POST OPERATIVE CARE

OF PATIENTS

A PRESENTATION BY

DR. FARRUKH R. MALIK

HOUSE OFFICER
SURGICAL UNIT-II

CHANDKA MEDICAL COLLEGE HOSPITAL,

LARKANA, PAKISTAN.

©Farrukh R. Malik MBBS

2006
 INTRODUCTION
Post operative care of the patients is most important part of
the management:

 It gives a complete outline of actions to be taken

immediately after surgery to discharge of patient and follow
up.

 Plan laid and followed properly will optimize recovery and

enable early detection of impending complications.

Reference:
Russell, RCG et al (2004) ,Bailey and Love’s short practice of surgery, 24th
edition, Arnold, London.
Lavelle-Jones, Michael (2002), Master Medicine’s Surgery-I, 2nd edition,
Churchill Livingstone, Edinburgh.
 POST OPERATIVE CARE OF PATIENT

ROUNTINE POSTOPERATIVE CARE SPECIFIC CONSIDERATIONS

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery, 4th
edition, Lippincott Williams & Wilkins,USA.
 ROUNTINE POST OPERATIVE
CARE
 INTRAVENOUS FLUIDS
 MONITERING
 DEEP VENOUS THRMBOSIS PROPHYLAXIS
 WOUND CARE
 MEDICATION
 INVESTIGATIONS

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery, 4th edition,
Lippincott Williams & Wilkins,USA.
Lavelle-Jones, Michael (2002), Master Medicine’s Surgery-I, 2nd edition, Churchill
Livingstone, Edinburgh.
 INTRAVENOUS FLUIDS
 Insensible fluid loss and redistribution is
responsible for intravascular volume
depletion.

 Surgical patients, as a general rule, are

given intravenous infusion until and unless
they are not able to take per oral

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery,
4th edition, Lippincott Williams & Wilkins,USA.
 INTRAVENOUS FLUIDS
(conti…)

Courtesy: Bed no. 16, Male surgical unit-II, Chandka Medical college hospital, Larkana,
Pakistan
 INTRAVENOUS FLUIDS
(conti…)

Courtesy: Bed no. 16, Male surgical unit-II, Chandka Medical college hospital, Larkana,
Pakistan
 MONITERING

Courtesy: surgical unit-II, Chandka Medical college hospital, Larkana,

Pakistan
•Temperature, Pulse, Blood Pressure and Respiratory
Rate should be monitored.
 DEEP VENOUS THRMBOSIS
PROPHYLAXIS
 In patients going through major procedures there
are chances of venous stasis and relative
hypercoagulability.

 These patients are classified as low risk, low or

moderate risk, high risk and highest risk patients
on the basis of age and nature of procedure.

 Patients belonging to different risk groups are

provided with prophylaxis with different
modalities (i.e. Mechanical prophylaxis,
unfractionated heparin, Low molecular weight
heparin, Warfarin).
(Conti…..)
 DEEP VENOUS THRMBOSIS PROPHYLAXIS
(conti…)

 Low risk=Age less than 40 years+no risk factor

 Low or Moderate risk=Major surgery & age less

than 40 years or minor surgery with risk factor or
age between 40 & 60 years.

 High risk=Major surgery+age over 40 years or

with risk factor or minor procedure with age over
60 years with risk factor.

 Highest risk=Age over 60 years with multiple risk

factors or with major procedure
(Conti…..)
 DEEP VENOUS THRMBOSIS PROPHYLAXIS
(conti…)

Patient Surgery Prophylaxi

Group Type s
Low risk Minor None
Low or moderate risk Major GCS, SQH-12 or
IPC
High Major SQH-8 or LMWH

Highest Major SQH-8/12 or

LMWH+IPC

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery,
4th edition, Lippincott Williams & Wilkins,USA.
 WOUND CARE
 After surgery the wound care is one
of the important considerations.

 In order to keep the wound clean,

dressing is being done in our wards
with topical applications.
Reference:
Russell, RCG et al (2004) ,Bailey and Love’s short practice of surgery,
24th edition, Arnold, London.
(conti…
)
 WOUND CARE (Conti…)

Courtesy: surgical unit-II, Chandka Medical college hospital, Larkana,

Pakistan
(Conti…
 WOUND CARE (Conti…)

Courtesy: surgical unit-II, Chandka Medical college hospital, Larkana,

Pakistan

•Bed Sores maybe avoided in bed ridden

patients by changing the position of patient
time to time.
 MEDICATION

Courtesy: surgical unit-II, Chandka Medical college hospital, Larkana,

Pakistan
 MEDICATION (CONTI…)
 Antiemetics
 Ulcer Prophylaxis
 Pain control
 Antibiotics

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of
surgery, 4th edition, Lippincott Williams & Wilkins,USA.
 MEDICATION (CONTI…)
 Antiemetics are given as postoperative nausea is common after
general anesthesia.

 Patients with or without peptic ulcer disease on prolonged

ventilator support are prescribed with acid-reducing agents or
cytoprotective agents like sucralfate.

 Pain control is necessary for early mobility and healing as well as

prevention of cardiac complications.

 Antibiotics are needed to prevent nosocomial infections.

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery,
4th edition, Lippincott Williams & Wilkins,USA.
 MEDICATION (CONTI…)

Courtesy: surgical unit-II, Chandka Medical college hospital, Larkana,

Pakistan
 INVESTIGATIONS

COURTESY: Pathology laboratory, Chandka Medical College Larkana,

Pakistan
 INVESTIGATIONS (conti…)

• As a routine practice it is required that blood cp, serum electrolytes,

blood urea, creatinine and coagulation studies should be done.

