外科學(xué)教學(xué)課件：Perioperative Management

PerioperativeManagementPerioperativeManagementPerioperativePeriodDefinitiondependsonmultiplefactorsImportancedirectlyrelatedtotheoutcomeofsurgeryitselfCompositionpreoperativepreparation&postoperativemanagementPerioperativePeriodDefinition

1.Electivesurgery2.Restrictivesurgery3.EmergentsurgeryPreoperativePreparationTheprincipleDifferentpreparationfordifferentproceduresTheclassificationofoperationsaccordingtothecharacteristicsofoperationsElectivesurgeryRestrictivesurgeryEmergentsurgery1.ElectivesurgeryPreoperativElectiveSurgeryElectiveSurgeryRestrictiveSurgeryRestrictiveSurgeryEmergentSurgeryEmergentSurgeryDr.EvilSays….$$$$????Dr.EvilSays….$$$$TheodorKocher(1841-1917)WithTheodorBillrothestablishedlargeclinicsinEuropeand,throughdevelopmentofskilledsurgicaltechniquescombinedwithneweranestheticandantisepticprinciples,providedsurgicalresultsthatprovedthesafetyandefficacyofthyroidsurgeryforbenignandmalignantproblemsTheodorKocher(1841-1917)WitWilliamStewartHalsted(1852-1922)ASCENTOFSCIENTIFICSURGERYResearchbasedonanatomic,pathologic,andphysiologicprinciplesandemployinganimalexperimentationHalstedianprinciples

WilliamStewartHalsted(1852-ToconfirmthediagnosisToassesstheriskofoperationToassessthegeneralconditionandfunctionofimportantorgansToevaluatethepatientsendurancetotheoperationandriskofoperationPreoperativeAssessmentToconfirmthediagnosisPreoEssentialStepsHistorytakingPhysicalexaminationArranginganyfurtherdiagnosticinvestigationMakingspecialpreparationsfortheparticularoperationInvestigatinganyintercurrentoroccultillnesssuggestedbymedicalclerkingEssentialStepsHistorytakingEssentialStepsDiscussingtheoperationwiththepatientandhisfamilyandobtainingsignedconsentMarkingtheoperationsiteMakingarrangementsfortheoperationwiththeoperatingtheatrestaffArrangingandinformingtheanesthetistsPrescribingmedication:prophylacticantibioticsetc.PlanningrehabilitationandconvalescenceEssentialStepsDiscussingthePsychologicalpreparation

talkfranklyandappropriatelytopatientsandfamiliesPhysiologicalpreparationAdaptiveexerciseTransfusionPreventionofinfectionGastro-intestinaltractpreparationMaintenanceoffluid,electrolytesandnutritionGeneralPreparationPsychologicalpreparationAdaMalnutritionanddysfunctionofimmunesystem

MalnutritiondramaticallyincreasesthemorbidityandmortalityPreoperativenutritionalsupportismorevaluableSpecificPreparationMalnutritionanddysfunctionoHypertension

Mild-to-moderateessentialhypertension

systolicpressure＜180mmHg

diastolicpressure＜110mmHg

Atminimalriskofcardiaccomplication

AntihypertensivedrugsshouldbeusedalltimeSuddenwithdrawalofdrugsisdangerousHypertensionMild-to-moderaSevereorPoorlyControlledHypertensionAthighriskofperioperativecardiacfailureorstroke.Thistypeofpatientsshouldnotundergogeneralanaesthesiaandsurgeryuntiladequatelytreated.Thebloodpressureshouldbereasonablycontrolledunder160/100mmHg.SevereorPoorlyControlledHyCardiovascularDiseasesIschemicheartdiseaseCardiacfailureArrhythmiasValvularheartdiseaseCerebrovasculardiseaseCardiovascularDiseasesIscheAnginaandPreviousInfarctionPreviousinfarctionStableanginaposeslittleincreasedriskduringoperationbutunstableanginaisasdangerousasrecentmyocardialinfarctionTheriskofreinfarctionisabout30%ifanoperationisperformedduringthefirst3monthsAt6monthstheriskisabout10~15%whichmaybeacceptableforimportantelectivesurgeryAnginaAnginaandPreviousInfarctionAdequatePreparationforHeartDiseaseTocorrectthefluidandelectrolytesimbalance.Tocorrectanaemiathroughseveralbloodtransfusionwithsmallamount.Tocontrolthecardiacarrhythmias.(Atrialfibrillation,Tachycardia,Bradycardia)AdequatePreparationforHeartRespiratorydysfunctionRespiratorycomplicationsoccurinupto15%ofsurgicalpatientsandaretheleadingcauseofpostoperativemortalityintheelderly.RespiratorydysfunctionRespiraRiskFactorsforRespiratoryComplicationChronicobstructivepulmonaryorairwaysdiseaseChronicbronchitis,emphysema,bronchiectasis,pneumoconiosis,pulmonarytuberculosesCigarettesmokingCurrentrespiratoryinfectionsAsthmaRiskFactorsforRespiratoryCPreoperativeInvestigationAchestX-rayCTscanifnecessaryEKGSpirometerBloodgasmeasurementPreoperativeInvestigationAPerioperativemanagement`PreoperativephysiotherapyteachingthepatientbreathingexercisesandcorrectpostureDrugtherapyTheophyllinesProphylacticantibioticsPreoperativebronchodilatorAdequatehydrationPerioperativeManagementPerioperativemanagement`PreopEncouragetostopsmokingfromthetimeofbookforelectivesurgeryAlternationmethodsofanesthesia

