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

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.

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...

SYSTEM-SPECIFIC COMPLICATIONS Respiratory system Early detection of respiratory complications is facilitated by periodic assessment of airway patency , respiratory rate and routine oxygen saturation measurement, performed during emergence and recovery as des...

Thoracic surgery Careful fluid management is important in patients undergoing a lobectomy or pneumonectomy as they are susceptible to fluid overload in the first 24–48 hours postoperatively . Chest drains require regular review . If the fluid in a chest drain swi...

Urology Catheter patency must be checked regularly following urolog ical surgery . In patients who have undergone transurethral resection of the prostate, continuous bladder irrigation may be used. More generalised complications can occur, for example transur...

Vascular surgery The patency of grafts and anastomoses, for example femoro popliteal bypasses and abdominal aneurysm, needs to be checked by regular clinical assessment of the limbs and by Doppler ultrasound in the postoperative phase.

Wound care Within hours of the wound being surgically closed, the dead space fills up with an inflammatory exudate. Within 48 hours of closure a layer of epidermal cells from the wound edge bridges the gap. Consequently , sterile dressings applied in theatre s...

Wound dehiscence Wound dehiscence is disruption of any or all of the layers in a wound. Dehiscence may occur in up to 3% of abdominal wounds, increases the risk of postoperative mortality and is very distressing to the patient. Wound dehiscence most common...

ARTIFICIAL NUTRITIONAL SUPPORT Given the importance of adequate nutrition in recovery from illness and surgery , consideration for artificial nutritional support should be given in any patient who has had inadequate nutritional intake for 5 days or more. In pa...