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Post-operative care |
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The immediate post-operative period is the most dangerous for the patient and close supervision of the airway is essential, with the patient in the recovery position. Suction and oxygen must be to hand. Any continued bleeding should respond to direct pressure for 15 minutes. Prolonged bleeding for the operation site in the mouth may require suturing of the use of oxidised cellulose (‘Surgicel’ made by Johnson & Johnson). Consider a clotting screen.
Intravenous Fluids Most patients require 3L per day if taking nothing orally. However, elderly patients weighing less than 60kg may require much less. This is usually made up as follows: ¨ 1L 5% dextrose ¨ 1L Normal saline ¨ 1L 5% dextrose Add 60mmol (6g) of potassium per day. Check the U&E every day in patients on supplements. 24 hours post– operation fluid intake is often much less (2L/24h) in the elderly especially.
Post-operative analgesia If the pain is severe then an opioid such as pethidine (50-100mg) may be administered intramuscularly, up to 4 hourly. An anti-emetic such as Stemetil 12.5mg IM must also be prescribed with opioids to prevent nausea. PCA may be initiated after some painful operations.
Move onto oral or rectally administered analgesics as soon as is practical. Either aspirin/paracetomol combinations with opioids or non-steroidals are suitable.
Bloods All major cases should have the FBC and U&E measured on the first post-operative day. If the patient is still on iv fluids and supplements, then repeat the U&E daily. Diabetics should have two random blood sugars and four hourly urine tests until fully recovered.
Tracheostomy Cases Portex tubes are often replaced with fenestrated speaking tubes after 4—5 days, prior to complete removal. |
