Post Operative Critical Care Issues

Steven Podnos MD

Awakening from Anesthesia

• Many factors influence the time of awakening from anesthesia including patient factors, drug factors, anesthetic agents used and time of surgery.

• Consider reversible electrolyte problems for delayed emergence of consicousness

• Treat and Prevent Hypothermia which is common

Post Operative Extubation

• Early SBT may be appropriate in patients who are awake and have no underlying cardiac and/or pulmonary issues

• Early extubation reduces the risk of pneumonia

DVT Prevention

• Post Operative patients are at high risk for DVT• LMWH is usually the best option for DVT

prophylaxis, although mechanical compression devices are possibly effective

Nutrition

• The goal is enteral nutrition within 72 hours for most patients.

• Trauma patients may benefit from earlier nutrition

• TPN is rarely necessary• Gastric or Post Pyloric feeding seems

equivalent in most cases. Gastric residuals of 300 cc are tolerated if there is not severe abdominal distention or vomiting

Drains

• Each drain has a purpose. Changes in flow or character of secretions may be important

• Passive (Penrose) and Active (Hemovac, Woundvac(

Wound Care

• Primary Closure• Secondary Intention healing with wet to dry• Vacuum devices

Post Operative Hemmorhage

• Shock after trauma or surgery should always assumed first to be due to hemmorhage.

• Initial Hb/Hct may not be helpful• Get help