Postoperative Care




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Chapter 7 : Postoperative Care



Postoperative Care arrow_upward


  • Postoperative care is the management of a patient after surgery.
  • Immediate postoperative period is the crucial period when numerous physiological and pharmacodynamics changes occur due to surgical trauma and anesthesia.

  • Goals of Postoperative Care arrow_upward


  • The goals of postoperative care is to prevent complications such as,
    • Infections
    • To promote healing of the surgical incision.
    • To return the patient to a state of health.

    Postoperative Considerations arrow_upward


  • Patients have generalized deterioration of organ function and loss of reserve capacity to withstand even minor stress like surgical trauma causing life-threatening complications.
  • The condition of older patients can change rapidly and therapy may need to be adjusted every few hours if optimum cardio-respiratory function is to be maintained.
    • Diagnose and treat complications quickly.
    • Plan intensive monitoring during surgery and in postoperative wards.
    • Institute invasive monitoring and elective ventilation when required.
    • Continue with postoperative care to increase the rate of recovery.

    Early Postoperative Period arrow_upward


  • Monitoring the following is essential:
    • Blood pressure, temperature, pulse, respiratory rate.
    • Electrolytes, glycemic control, liver and renal functions.
    • Good nutritional intake and bowel movement.
    • Fluid balance and urine output.
    • Drain and wound status and appropriate care.
    • Medication for pain relief.
    • Mental and cardio respiratory status.
  • The three factors which are interlinked to each other and produce combined ill effects leading to life threatening complications are:
    • Hypotension.
    • Hypoxia.
    • Hypothermia.

    Hypotension

  • Anesthetic drugs and muscle relaxants may lead to profound vasodilatation and lot of fluid is diverted to extra cellular space.
  • Hypotension causes poor perfusion thereby leading to hypoxia.

  • Hypoxia

  • Abdominal pain and the effects of opioid drugs given to relieve postoperative pain can depress respiratory function.
  • It is necessary to give oxygen to patients after surgery to prevent hypoxia.

  • Hypothermia

  • There is a heat loss in the operating room under general anesthesia.
  • It is necessary to cover the patient with warm blankets in cold.

  • Late Postoperative Period arrow_upward


  • Control of infection is done with appropriate antibiotics after culture and sensitivity if required.
  • Prevention of pressure ulcers is a critical part of postoperative management.
  • Rehabilitation and follow up is important to continue the comprehensive care.

  • Postoperative Complications arrow_upward


  • Postoperative complications can range from minor self-limiting problems to major life threatening ones depending on the nature of the surgery and the organ operated upon.
  • Complications can be due to:
    • Anesthesia.
    • Surgery.
    • A reaction to the stress of surgery itself.
  • Following are the complications associated with surgery:
    • Circulatory Complications.
    • Pulmonary Complications.
    • Urinary Complications.

    Circulatory Complications arrow_upward


  • Circulatory Complications include:
    • Shock.
    • Hemorrhage.

    Shock

  • Shock is a life-threatening condition that occurs when the body is not getting enough blood flow.

  • Signs and Symptoms of Shock:

  • Hypovolemic shock: Hypovolemia is a direct loss of effective circulating blood volume leading to:
    • A rapid, weak, thready pulse due to decreased blood flow combined with tachycardia.
    • Cool, clammy skin due to vasoconstriction and stimulation of vasoconstriction.
    • Rapid and shallow breathing due to sympathetic nervous system stimulation and acidosis.
    • Hypothermia due to decreased perfusion and evaporation of sweat.
    • Thirst and dry mouth, due to fluid depletion.
  • Cardiogenic shock: Cardiogenic shock occurs whenever the heart is unable to pump as much blood as the body needs.
    • Symptoms of cardiogenic shock include:
    • Distended jugular veins due to increased jugular venous pressure
    • Weak or absent pulse
    • Arrhythmia, often tachycardic
    • Pressure on the heart due to a buildup of the fluid around it (pericardial tamponade).
  • Distributive shock: Distributive shock includes infectious, anaphylactic, Endocrine and neurogenic causes.

  • Treatment of Shock:

  • Treatment of shock depends on the type of shock and the cause.
  • The primary treatment of Hypovolemic shock is the restoration of a blood volume.
  • Primary treatments for other types of shock might include the following:
    • Checking of the airway and the administration of oxygen.
    • Checking or changing the patient’s position to relieve pain or assist the airway.
    •  Attention to urinary volume and medication.

    Hemorrhage

  • Hemorrhage is any profuse internal or external bleeding from the blood vessels.
  • Symptoms of Hemorrhage:
    • The patient is apprehensive, restless and thirsty.
    • The skin is cold, moist, pale and temperature falls.
    • The pulse rate increases and respirations become rapid and deep.
  • Treatment of Hemorrhage:
    • The surgeon must be notified immediately and emergency measures are instituted until patient arrives.
    • The patient should be given oxygen, and the rate of intravenous drip should be increased.
    •  His feet should be elevated, if possible.
    •  Blood pressure should be checked again.

    Pulmonary Complications arrow_upward


  • The patients who have a respiratory disease at the time of surgery are more likely to develop postoperative pulmonary complications.
  • Postoperative pulmonary complications, including pneumonia, bronchospasm, respiratory failure and prolonged mechanical ventilation, occur commonly and are a significant source of morbidity and mortality.
  • Treatment involved removal of fluid or air by needle aspiration and sedation.

  • Urinary Complications arrow_upward


  • Urinary Retention or complications may occur after any operation, but it occurs most frequently after operations on the rectum, anus, vagina or lower abdomen.
  • Urinary retention is defined as the inability to completely or partially empty the bladder.
  • Treatment depends on the individual patient but may include diuretics or increasing intravenous fluids.
  • Diuretics are the drugs that act directly on the kidneys to increase urine volume and to produce a net loss of solute and water.
  • Urinary incontinence (UI), involuntary urination, or enuresis is any involuntary leakage of urine. It can be a common and distressing problem, which may have a profound impact on the quality of life.

  • Pain Management arrow_upward


  • Pain is one of the main postoperative adverse outcomes causing distress to patients, prolonging hospital stay, and increasing the incidence of admissions after surgery.
  • Postoperative pain management aims not only to decrease pain intensity but also to increase patient’s comfort and to improve postoperative outcome.
  • The major goal in the management of postoperative pain is minimizing the dose of medications to lessen side effects while still providing adequate analgesia.
  • A multidisciplinary team approach is useful for formulating a plan for pain relief, particularly in complicated patients.
  • Multimodal analgesia is currently recommended for effective postoperative pain control.
    • A multimodal combination of regional analgesic techniques and systemic administration of analgesic agents results in better pain control.
  • Multimodal analgesia is achieved by combining different analgesics that act by different mechanisms resulting in additive pain relief, lower total doses of analgesics, and fewer side effects.
  • Multimodal analgesia includes various classes of drugs that are:
    • Opioids
    • Non-steroidal anti-inflammatory drugs
    • Cyclooxygenase-2-selective inhibitors
    • N-methyl-D-aspartate antagonists
    • Alpha-2 adrenergic agonists
    • Gabapentin-type drugs
    • Glucocorticoids
    • Cholinergic drugs
    • Local anesthetics


    Thank You from Kimavi arrow_upward


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