![]() ![]() ![]() As these factors are progressively corrected, the heart rate should return to normal. Immediately postoperatively, the pulse rate is usually higher than normal with a decreased amplitude, may be justified by intra operative blood loss, which may remain insignificant in the overall economy of the patient’s healing, or by anesthetic drugs, the extent of surgical “aggressiveness”, pain, etc. Heart rate is systematically monitored several times a day. However, the surgeon must be prepared to recognize cardiac risks and main syndromes and even manage the patient until one of the above mentioned specialists are available. Complex surveillance is needed in many cases and the rehabilitation measures must be intensive and prompt, conducted in most cases by the intensive care specialist or cardiologist. Supervision of the cardiovascular systemĬardiovascular system stability is crucial in the postoperative evolution of the patient. Therefore, we can conclude that fever is a general sign that should always be interpreted in accordance with other signs and symptoms but it is an alarming sign that should lead to careful and complete physical examination and laboratory tests or imaging studies evaluated on a case-by-case basis.ģ. When the febrile ascension appears suddenly on the fifth day after surgery, without signs of wound infection anastomosis dehiscence should be suspected, however, it can also be caused by thrombophlebitis. From day 4 to 30 postoperatively, superficial or profound surgical site infections become the main cause for fever development, while thrombosis can cause fever at any time between the day of surgery and postoperative day 30. Urinary infections usually occur in 2–3 days postoperatively but can also begin later. On the day of surgery, cardiac pathology and specific myocardial infarction seem to be the most common, then pulmonary pathology – pneumonia and atelectasis seem to cause fever in days 1–3 postoperatively. In a large cohort study, the most common causes of fever development were stratified a few days after surgery. Particular attention should be paid to the occult causes of fever such as endocarditis, phlebitis, lamellar atelectasis that should be systematically searched for in the context of an unjustified febrile syndrome with an apparently good evolution in the operative site. The first to be checked is the surgical site, then the lung and urinary system, as these are the most frequent sites of infection after surgery. However, the persistence of the fever with the configuration of “saw teeth” on the thermal chart suggests the development of a septic process. A single febrile rise, below 38 degrees Celsius can often be caused by the resorption of blood degradation products from the operative wound or secondary to the excessive maintenance of a drainage tube, without major pathological significance. The determinations are included in the observation sheet completing the temperature graph whose oscillations become suggestive in a clinical context. The patient’s temperature, despite being a general and non-specific parameter, is one of the most important and easy to monitor.ĭuring the follow-up period of the surgical patient, the temperature is usually measured at least twice a day, in the morning and in the afternoon, and whenever there is a suspicion of fever. To monitor the operated patient, we have at our disposal the clinical and paraclinical parameters. We will also discuss the need for different types of surgical bed drains placement and their management, the use of antibiotics and thrombotic event prophylaxis. In this chapter, we propose to explore the main clinical and paraclinical means and tools that can improve the outcomes of surgical procedures for a faster and safer recovery. Those attributes gained through continuous theoretical preparation but validated by current practice bring added value, always in favor of the patients’ best interests. Computing, interpreting and integrating signs and symptoms with active search of proofs by lab tests or other paraclinical explorations highly depends on skills and dedication of the entire healthcare team. While these distinctions are purely didactic, the postoperative care merges into an active surveillance with a higher level of standardization than it would seem at first glance. Postoperative patient care has several components: - surveillance, − prevention of complications associated with surgical disease or other preexisting comorbidities, − specific postoperative treatment of the surgical disease and its complications. ![]()
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