Post operative care following a major surgery could well be recognised as important as the surgery itself due to the fact that many complications could arise in the said period. Avoiding these complications and maintaining optimal body function is one aspect of a successful surgery and this article would outline the important aspects as well as there significance in achieving optimal post operative care.
The post-op management of a patient who had undergone major surgery would focus on three time frames. These would be immediate, intermediate and late. The observation will be more frequent as well as detailed in the immediate post operative period and it will focus on identifying immediate complications as well as recovery from anaesthesia while rest of the post op management would be focused more towards the healing process as well as gaining the proper functionality at the surgical site.
Post op care soon after the surgery:
Following a major surgery, the surgical team would decide on where should the patient be observed based on the surgical procedure, the findings as well as the state of the patient. Thus, the patient might be observed in the ICU, Ward or in a high dependency unit.
What ever the place that the observation is to be done, following parameters will be assessed regularly.
Blood pressure Pulse rate Respiratory rate Oxygen saturation Urine output Drain volume Soaking of the dressing or local bleeding Consciousness of the patient
By observing these variables, the clinical staff would be able to make judgements on patients recovery or the initiation of complications. For example, if there is a bleeding which could not be detected from outside, the pulse rate will rise with a drop in the blood pressure. Similarly the oxygen saturation can go down and the respiratory rate can go up in the same instance as well as in instances of respiratory failure or impairment.
The urine output along with the intake would be able to describe the kidney function following surgery and by adjusting the intravenous fluids, the output can be maintained at satisfactory levels.
Local signs are also important and sometimes indicate to the clinical staff of continuous bleeding in the surgical site and a decision could be taken with regard to re-exploration before it becomes complicated.
Apart from the signs of complications, the post op management would also focus on maintaining adequate fluid intake, pain relief as well as good ventilation.
In most instances, start of oral fluids will be delayed till 6 – 12 hours and sometimes even more depending on the surgical procedure. But, till such time, the fluid intake will be mainly by intravenous fluids both by normal saline as well as glucose solutions.
Another important aspect in the post op period is the pain relief. Many methods can be used and the decision would depend on how sensitive the surgery would be as well as how sensitive the patient would be. Thus, subcutaneous morphine, intramuscular pethedine, suppositories as well as epidural analgesics would be used in the initial phase of post op management.
Proper ventilation would not be a problem in most instances as the patients will be able to compensate through their own breathing. But, at times, they may be needed to be given oxygen via face mask or through a nasal prong for a short period of time.
After the first 24 hours:
Following the first 24 hours, often the patients would be out of acute dangers but still are vulnerable in developing complications. These could be secondary haemorrhage, infections, organ failure or even failed surgery. Thus, the monitoring would further continue but probably not as frequent as in the immediate post op period.
This time period will continue measuring the vital signs as well as urine output, drain amount if present, wound appearance, temperature, intake, other associated symptoms…etc.
The post op management will continue to instil adequate pain relief and will promote the patient to be mobilized as early as possible depending on the surgery. The time period will also make the patient take enough liquids orally and gradually will introduce to solids as well. Although in most instances, the introduction to solids would happen within the first 24 hours if patient does not show signs of complications and if the bowel sounds are adequately present.
The medications would be continued during this time and sometimes the clinicians will decide on doing investigations to assess the success of the surgery or to be sure about organ functioning. Thus, a haemoglobin levels, white cell count, renal profile and liver profile would be done in this regard.
At the time of discharge:
At this time, most often the patients would be,
Pain free or having minimal pain Can take orally Adequate voluntary urine output Mobile No fever Devoid of any unusual symptoms Adequate wound healing
The patient would be provided with instruction on what to do and what not to do along with a prescription of medications that should be taken. A follow up date would also be decided and will be asked to contact the hospital if they have any query or unusual development within that duration.