post operative care.pptx

Postoperative Care

• Aim of postoperative care: to ensure a quick, painless, and safe recovery from surgery.

• Importance of knowledge and skills to manage both medical and surgical postoperative problems.

Standards for Postoperative Care

• Organizations Involved:

  • American Society of Anaesthesiologists (ASA)

  • Association of Anaesthetists of Great Britain and Ireland (AAGBI)

• Care Provision Requirements:

  • Immediate postoperative care must occur in a dedicated Post Anaesthetic Care Unit (PACU).

  • Staff should be trained in managing patients in the immediate postoperative period.

• Equipment and Procedures:

  • Standards for monitoring equipment (resuscitation, difficult airway management).

  • Protocols for drug administration and vital signs monitoring.

  • Discharge criteria must be met before a patient's transfer out of the PACU.

Immediate Postoperative Care

• Process begins with a 'sign out' as per the WHO checklist.

• Information Handover:

  • Patient's name, age, surgical procedure.

  • Existing medical problems and allergies.

  • Details on anaesthesia and analgesics used.

  • Fluid replacement, blood loss, urine output, and any surgical and anaesthetic issues encountered.

  • Management plans for pain and nausea/vomiting.

Postoperative Observations

• Vital signs monitored: pulse, blood pressure, pulse oximetry, level of consciousness, pain, hydration status.

• Supportive treatment is provided based on observed parameters.

• Utilization of recording systems for early warning of clinical deterioration.

NEWS Key Metrics

• Introduction of reporting format for patient observations based on a scoring system, assessing:

  • Respiratory rate, oxygen saturation (SpO2), temperature, blood pressure, heart rate, consciousness level, blood sugar, and pain score.

• Total score calculated for monitoring patient status and potential escalation plans.

Surgery-Specific Observations

• Require specific monitoring methods, like Doppler flow for free flaps and regular neurological evaluations.

• Laboratory tests, such as blood gas analysis, conducted as needed.

Discharge Criteria from PACU

• Patient must be:

  • Fully conscious.

  • With satisfactory respiration and oxygenation.

  • Normothermic and free from pain or nausea.

  • With stable cardiovascular parameters.

  • Medications for oxygen, fluids, and analgesics prescribed.

  • No surgical concerns noted.

General Postoperative Period Guidelines

• All anaesthetised patients should recover in a dedicated PACU.

• Vital parameters monitored and documented per local protocols.

• Pain and nausea/vomiting treated as needed.

• Watch for complications systematically.

Postoperative Complications

• Importance:

  • Complications lead to morbidity, mortality, longer hospital stays, and increased costs.

• Utilization of preoperative assessments can identify patients at risk of postoperative complications.

• Effective pre-surgical evaluations assist in providing anticipatory medical care.

Classification of Postoperative Complications

1. By Time After Surgery:

   • Immediate (within 6 hours)

   • Early (6–72 hours)

   • Late (beyond 72 hours)

2. By Type:

   • Generic or surgery-specific.

3. Clavien-Dindo Classification:

   • Focuses on surgical complications to measure impact on outcomes.

Respiratory System Complications

• Detection:

  • Early identification of respiratory issues through airway assessment and vital sign checks during recovery phases.

Immediate Respiratory Complications

• Airway:

  • Common issues include obstruction (laryngospasm, muscle relaxation, oedema).

  • Require vigilance and often simple interventions.

• Respiration:

  • Effects of anaesthetic agents can lead to inadequate ventilation post-surgery.

  • Monitor with continuous pulse oximetry.

  • Supplemental oxygen is mandatory until normal levels are restored.

• Hypoxaemia:

  • Conditions like pulmonary oedema, bronchospasm, or pneumothorax can lead to hypoxia.

  • Quick treatment is critical, especially in high-risk patients (e.g., with sleep apnoea or lung disease).

Early and Late Respiratory Complications

• Significance:

  • Notable cause of morbidity and mortality; statistics range from 5% to 70%.

• Common Complications:

  • Fever, cough, dyspnoea, atelectasis, pneumonia, pleural effusion, and respiratory failure.

• Identifying patients by surgical type and risk factors can guide preventative strategies.

Summary of Respiratory Complications

• Immediate or delayed complications can arise post-surgery.

• Risk factors include obesity, smoking, chronic lung disease, etc.

• Early measures can mitigate life-threatening events.

Cardiovascular System Complications

• Prevalence:

  • Leading cause of death within 30 days post non-cardiac surgery.

• Monitoring:

  • Routine checks on pulse, blood pressure, ECG during emergence and recovery.

Immediate Cardiovascular Complications

1. Hypotension:

   • Major predictor of adverse events such as myocardial infarction.

   • Causes include hypovolaemia, myocardial impairment, anesthesia effects.

   • Requires rapid treatment to prevent organ dysfunction.

2. Hypertension:

   • Associated with pain and anxiety and can lead to severe outcomes (e.g., bleeding, stroke).

3. Myocardial Ischaemia:

   • At-risk patients may experience complications; cardiac care involvement is crucial.

4. Arrhythmias:

   • Can lead to serious outcomes; management varies based on the underlying cause.

5. Stroke:

   • Can occur due to several factors, requires careful monitoring and discussion between surgical and neurology teams.

Summary of Cardiovascular Complications

• Both hypotension and hypertension can lead to significant issues.

• Prompt management is essential for arrhythmias and cardiac events.

• Close cooperation with cardiovascular specialists is necessary.

Renal and Urinary System Complications

1. Acute Kidney Injury:

   • High incidence in the perioperative period; certain patient groups are at increased risk.

   • Detection criteria include serum creatinine rises or reduced urine output.

2. Urinary Retention:

   • Often occurs post pelvic/perineal surgeries; addressed through catheterisation or imaging.

3. Urinary Infection:

   • Common in postoperative patients; treatment often involves antibiotics and hydration.

Summary of Renal and Urinary Complications

• High mortality is associated with postoperative renal failure.

• Proactive measures can prevent complications in high-risk patients.

Central Nervous System Complications

1. Postoperative Delirium:

   • Particularly common in elderly patients; significant sequelae include increased morbidity and length of stay.

   • Risk factors include cognitive impairment and recent surgeries.

   • Management focuses on identifying reversible causes and potentially using haloperidol.

Causes of Delirium

• Can stem from various medical issues and medications affecting cognition.

2. Stroke and Seizures:

   • Though uncommon, can arise and necessitate careful monitoring, particularly in high-risk groups.