Postoperative care and complications

Published on 14/06/2015 by admin

Filed under Surgery

Last modified 14/06/2015

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 5016 times

9 Postoperative care and complications

Immediate postoperative care

Patients who have received a general anaesthetic should be observed in the recovery room until they are conscious and their vital signs are stable. Acute pulmonary, cardiovascular and fluid derangements are the major causes of life-threatening complications in the early postoperative period, and the recovery room provides specially trained personnel and equipment for the observation and treatment of these problems.

In general, the anaesthetist exercises primary responsibility for the patient’s cardiopulmonary function and the surgeon is responsible for the operative site, the wound and any surgically placed drains. Clinical notes should accompany the patient. These include an operation note describing the procedure performed, an anaesthetic record of the patient’s progress during surgery, a postoperative instruction sheet with regard to the administration of drugs and intravenous fluids, and a fluid balance sheet.

Monitoring of airway, breathing and circulation is the main priority in the immediate postoperative period (EBM 9.1). The nature of the surgery and the patient’s premorbid medical condition will determine the intensity of postoperative monitoring required; however, the patient’s colour, pulse, blood pressure, respiratory rate, oxygen saturation and level of consciousness will be routinely observed. The nature and volume of drainage into collecting bags or wound dressings, and urinary output are also monitored, if appropriate. Continuous electrocardiogram (ECG) monitoring is undertaken and oxygenation is assessed by the use of a pulse oximeter. Monitoring of central venous pressure (CVP) may be indicated if the patient is hypotensive, has borderline cardiac or respiratory function, or requires large amounts of intravenous fluids.

The patient may initially remain intubated, but following extubation should receive supplemental oxygen by face mask or nasal prongs and should be encouraged to take frequent deep breaths. The patient must breathe adequately and maintain a good colour. Shallow breathing may mean that the patient is still partially paralyzed. A dose of neostigmine can reverse the residual effects of curariform agents. Cyanosis is an ominous sign indicating hypoxaemia due to inadequate oxygenation, and may be due to airway obstruction or impaired ventilation. Respiratory depression later on in the postoperative period is usually caused by over-sedation with opioid analgesic agents.

Airway obstruction

The main causes of airway obstruction are as follows:

Attention is directed at defining and rectifying the cause of airway obstruction as a matter of extreme urgency. Airway maintenance techniques include the chin-lift or jaw-thrust manoeuvres, which lift the mandible anteriorly and displace the tongue forward (see Chapter 8). The pharynx is then sucked out, an oropharyngeal airway is inserted to maintain the airway, and supplemental oxygen is administered. If cyanosis does not improve or if stridor persists, reintubation may be necessary.

Surgical ward care

Complications of anaesthesia and surgery

General complications

Buy Membership for Surgery Category to continue reading. Learn more here