Perioperative Management of Surgical Patients

Preoperative preparation is classified into 3 categories according to an urgent degree.

Emergent operation necessary preparations should be done with the shortest time operate immediately.

e.g. rupture of the liver, large vessel in the abdomen.

Date-limited operation:  the date of operation can be selected, but cannot be over prolonged. Preparation is limited with a certain time, so sufficient preparation should be done within this limit.

Elective operation: the date of the operation does not affect the outcome of treatment.

Patients with compromised pulmonary function preoperatively are susceptible to postoperative complications, including hypoxia, atelectasis, and pneumonia.

Risk factors: COPD, smoking, advanced age, obesity, acute respiratory system infection.

Physical examination: wheezing and prolonged expiration.

The most helpful screening pulmonary function tests are forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Values less than 50% of predicted outcomes based on age and body size indicate significant airway disease with a high risk for complications.

The blood sugar level should be controlled before the operation, water-electrolyte imbalance and acidosis should be corrected, the nutritional state should be improved.

For a suspected infection, antibiotics should be given preoperatively

Before the operation, blood sugar should be at a steady mild elevated state (5.6～11.3 mmol/L) urine sugar + ~ ++.

The operation should be performed as early as possible to avoid long fasting time and ketogenesis

If the operation lasts long, glucose and insulin are given in infusion fluid with a ratio of 5:1.

Dosage of insulin after operation is determined by the urine sugar value within 4-6 h, ++++: 16 U; +++: 12 U; ++: 6 U: +: 0 U. Urine ketone positive: 6U.

Monitoring

  • Vital signs
  • Central venous pressure
  • Other special monitoring items
  • Body fluid balance

Incision classification

  • Clean Category I ）
  • Possibly contaminated Category II）
  • Contaminated Category III）

Postoperative fever classified into the infectious & noninfectious origin, with the latter occurring more earlier (1.4 d versus 2.7 d) and temperature lower than the former

Wound infection

  • Incident 3-4%, 3-4 days after operation.
  • Redness, swelling, hotness, pain & tenderness of incision.
  • With or without fever and increment of WBC
  • Discharge should be cultured for choosing antibiotics
  • Remove suture at the most obvious tender point and open the incision to release pus, etc. 


 

by