Local,regionalorspiralanesthesiashouldbeconsideredEarlypostoperativephysiotherapy

toenhancedeepbreathing,coughingandgeneralmobility

PerioperativeManagementEncouragetostopsmokingfromLiverDisorderThetolerancetooperationdependsupontheseverityofliverfunctionimpairment.TheliverfunctioncouldbeestimatedbyChildstagingorMELDscoreMalnutrition,ascitesandjaundicearecontraindicationsexceptforemergencysurgery.

LiverDisorderThetolerancePreoperativeAssessmentandManagementHBVandHCV,CBCClottingscreenandplateletcountElectrolytesLiverandrenalfunctionWhenprothrombintimeisprolonged,vitaminKshouldbegivenforseveraldaysbeforeoperation.PreoperativeAssessmentandMaRenalDisordersPreoperativeassessmentplasmaurea,electrolytes,creatinineandBicarbonateshouldbecheckedMildchronicrenalfailure

DrugsshouldbegiveninsmallerdosesFluidandelectrolytehomeostasisModerate-to-severechronicrenalfailure

Operationsshouldbeperformedunderhaemodialysis

RenalDisordersPreoperativeasDiabetesMellitusAtspecialriskfromgeneralanesthesiaandsurgery

Patientswithdiabetesfallintothreegroups1.Insulindependent2.Takingoralhypoglycaemicmedication3.Diet-controlledDiabetesMellitusAtspeciaAttempttomaintainbloodglucoselevelbetween4and10mmol/Lavoidhypoglycemiainparticular.Bloodglucoselevel＞13mmol/LAnunreceptibleriskofketoacidosisorahyperosmolarnon-ketoticstate.PerioperativeManagementAttempttomaintainbloodglEstablishgooddiabeticcontrolbeforeoperationGiveninsulinasacontinuousintravenousinfusionduringtheoperativeperiodGivenaninfusionofdextrosethroughouttheoperativeperiodtobalancetheinsulingivenandtomakeupforlackofdietaryintakePerioperativeManagementEstablishgooddiabeticcontroPatientswithdiabetes:

whatpre-operativeassessmentisimportant?DocumentthefollowingTypeofdiabetesLengthoftimesincediagnosisCurrentmanagementCurrentglycemiccontrolHgBA1cGlucometerdtaPresenceofcomplicationsNeuropathyNephropathyRetinopathyAutonomicneuropathyincreaseriskofpostopgastroparesisandurinarytractinfectionPatientswithdiabetes:

whatp外科學(xué)教學(xué)課件：PerioperativeManagementPerioperativeanagementAddpotassiumtothedextroseinfusionMonitorbloodglucoseandelectrolytesfrequentlythroughouttheoperativeandearlypostoperativeperiodPerioperativeanagementAddpot

