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ENHANCED RECOVERY Enhanced recovery is an approach to the perioperative care of patients undergoing surgery . It is designed to speed clinical recovery of the patient and reduce both the cost and the length of stay of the patient in the hospital. It is ach...

FURTHER READING Goren O, Matot I. Perioperative acute kidney injury . Br J Anaesth 2015; 115 (Suppl 2): ii3–14. https://anaesthetists.org/Home/Resources-publications/Guidelines/ Immediate-post-anaesthesia-recovery (accessed 27 November 2021). https://cpoc.org....

Fever About 40% of patients develop pyrexia after major surgery; however, in most cases no cause is found. The inflammatory response to surgical trauma may manifest itself as fever, and so pyrexia does not necessarily imply sepsis. However, in all patients wi...

Follow-up in clinic Patients should be reviewed in clinic if a key decision on management needs to be made. The findings and the care plan agreed with the patient at the clinic appointment should be included in a letter to the patient’s GP , as well as in a cl...

GENERAL POSTOPERATIVE COMPLICATIONS Bleeding Postoperative haemorrhage is most common in the immediate postoperative period. It may be caused by an arterial or venous leak, but also by a generalised ooze or a coagulopathy . Slow bleeds may go undetected for ho...

GENERAL POSTOPERATIVE PROBLEMS AND MANAGEMENT This section provides an overview of selected important post operative problems and the principles of their management. It does not set out to describe such problems relating to the vast arra y of all surgical t...

INTRODUCTION Perioperative care is integrated care delivered to the patient by a multidisciplinary team before, during and after surgery . The multidisciplinary perioperative team comprises doctors from various specialties, such as surgery , anaesthesia, acute...

Learning objectives To understand: The integrated approach to caring for patients in the • perioperative period Common postoperative problems seen in the immediate • postoperative period Learning objectives To understand: The integrated approach to caring for ...

Neck surgery Patients undergoing neck surgery , e.g. thyroid surgery , must be observed for accumulation of blood in the wound, which may obstruct the airway and cause rapid asphyxia. This potentially life-threatening complication necessitates systems for ear...

Orthopaedic surgery Neurovascular supply to the extremity Patients who have undergone extremity surgery , for example open reduction and internal fixation of a fracture, require regular neurovascular observations, both in recovery and on the ward (this will us...

POSTOPERATIVE COMPLICATIONS Postoperative complications are an important cause of morbidity , mortality , extended hospital stay and increased costs. Most patients at increased risk of developing postoperative complications can be identified prior to surgery a...

POSTOPERATIVE OBSERVATIONS The patient’s vital signs (including pulse, blood pressure and pulse oximetry reading), level of consciousness, pain and hydration status are monitored in the recovery room and supportive treatment is given. In recent years, patient...

PREHABILITATION The functional capacity of a patient can be reduced following major surgery . This can have a significant negative impact on the recovery of patients with poor functional reserve prior to surgery . Prehabilitation is a process of improving th...

Plastic surgery The viability of flaps is crucial and the perfusion needs to be monitored regularly . The blood supply may be compromised by position, dressings or collection of fluids or blood beneath the flap. Plastic surgery The viability of flaps is crucial...

Pressure sores Patients undergoing surgery for a prolonged period of time are vulnerable to the development of a pressure sore or to worsening of a pre-existing sore as a result of prolonged immobility during, and sometimes after, the operation. Careful pos...

Pulmonary embolus PE is not usually an immediate complication but can present in the early postoperative period. Thrombus can arise from DVT in the legs/pelvis, venae cavae or the right atrium. Signs and symptoms depend on the size of the embolus and may rang...

Renal and urinary system Acute kidney injury Renal failure occurring during the perioperative period is associated with considerable mortality and morbidity . About one-quarter of cases of hospital-acquired renal failure occur in the perioperative period and...

SURGERY-SPECIFIC COMPLICATIONS This section provides an overview of selected important complications, rather than a comprehensive account of all possible complications. The reader is advised to consult chap - ters where specific procedures are described in mo...