Preoperative and postoperative care

Published on 10/04/2015 by admin

Filed under Surgery

Last modified 10/04/2015

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 1026 times

CHAPTER 5 Preoperative and postoperative care

Preoperative preparation

Postoperative care

Conditions affecting surgical risk

Medical problems in surgical patients

Cardiovascular

In elderly patients, the following are common: angina, cardiac failure, arrhythmias, valvular heart disease, hypertension, cerebrovascular disease, peripheral vascular disease. It is necessary to obtain a cardiology opinion, optimize medical treatment and assess operative risk. The decision to operate rests with the surgeon and anaesthetist.

Renal disease

This should be managed jointly with a nephrologist. Symptoms of renal failure do not usually become apparent until 80–90% of renal function has been lost and there is little renal reserve.

Hepatic disease

There is a high incidence of morbidity and mortality with cirrhosis. Predisposing factors are anaemia, electrolyte disturbances, abnormal clotting, malnutrition, abnormal drug metabolism, ascites, portal hypertension. Defective synthesis of clotting factors in the liver and thrombocytopenia due to hypersplenism may result in excessive bleeding. The Child–Pugh score can be used to assess the ‘hepatic reserve’, the higher the score the greater the operative risk (measures albumin, bilirubin, prothrombin time and the presence and severity of ascites and encephalopathy).

Care must be taken to assess a past history of jaundice. This may be due to hepatitis, obstructive jaundice or haemolytic disease.

Haematological disease

Bleeding disorders

Endocrine disease

Diabetes

This poses numerous risks and affects many systems. Complications include:

The principles of management of diabetes in the perioperative period depend on whether patients are insulin dependent, on oral hypoglycaemics or controlled by diet.

Postoperative complications

All operations carry a risk of complications (a Classification is shown in Table 5.1). Complications may be divided as:

TABLE 5.1 Postoperative complications

Haemorrhage Early postoperative
Secondary haemorrhage
Wound Infection
Bleeding
Haematoma
Seroma
Suture sinus
Breakdown:

Cardiovascular Cardiac arrest
MI
Pulmonary oedema
Arrhythmias
DVT Lung Atelectasis
Aspiration
Pneumonia
PE
Pulmonary oedema
Pneumothorax
ARDS Cerebral
Buy Membership for Surgery Category to continue reading. Learn more here