0.06-0.08
II Patient with mild or medium 0.19-0.47
systematic disease
III 1.1-1.8
Patient with severe systematic
disease is not disabling.
IV 7.6-23.5
Patient with disabling illness that is
a threat to life.
V 9.4-50.8
Dying patient who will not survive
24 hours with or without surgery.
AND In case of emergency, mortality
quadruples.

• Health problems that increase surgical risk.

► -malnutrition: The incidence of infectious, pulmonary and local complications is high, as a consequence of
hypoproteinemia, albumin deficiency and muscle atrophy, lack of energy deposits and the frequent coexistence of
immunological deficit.
► -Obesity: It also represents a high surgical risk. On the one hand, because the abundance of fat panicle produces
a marked liposolubilization of anesthetic agents. On the one hand it increases the anesthetic risk and on the other
it creates technical difficulties. They are subjects with frequent associated cardiovascular, pulmonary,
osteoarticular and metabolic diseases. Postoperative thrombotic and respiratory complications are common here.
The fatty infiltration of the tissues also explains the higher rate of surgical wound infections.
► -Cardiac disorders: Cardiac patients who are treated surgically have a high operative risk that is related to the
depressant action of anesthesia on myocardial and nervous tissue, on peripheral resistance and on cardiac
rhythm, especially in patients with vascular medication. associated. The presence of a recent infarction, especially
in the six months prior to surgery, arrhythmias, congestive heart failure, severe aortic stenosis and uncontrolled
arterial hypertension, significantly aggravates the risks.

► Also note that the loss of volume of both blood and fluids can
 trigger heart failure.
► -coagulation disorders: this is when the blood does not have enough platelets or
clotting factors or they do not work normally.
► -respiratory infections: Patients who suffer from chronic obstructive pulmonary disease have a high
complication rate, usually respiratory and a
significant increase in mortality rates due to the physical action of artificial ventilation and for the
depressant action of anesthesia and changes in
respiratory functionalism caused by surgery, incision, pain and bandages.

► -kidney diseases: In patients with kidney disease, surgical aggression can further damage kidney function
by causing hydroelectrolyte and acid-base balance disorders. Knowledge of kidney disease and
assessment of risk factors allows for measures to be taken. driving that prevents or reduces damage.
► -diabetes mellitus: Surgical aggression alters the evolution of diabetes, causing significant elevations in
blood glucose due to hormonal and nervous mechanisms, which have to be monitored and treated in time.
► -Hepatopathies: Chronic liver disease and, to a greater extent, acute liver disease are associated factors of
 high surgical risk, since they accentuate the anesthetic risk and are associated with malnutrition,
hypoalbuminemia and coagulation disorders. On the other hand, the surgical act can accentuate liver
dysfunction by reducing glandular flow and causing hepatocellular injury. The postoperative incidence of
gastrointestinal bleeding and encephalopathy, infections and alterations in healing is high. The possibility of
behavioral alterations occurring in the postoperative period is also important.
► -uncontrolled neurological diseases.
Thank you for your time