Recoveryroomisnecessary

ICUisoptimalifpossibleMonitoring

CloselymonitorthelifesignsasaroutineCVPmonitoringisnecessaryifhemodynamicunstableduringoperationOtheritemsmonitoredaccordinglyFluidbalancePost-operativeManagementRecoveryroomisnecesPositionandGetting-upSupinepositionforspiralanaesthesiaSemirecliningpositionforneckandchestoperation.Lateralpositionforobesitypatients.GetupasearlyaspossibleandmakemovementsasmuchaspossiblePositionandGetting-upSupinDietandTransfusionPeriodoffastdependsuponthetypeofoperation.Enteralandparenteralnutritionshouldbetakenintoconsideration.Fluidandelectrolyteshomeostasisshouldbemaintained.DietandTransfusionPeriodoManagementofDrainageDifferentdrainagefordifferentpurpose(infectionfocus,leakagepreventionandmassiveexudation)Nasal-gastrictubeUrinarycatheterManagementofDrainageDiffere外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagementWoundHealingandSutureRemovingClassificationofincision

cleanincisioncontaminatedincisioninfectedincisionTypeofhealing

TypeAperfecthealingBsomeinflammationCinfectedWoundHealingandSutureRemovPostoperativepain

anymotionsincreasingtensionswillincreasepainAnalgesiaisobligatoryPyrexia

commonpostoperativeobservationasearchbemadeforafocusofinfectionnon-infectivecausesofpyrexiaManagementofPostoperativeComplaintsPostoperativepainManagementoNauseaandVomitingDrugsopiates,antibiotics,metronidazoleBowelobstructionmechanicalobstructionAdynamicbowelHypokalaemiafaecalimpactionSystemicdisorderselectrolytedisturbancesUraemiaraisedintracranialpressureNauseaandVomitingDrugsAbdominalDistensionMorecommonafterabdominalsurgeryHiccupDiaphragmirritationorcentralnervoussystemstimulatedSubphrenicinfectionshouldbesuspectedforcontinuoushiccupAbdominalDistensionMorecommoRetentionofUrineThereisapalpablesuprapubicmasswithdulltopercussion.Urinarycatheterisindicatedwhendiagnosed.RetentionofUrineThereisaThemainpostoperativecomplicationsAtelectasisChestinfectionAspirationpneumonitisPneumoniaThemainpostoperativecomplicPostoperativeHaemorrhageCausesinadequateoperativehaemostasisatechnicalmishapasslippedligatureManagementre-operationtostopbleedingsomepreparationisnecessaryPostoperativecomplicationsPostoperativeHaemorrhageCauseWoundDehiscence(BurstAbdomen)Causesbloodsupplyispoorexcesssuturetensionlong-termsteroidtherapyimmunosuppressivetherapymalnutritioninfectioncoughingorabdominaldistensionManagementre-suturingwithtensionsuturesthewholethicknessoftheabdominalwallWoundDehiscence(BurstAbdomeMinorwoundinfectionslocalizedpain,rednessandaslightdischargeWoundCellulitisandAbscesscellulitistreatedbyantibioticsabscesstreatedbysurgical drainage

WoundInfectionMinorwoundinfectionsWoundIn外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagementAtelectasis

AirwayobstructedairisabsorbedfromtheairspacesdistaltotheobstructionBronchialsecretionsarethemainPreventionandtreatment

perioperativephysiotherapyisthebestwayforpreventiondeepbreathingexercisesregularadjustmentsofposturevigorouscoughingflexiblebronchoscopytoaspirateoccludingmucusplugsAtelectasisAirwayobstructedUrinaryTractInfectionsCausesreducedurinaryoutputreducing“flushing”ofbladderincompletebladderemptyinginadequateperinealhygieneTreatment

ensuringadequatefluidinputappropriateantibioticsUrinaryTractInfectionsCausesCauses

bedboundafteroperationvenousstasisplasmaconcentratedduedehydrationviscosityincreasedManifestationsswellingofthelegtendernessofthecalfmuscleincreasedwarmthofthelegcalfpainonpassivedorsiflexionofthefootDeepVeinThrombosisCausesbedboundafteroTreatment

Anticoagulation:

Systemicthrombolytictherapy:

