Postoperative

Care
 Outline
- Definition
- Purposes
- Phases
- Prevention of complications
Definition
- Is the care the patient receives after anesthesia
and surgery. Often depends on pain management
and wound care
- Starts at the time the pt. leaves the operating room, ends
with the 1st F/U visit by the surgeon
A good surgeon is a good physician first ???
Purposes
- √ successful + faster recovery
- ↓ p.o. ( Complications ) morbidity + mortality
- provide quality care service
- ↓ length of stay + hospital cost
- Return the patient to the state of health
Phases
• Phase I = Immediate ( post-anesth , 1st 6 hours )

• Phase II = Intermediate ( hospital stay, 6 - 72 hours )

• Phase III = Late ( convalescent , 72 hrs to 1st visit

to OPC )
 Phase I
- PACU ( Post Anesthesia Care Unit – Recovery Room )
- Responsibility of anesthesia because pt. still under anesth.
done by highly skilled nurses, anesthetists, surgeons
- Assessment of
• airway • vital signs • O2 saturation

• L.O.C • skin color • intake + output

 Phase I. Care
- Treatment of pain. PONV
- Prevention & detection of complication
• acute pulmonary problems
• cardio-vascular problems
• L.O.C
• I.V. fluid stability
- Hemostasis ( general + surgical site )
Recovery Room
- One nurse ≈ one patient 1st 15 minutes then one for every
2 patients 1.5 PACU beds for each operating room
( theatre )
- Special in : location, isolation, design, equipment's, staff,
quietness
Airway obstruction
- ↓ Adequacy of airway = sagging tongue, mucous block,
anesth. drugs, 02 supply, foreign body
- Hypoxemia = A. pul. Odema, bronchospasm,
pneumothorax, aspiration, PE
- Surgery comp.= nerve injury , hematoma
- ttt principally by “ jaw thrust maneuver “ or continuous
positive airway pressure “ CPAP “
P. O. Pain
1- Cognitive ttt : psychological support by relaxation,
explanation, distraction
2- Systemic drugs :
• Opioids = morphine, hydromorphone, fentanyl
• NSAID = x be given to asthmatic, P U disease, renal dys
• Paracetamol
• Anxiolytic agents
3- patient controlled analgesia ( PCA )
PONV Post Operative Nausea + Vomiting
- Relieve pain & anxiety
- Maintain BP
- Maintain hydration
Drugs :
• Metoclopramide
• HT3 antagonist ( ondansetron )
• Steroids ( dexamethasone )
• Antihistamine ( cyclizine )
• Phenothiazine ( prochlorperazine )
C.V.S comp
- Hypotension ( hypovolemia, spinal anesthesia, sepsis
T. pneumothorax
- Hypertension ( pain, anxiety, agitation, preexisting ↑BP )
- M.I
- Arrythmia
- Stroke
C.N.S comp.
- Mental changes : somnolence, coma, confusion,
disorientation, agitation, and convulsions
- Elderly
- This could be due : hypoxia, ↓ B.S., uremia, ammonia,
or anesthetic agents
- Consider p.o. stroke in patients with carotid bruits
Respiratory Comp. 2/3 of major anesthesia comp may be resp
- Airway obstruction
- Laryngeal spasm ( due to secretions )
- Atelectasis
- Aspiration
- Pulmonary oedema
- Pulmonary embolism
- Hypoxemia
- Hypoventilation
Phase II Care ( step down or progressive care unit)
- Discharge criteria from recovery room :
• Conscious
• PO2 > 92%, sable vitals, N temp
• Pain free
• Good surgical site
- Aldrete score > 6
- Post Anesthesia Discharge Scoring system PADS
- Usually takes 1 – 3 hours , if not  I.C.U
Aldrete Score
Post anesthesia discharge scoring system ( PADS )
 Phase II
( Starts from complete recovery from anesthesia and lasts
for the rest of hospital stay 6 – 72 hours )
(1)- Fever 40 % of patients develop pyrexia after major s.
• Day 0 – 2 = < 38 ͦC  tissue damage, hematoma
> 38 ͦC  atelectasis, blood transfusion #
• Day 3 – 5 = B.pneumonia, sepsis, w. infection, phlebitis
abscess formation, D.V.T
• > day 5 = specific comp. related to surgery ( fistula formation )
• > day 7 = hemorrhage, wound inf, U.T.I, D.V.T , P.E
(2)- Deep Vein Thrombosis ( DVT )
- occurs in calf area, mostly show no physical signs
- Dx = colored Doppler U/S, or venography
- prophylaxis = stocking, calf pumps, LMW heparin
- ttt = I V heparin, long tern warfarin
(3)- Bleeding ( hemorrhage )
- primary = at the time of surgery
- Reactionary = within 24 – 48 hours of surgery
- Secondary = several days to weeks after surgery
 s

(4)- Wound
- infection = starts to occur from day 5-7
- Dehiscence =
starts on the 5 – 8 postoperative day
weakest time for healing > straining, or coughing
Occur in 3 % of abdominal wounds
(5)- Comp. related to specific surgical specialty
Abdominal : paralytic ileus, bleeding, abscess, # leak
Neck : hematoma in wound
Thoracic : susceptible to fluid overload
Urology : catheter blockage
Orthopedic : neurovascular status should be checked
every 1/2 – 4 hours
● compartment syndrome -pain unresponsive to analgesia
- pain on passive stretching of muscles
- paresthesia, paralysis, pulselessness PPP???
are very late signs for Dx.
Thank you