Post-operative Management
Note-taking
Thyroid Surgery
Lobectomy
Total thyroidectomy
Breast Surgery
SLE + SLNBx
Mastectomy
Hernia Surgery
Open inguinal
Lap inguinal
Open femoral
Cholecystectomy
Laparoscopic
Open
Complications
General surgical cx
Bleeding
Primary = intraop
- joint/ spine
- liver op
- traumatic spleen
- ruptured AAA
Secondary = 12-24h
- thyroid
Tertiary = 5-7d
- Tonsils
Specific surgical
Anatomy
Pelvic/ abdo surgery: ureteric injury (serous d/c d1-2 post op), impending dehiscence (serous d/c D5)
Immobility
PE, DVT, pneumonia
Anaesthetic
Source
Dr Fiona Lee 2015
- Pain
- Vitals
- Fluid status
- Operation site (Drains, painbuster, NG/NJT)
- Lungs (Creps: Fine - Fibrosis, Medium - Fluids Coarse - atelectasis, bronchiectasis)
- Bloods (K > 4: ileus. FBC/ UEC daily till off IV fluids, LFT for albumin)
- Medications (? DVT prophylaxis, abx)
- Special conditions (diabetes, prednisolone, anticoags)
- Education (stoma nurse, diet)
- Discharge/ Follow up
Thyroid Surgery
Lobectomy
- Pain (not severe)
- Voice/ cough
- Neck swelling/ Haematoma (causes laryngoedema --> stridor)
- Overnight stay
- Education (HypoCA sx: perioral/ peripheral tingling, no work for 2 weeks, meds, wound care - dressings out in 5 days)
Total thyroidectomy
- Calcium levels (parathyroids) (Rx: IV Ca infusion if very low, Ca+calcitriol tablet if low)
- Thyroid crisis --> Rx: Thyroxine 100mcg
- Stay 2 nights
Breast Surgery
SLE + SLNBx
- Pain: simple analgesia
- DVT prophylaxis (mobility, obesity, ca)
- Complications: Seroma, arm numbness, lymphoedema, haematoma
- Breast care nurse/ breast ca support group
- F/U 1/52
Mastectomy
- Drains
- Physio/ lymphoedema mx/ shoulder mobility
- Breast care nurse/ breast ca support group
- F/U 1/52
Hernia Surgery
Open inguinal
- Pain +++ (stitches into mm to anchor mesh) Rx: S/C morphine
- Complications: Urinary retention, haematoma
- Discharge: Oxycodone, Paracetamol
- Absence: 4 weeks off, 8 weeks no lifting
- F/U: 4/52
Lap inguinal
- Pain +; Rx: Paracetamol
- Complications: Urinary retention, haematoma
- Discharge: Oxycodone, Paracetamol
- Absence: 2 weeks off, 4 weeks no lifting
- F/U: 4/52
Open femoral
- Pain ++ (Less stitches than open inguinal)
- Complication: Lymphoedema (seroma lymphatics in femoral canal)
- F/U: 2/52
- Absence: 2 weeks off, 4 weeks no lifting
Cholecystectomy
Laparoscopic
- Pain +. Rx: Paracetamol/ Oxycodone
- Wound/ op site (Only difficult patients have drain)
- Complications: Atelectasis (Rx: cough)
- Meds: DVT prophylaxis (TEDs, if on pill, heparin)
- Discharge: 1-2 days
- F/U: 4/52
Open
- Pain ++. Rx: Painbusters 3/7 +/- PCA
- Drains (***no bile)
- Complications: Atelectasis (Rx: cough)
- Meds: DVT prophylaxis
- Discharge: 5-7 days
- F/U: 2/52 remove staples
Complications
General surgical cx
Bleeding
Primary = intraop
- joint/ spine
- liver op
- traumatic spleen
- ruptured AAA
Secondary = 12-24h
- thyroid
Tertiary = 5-7d
- Tonsils
Specific surgical
Anatomy
Pelvic/ abdo surgery: ureteric injury (serous d/c d1-2 post op), impending dehiscence (serous d/c D5)
Immobility
PE, DVT, pneumonia
Anaesthetic
Source
Dr Fiona Lee 2015