streptokinaseLocalthrombolyticdrugsismorepromisingintravenousheparinsubcutaneousheparinoralwarfarintherapyDeepVeinThrombosisTreatmentintravenousheparinDepostoperativemobilizationadequatehydrationavoidingcalfpressurePreventionHighRiskCaseslowdosesubcutaneousheparincalfcompressiondevicesgraded-compression‘a(chǎn)nti-embolism’stockingsIntravenousdextranWarfarinanticoagulationDeepVeinThrombosispostoperativemobilizationPSamplePreoperativeChecklistOperativepermit,appropriatelysignedandwitnessedDietaryconsiderationsForabdominaloperation,liquiddietandlaxativestoensureclean,collapsedbowelNothingbymouthatleast6hrbeforeoperationSamplePreoperativeChecklistReviewoflife-supportsystemsVitalsignsrecordedoftenenoughtoestablishnormalvaluesPulmonarysystem:chestfilms;OtherstudiesasindicatedCardiacfunction:electrocardiogram;OtherstudiesasindicatedSamplePreoperativeChecklistReviewoflife-supportsystemsRenalfunction:urinalysis;BloodureanitrogenandpossiblybloodcreatininedeterminationsAdequatehydrationuptotimeofoperation,especiallytocompensateforlaxativesandfastingAreaofoperationwashedwithappropriategermicidaldetergentandshaved,clipped,orcleansedwithdepilatoryagentBloodtransfusionspreparedasanticipatedSamplePreoperativeChecklistRenalfunction:SamplePreoperaOrderforpatienttovoidoncalltooperatingroomPreoperativemedications:vagolyticandsedativedrugsSpecialmedications:digitalis,insulin,etc.SamplePreoperativeChecklistOrderforpatienttovoidoncFast—trackrehabilitationinsurgery(外科快速康復(fù)方法)Enhancedrecoveryaftersurgery(促進(jìn)外科手術(shù)后康復(fù)程序)Fast-trackSurgeryFast—trackrehabilitationinsSurgeonsNamedNobelLaureates

inMedicineandPhysiologySurgeon(Dates)

Country

Field(YrofAward)

TheodorKocher(1841-1917)AllvarGullstrand(1862-1930)AlexisCarrel(1873-1944)RobertBarany(1876-1936)FrederickBanting(1891-1941)WalterHess(1881-1973)WernerForssmann(1904-1979)CharlesHuggins(1901-1997)JosephMurray(born1919)SwitzerlandSwedenFranceandU.S.AAustriaCanadaSwitzerlandGermanyUnitedStatesUnitedStatesThyroiddisease(1909)Oculardioptrics(1911)Vascularsurgery(1912)Vestibulardisease(1914)Insulin(1922)Midbrainphysiology(1949)Cardiaccatheterization(1956)Oncology(1966)Organtransplantation(1990)SurgeonsNamedNobelLaureatesQuestions?Questions?ThankYou!ThankYou!PerioperativeManagementPerioperativeManagementPerioperativePeriodDefinitiondependsonmultiplefactorsImportancedirectlyrelatedtotheoutcomeofsurgeryitselfCompositionpreoperativepreparation&postoperativemanagementPerioperativePeriodDefinition

1.Electivesurgery2.Restrictivesurgery3.EmergentsurgeryPreoperativePreparationTheprincipleDifferentpreparationfordifferentproceduresTheclassificationofoperationsaccordingtothecharacteristicsofoperationsElectivesurgeryRestrictivesurgeryEmergentsurgery1.ElectivesurgeryPreoperativElectiveSurgeryElectiveSurgeryRestrictiveSurgeryRestrictiveSurgeryEmergentSurgeryEmergentSurgeryDr.EvilSays….$$$$????Dr.EvilSays….$$$$TheodorKocher(1841-1917)WithTheodorBillrothestablishedlargeclinicsinEuropeand,throughdevelopmentofskilledsurgicaltechniquescombinedwithneweranestheticandantisepticprinciples,providedsurgicalresultsthatprovedthesafetyandefficacyofthyroidsurgeryforbenignandmalignantproblemsTheodorKocher(1841-1917)WitWilliamStewartHalsted(1852-1922)ASCENTOFSCIENTIFICSURGERYResearchbasedonanatomic,pathologic,andphysiologicprinciplesandemployinganimalexperimentationHalstedianprinciples

WilliamStewartHalsted(1852-ToconfirmthediagnosisToassesstheriskofoperationToassessthegeneralconditionandfunctionofimportantorgansToevaluatethepatientsendurancetotheoperationandriskofoperationPreoperativeAssessmentToconfirmthediagnosisPreoEssentialStepsHistorytakingPhysicalexaminationArranginganyfurtherdiagnosticinvestigationMakingspecialpreparationsfortheparticularoperationInvestigatinganyintercurrentoroccultillnesssuggestedbymedicalclerkingEssentialStepsHistorytakingEssentialStepsDiscussingtheoperationwiththepatientandhisfamilyandobtainingsignedconsentMarkingtheoperationsiteMakingarrangementsfortheoperationwiththeoperatingtheatrestaffArrangingandinformingtheanesthetistsPrescribingmedication:prophylacticantibioticsetc.PlanningrehabilitationandconvalescenceEssentialStepsDiscussingthePsychologicalpreparation

talkfranklyandappropriatelytopatientsandfamiliesPhysiologicalpreparationAdaptiveexerciseTransfusionPreventionofinfectionGastro-intestinaltractpreparationMaintenanceoffluid,electrolytesandnutritionGeneralPreparationPsychologicalpreparationAdaMalnutritionanddysfunctionofimmunesystem