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery, 4th
edition, Lippincott Williams & Wilkins,USA.
 INVESTIGATIONS (conti…)
 X-ray is required, particularly of chest, in
procedures in which the thoracic cavity is
entered or when central venous access is
attempted.

 In certain cases like that of inflamed

appendix or peritoneal collection,
ultrasound is required to ensure the
presence of pathological state.
Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery, 4th
edition, Lippincott Williams & Wilkins,USA.
 INVESTIGATIONS (conti…)

Courtesy: Department of Radiology, Chandka Medical College hospital, Larkana,

Pakistan
 POST OPERATIVE CARE OF PATIENT

ROUNTINE POSTOPERATIVE CARE SPECIFIC CONSIDERATIONS

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery, 4th
edition, Lippincott Williams & Wilkins,USA.
 SPECIFIC
CONSIDERATION
 SEIZURE DISORDERS
 CARDIOVASCULAR DISEASES
 RENAL DISEASES
 DIABETES

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery,
4th edition, Lippincott Williams & Wilkins,USA.
Lavelle-Jones, Michael (2002), Master Medicine’s Surgery-I, 2nd
edition, Churchill Livingstone, Edinburgh.
 SEIZURE DISORDERS
 Management of patients with known seizure disorders be
directed by keeping in view the type of seizure (i.e. general
versus partial, simple partial versus complex partial),
frequency and degree of control of disorder.

 Well controlled disorders pose little risk.

 Standard precaution may be taken including medication.

 Phenytoin and Phenobarbital are available in parenteral

form.

 Carbamazepine,ethosuximide and valproic acid are not

available in parenteral form.

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery,
4th edition, Lippincott Williams & Wilkins,USA.
 CARDIOVASCULAR
DISEASES
 In case of coronary artery disease
the control of precipitants is
required.

 Stresses that exacerbate the

ischemia are required to be avoided.
Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery, 4th
edition, Lippincott Williams & Wilkins,USA.

(Conti…
)
 CARDIOVASCULAR DISEASES
(Conti…)

 Acute hypertension must be

controlled as it increases the oxygen
requirement and exacerbates
ischemia.

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery, 4th
edition, Lippincott Williams & Wilkins,USA.
Lavelle-Jones, Michael (2002), Master Medicine’s Surgery-I, 2nd edition,
Churchill Livingstone, Edinburgh.
(Conti…
)
 CARDIOVASCULAR DISEASES
(Conti…)

•Pain is required to be controlled with

analgesics as it can cause tachycardia and
hypertension.
Reference:
Lavelle-Jones, Michael (2002), Master Medicine’s Surgery-I, 2nd
edition, Churchill Livingstone, Edinburgh.
(Conti…
 CARDIOVASCULAR DISEASES
(Conti…)

Courtesy: surgical unit-II, Chandka Medical college hospital, Larkana,

Pakistan
•Oxygen is required to be given
continuously in postoperative patients to
increase the oxygen content of the blood.
(Conti…
)
 CARDIOVASCULAR DISEASES (Conti…)

Courtesy: surgical unit-II, Chandka Medical college hospital, Larkana,

Pakistan

•Anemia should be avoided as it decreases the

oxygen carrying capacity of the patients.
Transfusion should be considered when
hemoglobin falls below 9.0 (Conti…
)
 CARDIOVASCULAR DISEASES
(Conti…)

 Role of medication in postoperative

care of patients having cardiovascular
disease is very important.

 Patient receiving beta-adrenergic

antagonists, nitrate therapy and/or
calcium channel blocker should be
continued same.
Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery,
4th edition, Lippincott Williams & Wilkins,USA.
 RENAL DISEASES
 Fluid replacement in postoperative patients having chronic
renal disease should be done as in normal individual.

 Care must be taken to avoid excessive fluid replacement.

 Maintenance fluids should not contain potassium.

 Serum electrolytes should be measured time to time.

 Early dialysis may be necessary in case of hyperkalemia or

intravascular volume overload.

Reference:
Russell, RCG et al (2004) ,Bailey and Love’s short practice of surgery,
24th edition, Arnold, London.
Lavelle-Jones, Michael (2002), Master Medicine’s Surgery-I, 2nd
edition, Churchill Livingstone, Edinburgh.
(Conti…
 RENAL DISEASES (conti…)

Courtesy: surgical unit-II, Chandka Medical college hospital, Larkana,

Pakistan

•Patient should be catheterized to monitor

the urine output.

(Conti…
 RENAL DISEASES (conti…)

 In patients having renal insufficiency

and decreased creatinine clearance
the dosages of the drugs should be
adjusted.

 Some medications such as

meperidine are contraindicated.
Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery,
4th edition, Lippincott Williams & Wilkins,USA.
 DIABETES

Courtesy: surgical unit-II, Chandka Medical college hospital, Larkana,

Pakistan

•Postoperative management of diabetic surgical

patient centers on maintenance of euglycemia and
management of chronic complications.
•The blood glucose levels should be measured time
to time.
(Conti…
 DIABETES (conti…)
 Diet controlled diabetic patients infrequently need glucose or
insulin therapy after minor surgeries.

 Diabetic patients who are receiving oral hypoglycemic agents

frequently need insulin postoperatively.

 Patients who are taking insulin preoperatively usually require

insulin postoperatively to achieve adequate control of serum
glucose levels.

 Intermittent dosing of subcutaneous insulin can be given as

intermediate acting insulin twice a day, with hyperglycemia
managed by supplemental dosing of regular insulin.

 Continuous intravenous insulin infusion in a monitored setting is

indicated in patients with hyperglycemia that is not controlled by
intermittent subcutaneous dosing.

Reference:
Klingensmith Mary E. et al (2005),The Washington Manual of surgery,
4th edition, Lippincott Williams & Wilkins,USA.
THANKS