Post-operative care

Question 1

What is patient controlled analgesia?

Answer 1

An intravenous infusion of a strong opiate such as morphine, oxycodone or fentanyl. The patient will press a button as the pain starts to develop to administer a bolus of short acting medication.

Requires careful monitoring and requires input from an anaesthetist.

Question 2

Risk factors for post operative nausea and vomiting?

Answer 2

Female 
History of motion sickness 
Previous post op n+v
non smoker 
use of post operative opiate medications
younger age
use of volatile anaesthetics

Question 3

What are some examples of prophylactic antiemetics and when should these options be avoided?

Answer 3

Ondansetron - Serotonin receptor antagonist (must be avoided in patients who are at risk of a prolonged QT)

Dexamethasone - used with caution in diabetic or immunocompromised patients.

Question 4

Examples of rescue antiemetics?

Answer 4

Ondansetron

Prochlorperazine

Cyclizine

Question 5

When can drains be removed?

Answer 5

When the drains are no longer draining anything at all or very little

Question 6

When are catheters removed post operatively?

Answer 6

When the patient can mobilise to go to the toilet.

Question 7

What is enteral feeding?

Answer 7

Feeding via the gastrointestinal tract

This could be by mouth, NG tube, or percutaneous endoscopic gastrostomy (PEG)

Question 8

What is total parenteral nutrition?

Answer 8

This is where nutritional requirements of the patients are met by using an intravenous infusion. This is only used when it is not possible to use the GI tract for nutrition - e.g. If the patient has an ongoing bowel obstruction.

Question 9

What are some of the complications are monitored for in the post operative period?

Answer 9

Bloods - Anaemia, AKI, DVT 
Pulmonary - Atelectasis, PE 
Cardiac - heart failure, arrhythmia, ACS, CVA
Infections/Sepsis (chest, urinary tract or wound site infections)
Abdominal - Wound dehiscence, ileus
Haemorrhage/Shock
Arrythmias
Urological - Urinary retention 
Delerium

Question 10

What is the management for post operative anaemia?

Answer 10

Hb <100g/L - oral iron

Hb <70-80g/L - blood transfusion considered

Symptoms of anaemia or heart failure with new onset anaemia may require a transfusion at higher haemoglobin levels (<90 or 100)