MalnutritiondramaticallyincreasesthemorbidityandmortalityPreoperativenutritionalsupportismorevaluableSpecificPreparationMalnutritionanddysfunctionoHypertension

Mild-to-moderateessentialhypertension

systolicpressure＜180mmHg

diastolicpressure＜110mmHg

Atminimalriskofcardiaccomplication

AntihypertensivedrugsshouldbeusedalltimeSuddenwithdrawalofdrugsisdangerousHypertensionMild-to-moderaSevereorPoorlyControlledHypertensionAthighriskofperioperativecardiacfailureorstroke.Thistypeofpatientsshouldnotundergogeneralanaesthesiaandsurgeryuntiladequatelytreated.Thebloodpressureshouldbereasonablycontrolledunder160/100mmHg.SevereorPoorlyControlledHyCardiovascularDiseasesIschemicheartdiseaseCardiacfailureArrhythmiasValvularheartdiseaseCerebrovasculardiseaseCardiovascularDiseasesIscheAnginaandPreviousInfarctionPreviousinfarctionStableanginaposeslittleincreasedriskduringoperationbutunstableanginaisasdangerousasrecentmyocardialinfarctionTheriskofreinfarctionisabout30%ifanoperationisperformedduringthefirst3monthsAt6monthstheriskisabout10~15%whichmaybeacceptableforimportantelectivesurgeryAnginaAnginaandPreviousInfarctionAdequatePreparationforHeartDiseaseTocorrectthefluidandelectrolytesimbalance.Tocorrectanaemiathroughseveralbloodtransfusionwithsmallamount.Tocontrolthecardiacarrhythmias.(Atrialfibrillation,Tachycardia,Bradycardia)AdequatePreparationforHeartRespiratorydysfunctionRespiratorycomplicationsoccurinupto15%ofsurgicalpatientsandaretheleadingcauseofpostoperativemortalityintheelderly.RespiratorydysfunctionRespiraRiskFactorsforRespiratoryComplicationChronicobstructivepulmonaryorairwaysdiseaseChronicbronchitis,emphysema,bronchiectasis,pneumoconiosis,pulmonarytuberculosesCigarettesmokingCurrentrespiratoryinfectionsAsthmaRiskFactorsforRespiratoryCPreoperativeInvestigationAchestX-rayCTscanifnecessaryEKGSpirometerBloodgasmeasurementPreoperativeInvestigationAPerioperativemanagement`PreoperativephysiotherapyteachingthepatientbreathingexercisesandcorrectpostureDrugtherapyTheophyllinesProphylacticantibioticsPreoperativebronchodilatorAdequatehydrationPerioperativeManagementPerioperativemanagement`PreopEncouragetostopsmokingfromthetimeofbookforelectivesurgeryAlternationmethodsofanesthesia

Local,regionalorspiralanesthesiashouldbeconsideredEarlypostoperativephysiotherapy

toenhancedeepbreathing,coughingandgeneralmobility

PerioperativeManagementEncouragetostopsmokingfromLiverDisorderThetolerancetooperationdependsupontheseverityofliverfunctionimpairment.TheliverfunctioncouldbeestimatedbyChildstagingorMELDscoreMalnutrition,ascitesandjaundicearecontraindicationsexceptforemergencysurgery.

LiverDisorderThetolerancePreoperativeAssessmentandManagementHBVandHCV,CBCClottingscreenandplateletcountElectrolytesLiverandrenalfunctionWhenprothrombintimeisprolonged,vitaminKshouldbegivenforseveraldaysbeforeoperation.PreoperativeAssessmentandMaRenalDisordersPreoperativeassessmentplasmaurea,electrolytes,creatinineandBicarbonateshouldbecheckedMildchronicrenalfailure

DrugsshouldbegiveninsmallerdosesFluidandelectrolytehomeostasisModerate-to-severechronicrenalfailure

Operationsshouldbeperformedunderhaemodialysis

RenalDisordersPreoperativeasDiabetesMellitusAtspecialriskfromgeneralanesthesiaandsurgery

