Preoperative and postoperative care

Published on 10/04/2015 by admin

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Last modified 10/04/2015

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CHAPTER 5 Preoperative and postoperative care

Preoperative preparation

Postoperative care

Conditions affecting surgical risk

Medical problems in surgical patients


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


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
Suture sinus

Cardiovascular Cardiac arrest
Pulmonary oedema
DVT Lung Atelectasis
Pulmonary oedema
ARDS Cerebral
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