Documents

Before every operation it is necesarry to fill out certain documents. In these documents you will find information about procedures and general anesthesia. You can download them here or you will get them at the reception at Modřany.

Procedures in general anesthesia

For the below stated procedures please fill out the particular document and also the Informed consent of the patient with treatment in general anesthesia, which you will find below. Please bring all filled-out documents to the attending physician afterwards.

LASER ADENOIDECTOMY

Endoscopic, laser-assisted removal of the pharyngeal tonsil

PLASMA ADENOIDECTOMY

Endoscopic removal of pharyngeal tonsil with plasma coblation

TONSILLOTOMY

Reduction of tonsils by laser or plasma coblation

RHINOSEPTOPLASTY

Plastic surgery of nose and nasal septum

FESS, FEELS SURGERY

Functional endoscopic surgery of paranasal sinuses,
laser- or plasma-assisted endoscopic nasal polypectomy

SEPTOPLASTY + MUCOTOMY

Surgery of nasal septum + excision of the mucous membrane

OTOPLASTY

Ear pinning surgery

MYRINGOTOMY

Perforation of ear drum due to fluid in middle ear

UVULOPALATOPLASTY (LAUPP)

Removal of the tissue on the back of the mouth and upper throat that causes snoring

Adult patients

If the patient is an adult, please fill out the following document.

Informed consent of the patient with treatment in general anesthesia

Child patients

If the patient is a child, please fill out the following documents.

Informed consent of the patient with treatment in general anesthesia

Anesthesiological questionnaire

Questionnaire on the determination of a child’s blood coagulation

Preoperative examination

(Submit to your general practitioner or paediatrician.)

The tests can’t be carried out more than 7 days before the operation. Bring the results of examination with you on the day of surgery.

Adult patients

  • CBC (Complete blood count) + Leukocyte Differential Count (white blood cell count differential)
  • APTT (Activated partial thromboplastin time)
  • LFT (Liver function test)
  • Internal preoperative conclusion
  • For adults older than 50 years, EKG (Electrocardiography)
  • For adults older than 60 years, X-ray of lungs

Child patients

  • With healthy children we require only paediatrician’s evaluation where it is stated that the child is able to handle surgery in general anaesthesia. Laboratory tests are not required.
  • With children from families where there is blood coagulability problem, it is necessary to carry out the APTT test (activated partial thromboplastin time).

Recommendations after operation

Here you can find recommendations that a patient should follow after he has undergone surgery in general anaesthesia.

Adult patients

Child patients

Contact us

In case of any other questions regarding surgical procedures you can contact us through this contact form or you can visit us personally at the doctor’s office in Modřany.

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