Patientswithdiabetesfallintothreegroups1.Insulindependent2.Takingoralhypoglycaemicmedication3.Diet-controlledDiabetesMellitusAtspeciaAttempttomaintainbloodglucoselevelbetween4and10mmol/Lavoidhypoglycemiainparticular.Bloodglucoselevel＞13mmol/LAnunreceptibleriskofketoacidosisorahyperosmolarnon-ketoticstate.PerioperativeManagementAttempttomaintainbloodglEstablishgooddiabeticcontrolbeforeoperationGiveninsulinasacontinuousintravenousinfusionduringtheoperativeperiodGivenaninfusionofdextrosethroughouttheoperativeperiodtobalancetheinsulingivenandtomakeupforlackofdietaryintakePerioperativeManagementEstablishgooddiabeticcontroPatientswithdiabetes:

whatpre-operativeassessmentisimportant?DocumentthefollowingTypeofdiabetesLengthoftimesincediagnosisCurrentmanagementCurrentglycemiccontrolHgBA1cGlucometerdtaPresenceofcomplicationsNeuropathyNephropathyRetinopathyAutonomicneuropathyincreaseriskofpostopgastroparesisandurinarytractinfectionPatientswithdiabetes:

whatp外科學(xué)教學(xué)課件：PerioperativeManagementPerioperativeanagementAddpotassiumtothedextroseinfusionMonitorbloodglucoseandelectrolytesfrequentlythroughouttheoperativeandearlypostoperativeperiodPerioperativeanagementAddpot

Recoveryroomisnecessary

ICUisoptimalifpossibleMonitoring

CloselymonitorthelifesignsasaroutineCVPmonitoringisnecessaryifhemodynamicunstableduringoperationOtheritemsmonitoredaccordinglyFluidbalancePost-operativeManagementRecoveryroomisnecesPositionandGetting-upSupinepositionforspiralanaesthesiaSemirecliningpositionforneckandchestoperation.Lateralpositionforobesitypatients.GetupasearlyaspossibleandmakemovementsasmuchaspossiblePositionandGetting-upSupinDietandTransfusionPeriodoffastdependsuponthetypeofoperation.Enteralandparenteralnutritionshouldbetakenintoconsideration.Fluidandelectrolyteshomeostasisshouldbemaintained.DietandTransfusionPeriodoManagementofDrainageDifferentdrainagefordifferentpurpose(infectionfocus,leakagepreventionandmassiveexudation)Nasal-gastrictubeUrinarycatheterManagementofDrainageDiffere外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagementWoundHealingandSutureRemovingClassificationofincision

cleanincisioncontaminatedincisioninfectedincisionTypeofhealing

TypeAperfecthealingBsomeinflammationCinfectedWoundHealingandSutureRemovPostoperativepain

anymotionsincreasingtensionswillincreasepainAnalgesiaisobligatoryPyrexia

commonpostoperativeobservationasearchbemadeforafocusofinfectionnon-infectivecausesofpyrexiaManagementofPostoperativeComplaintsPostoperativepainManagementoNauseaandVomitingDrugsopiates,antibiotics,metronidazoleBowelobstructionmechanicalobstructionAdynamicbowelHypokalaemiafaecalimpactionSystemicdisorderselectrolytedisturbancesUraemiaraisedintracranialpressureNauseaandVomitingDrugsAbdominalDistensionMorecommonafterabdominalsurgeryHiccupDiaphragmirritationorcentralnervoussystemstimulatedSubphrenicinfectionshouldbesuspectedforcontinuoushiccupAbdominalDistensionMorecommoRetentionofUrineThereisapalpablesuprapubicmasswithdulltopercussion.Urinarycatheterisindicatedwhendiagnosed.RetentionofUrineThereisaThemainpostoperativecomplicationsAtelectasisChestinfectionAspirationpneumonitisPneumoniaThemainpostoperativecomplicPostoperativeHaemorrhageCausesinadequateoperativehaemostasisatechnicalmishapasslippedligatureManagementre-operationtostopbleedingsomepreparationisnecessaryPostoperativecomplicationsPostoperativeHaemorrhageCauseWoundDehiscence(BurstAbdomen)Causesbloodsupplyispoorexcesssuturetensionlong-termsteroidtherapyimmunosuppressivetherapymalnutritioninfectioncoughingorabdominaldistensionManagementre-suturingwithtensionsuturesthewholethicknessoftheabdominalwallWoundDehiscence(BurstAbdomeMinorwoundinfectionslocalizedpain,rednessandaslightdischargeWoundCellulitisandAbscesscellulitistreatedbyantibioticsabscesstreatedbysurgical drainage

WoundInfectionMinorwoundinfectionsWoundIn外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科學(xué)教學(xué)課件：PerioperativeManagement外科