Post-operative Care

Question 1

What is enhanced recovery

Answer 1

• Aims to get patients back to pre-op condition early as possible by encouraging independence, early mobility and appropriate diet
• Calories very important, body needs lots post surgery

Question 2

Principles of enhanced recovery

Answer 2

• Good preparation for surgery (e.g., healthy diet and exercise)
• Minimally invasive surgery (keyhole or local anaesthetic where possible)
• Adequate analgesia
• Good nutritional support around surgery
• Early return to oral diet and fluid intake
• Early mobilisation
• Avoiding drains and NG tubes where possible, early catheter removal
• Early discharge

Question 3

Why is post-op analgesia important

Answer 3

• To encourage patient to
  
  • Mobilise
  • Ventilate their lungs fully
  • Have adequate oral intake

Question 4

Key conditions where NSAIDs contraindicated

Answer 4

• Asthma
• Renal impairment
• Heart disease
• Stomach ulcers

Question 5

What is patient controlled analgesia (PCA)

Answer 5

• IV infusion of strong opiate (eg morphine, oxycodone or fentanyl) attached to patient controlled pump
• Button stops responsing after administration for set time to prevent over-use

Question 6

Risk factors for post-op nausea and vomiting

Answer 6

• Female
• History of motion sickness or previous PONV
• Non-smoker
• Use of postoperative opiates
• Younger age
• Use of volatile anaesthetics

Question 7

Management of post-op nausea and vomiting

Answer 7

• Prophylactic antimetics given end of procedure to prevent
• Rescue antimetics can be used if nausea or vomiting occur

Question 8

Examples of prophylactic antimetics

Answer 8

• Ondansetron
• Dexamethasone
• Cyclizine

Question 9

Examples of rescue amnetics

Answer 9

• Ondanestron
• Prochlorperazine
• Cyclizine

Question 10

When are drains, NG tubes and catherters removed

Answer 10

• Drains - draining minimal or no blood/fluid
• NG tube - no longer required for intake or drainage of gas or fluid
• Catheters - when patient can mobilise to toilet

Question 11

What is removal of catheter called

Answer 11

Trial without catheter (TWOC) - risk of patient going into urinary retention so trial done

Question 12

Different nutrition options

Answer 12

• Enteral (by GI tract)
  
  • Mouth
  • NG tube
  • Percutaneous endoscopic gastrotomy (PEG)
• Total parenteral nutrition (TPN) - IV infusion, normally given through central line

Question 13

Post-op complications

Answer 13

• Anaemia
• Atelectasis
• Wound dehiscence
• Ileus
• Haemorrhage with bleeding into a drain, inside the body creating a haematoma or from the wound
• Deep vein thrombosis and pulmonary embolism
• Shock due to hypovolaemia (blood loss), sepsis or heart failure
• Arrhythmias (e.g., atrial fibrillation)
• Acute coronary syndrome (myocardial infarction) and cerebrovascular accident (stroke)
• Acute kidney injury
• Urinary retention requiring catheterisation
• Delirium

Question 14

Treatment of anaemia post-op

Answer 14

• Hb < 100g/L
  
  • Start oral iron (eg ferrous sulphate 200mg 3x daily for 3 months)
• Hb <70/80g/L
  
  • Blood transfusion in addition to iron