Perioperative Care
Dr. Thuc The BachHuntington Memorial HospitalPasadena, California
Perioperative Care Consists of:
Preoperative CarePreoperative PlanningPreoperative EvaluationsPostoperative ManagementPostoperative ProblemsPostoperative Complications
Preoperative Care
Diagnostic Work UpPreoperative EvaluationsPreoperative Preparations
Diagnostic Workup
Determine the cause and extent of the illness
Preoperative Evaluations
Overall assessment of patient’s healthIdentify significant abnormalities that may increase operative riskShould begin with a complete history and physical evaluationRoutine laboratories pertinent to surgeryEvaluation by the anesthesiologist
Specific Factors Affecting the Surgery
History of angina or infarctionHistory of anemia, lung disease, kidney disease, bleeding problemsNutritional status
Factors Affecting Wound Healing
SteroidsMalnutrition RadiationDiabetes
Factors Leading to PostopInfection
DiabetesRenal failureSteroid medicationsImmunosuppressive agentsSmokingPreoperative infection
Special Problems
DiabetesThyroid DiseaseHeart DiseaseRespiratory DiseaseKidney DiseaseHematologic Disease
AnemiaThrombocytopeniaAbnormal bleedingMedications (coumadin etc)
Dangerous Preoperative Herbal Medications
Ask about all Herbal medications !Herbs that may interfere with bleeding time
GingkoFeverfewGingerVitamin E
Dangerous Preoperative Herbal Medications
Herbs that may trigger high blood pressureGinseng
Herbs that may lower blood pressureGarlic
Herbs that can intensify or prolong anesthesia
St. John’s wortKava kava
Preoperative Preparations
Informing the patient about the risks and benefits of the surgeryProviding necessary pain control and discussing pain control options
Preoperative Preparations
Patient should quit smoking at least 2 weeks before surgeryPatient should quit herbal supplements mentioned at least 2 weeks before surgeryBowel preparation in advance might be helpful
Orders
Nothing by mouth at least 8 hours before surgeryLabs and xraysPrepare blood (if necessary)Sedation and pre-op anesthetic medsHydration and IV accessEnema, foley catheterProphylactic antibioticsInvasive cathetersConsent for surgery
Immediate Postoperative Period: First 1-2 hours
Anesthesiologist in charge of cardiopulmonary functionsSurgeon responsible for all the rest
Surgeon’s Responsibilities
Monitor vital signsCVP, Swan-Ganz reading, ICP, distal pulseFluid balance, electrolytesRespiratory carePosition in bedMobilizationDrainage tubesMedicationsDiet
Postoperative Pain Control
Parenteral opioidMorphine 10 mg q 3-4° given IV or IMMeperidine 75 – 100 mg q 3°Hydromorphone 1-2 mg IM q 2-3°
Non-opioid analgesicToradol 30 mg (no respiratory side-effects)
Epidural anesthesia
Postoperative Pain Control
Oral analgesicsTylenol #3 (with codeine)Darvocet N-50 (propoxyphene)Vicodin (hydrocodone)
Patient-controlled analgesiaIntercostal nerve block
Postoperative Complications
Wound complicationsHematomaSeromaWound dehiscenceInfection
Postoperative Complications
Pulmonary ComplicationsAtelectasisAspirationsPneumoniaPost-operative pleural effusionPneumothorax
Postoperative Complications
Fat embolismCardiac complications
ArrhythmiaFrequently due to hypoxemia, hypokalemia, alkalosis
Postoperative myocardial infarctionCardiac failure
Urinary complicationsRetentionAcute tubular necrosisUrinary tract infection
Postoperative Complications
Peritoneal complicationsHemoperitoneumPeritonitis
Cerebral complicationsCerebrovascular accidentConvulsions
Psychiatric complicationsICU syndromeDeleriumSexual dysfunctionDelerium tremens (alcohol withdrawal)
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