Pre and Postoperative Care Dept of Surgery Yong Loo Lin School of Medicine National University of Singapore
Preoperative Care “The most important decision a surgeon can make is to operate on a patient” The decision is a Risk-Benefit Analysis
Goals(Why) Recognize and Optimize the risk factors for surgery
How to do it History Examination Investigations
History Taking Past medical & surgical history Cardiac, respiratory, renal, nutrition Drug hx Social Hx Functional status
ASA Classification
Investigations Basics (for all age>50) FBC, urea/electrolyte CXR, ECG Specific (when indicated) LFT; PT/PTT ABG; Pulmonary function test others
Special Preparation Management of Diabetes DVT Prophylaxis Bowel preparation Prophylactic antibiotics selectively
Postoperative Care Recognize postop complications Pain management Postop fevers
Postop Complications General Examples: AMI, CVA, pneumonia/atelectasis, renal failure Specific Examples: anastomotic leakage, abscess formation, wound infection, ileus, bleeding
Postop Complications General Important examples: AMI pneumonia/atelectasis renal failure DVT/Pulmonary embolism CVA
Postop Complications Specific Examples: anastomotic leakage abscess formation wound infection ileus bleeding
Scenario
Pain Management Essential part of postop management Pain can increase risk of complications Pain relief- Multimodal E.g. PCA, IM pethidine, oral analgesics
Postop Fevers An important sign of postop complications Many possible DDX Time of onset may guide the management
Postop Fevers First 48hrs Atelectasis Transfusion rxn Pre-existing infection 3-7 days: infections UTI, wound infection, pneumonia, anastomotic leakage
Postop Fevers About 7 days onwards Infections Abscess formation DVT/PE
Postop Fevers History Examination Investigations (to confirm the diagnosis)
Summary Pre and Postop care are essential parts of surgical treatment Good History, physical examination and selected investigations are the key Complications do occur, but many are preventable!
Questions