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PerioperativeManagementPerioperativeManagementPerioperativePeriodDefinitiondependsonmultiplefactorsImportancedirectlyrelatedtotheoutcomeofsurgeryitselfCompositionpreoperativepreparation&postoperativemanagementPerioperativePeriodDefinition
1.Electivesurgery2.Restrictivesurgery3.EmergentsurgeryPreoperativePreparationTheprincipleDifferentpreparationfordifferentproceduresTheclassificationofoperationsaccordingtothecharacteristicsofoperationsElectivesurgeryRestrictivesurgeryEmergentsurgery1.ElectivesurgeryPreoperativElectiveSurgeryElectiveSurgeryRestrictiveSurgeryRestrictiveSurgeryEmergentSurgeryEmergentSurgeryDr.EvilSays….$$$$????Dr.EvilSays….$$$$TheodorKocher(1841-1917)WithTheodorBillrothestablishedlargeclinicsinEuropeand,throughdevelopmentofskilledsurgicaltechniquescombinedwithneweranestheticandantisepticprinciples,providedsurgicalresultsthatprovedthesafetyandefficacyofthyroidsurgeryforbenignandmalignantproblemsTheodorKocher(1841-1917)WitWilliamStewartHalsted(1852-1922)ASCENTOFSCIENTIFICSURGERYResearchbasedonanatomic,pathologic,andphysiologicprinciplesandemployinganimalexperimentationHalstedianprinciples
WilliamStewartHalsted(1852-ToconfirmthediagnosisToassesstheriskofoperationToassessthegeneralconditionandfunctionofimportantorgansToevaluatethepatientsendurancetotheoperationandriskofoperationPreoperativeAssessmentToconfirmthediagnosisPreoEssentialStepsHistorytakingPhysicalexaminationArranginganyfurtherdiagnosticinvestigationMakingspecialpreparationsfortheparticularoperationInvestigatinganyintercurrentoroccultillnesssuggestedbymedicalclerkingEssentialStepsHistorytakingEssentialStepsDiscussingtheoperationwiththepatientandhisfamilyandobtainingsignedconsentMarkingtheoperationsiteMakingarrangementsfortheoperationwiththeoperatingtheatrestaffArrangingandinformingtheanesthetistsPrescribingmedication:prophylacticantibioticsetc.PlanningrehabilitationandconvalescenceEssentialStepsDiscussingthePsychologicalpreparation
talkfranklyandappropriatelytopatientsandfamiliesPhysiologicalpreparationAdaptiveexerciseTransfusionPreventionofinfectionGastro-intestinaltractpreparationMaintenanceoffluid,electrolytesandnutritionGeneralPreparationPsychologicalpreparationAdaMalnutritionanddysfunctionofimmunesystem
MalnutritiondramaticallyincreasesthemorbidityandmortalityPreoperativenutritionalsupportismorevaluableSpecificPreparationMalnutritionanddysfunctionoHypertension
Mild-to-moderateessentialhypertension
systolicpressure＜180mmHg
diastolicpressure＜110mmHg
Atminimalriskofcardiaccomplication
AntihypertensivedrugsshouldbeusedalltimeSuddenwithdrawalofdrugsisdangerousHypertensionMild-to-moderaSevereorPoorlyControlledHypertensionAthighriskofperioperativecardiacfailureorstroke.Thistypeofpatientsshouldnotundergogeneralanaesthesiaandsurgeryuntiladequatelytreated.Thebloodpressureshouldbereasonablycontrolledunder160/100mmHg.SevereorPoorlyControlledHyCardiovascularDiseasesIschemicheartdiseaseCardiacfailureArrhythmiasValvularheartdiseaseCerebrovasculardiseaseCardiovascularDiseasesIscheAnginaandPreviousInfarctionPreviousinfarctionStableanginaposeslittleincreasedriskduringoperationbutunstableanginaisasdangerousasrecentmyocardialinfarctionTheriskofreinfarctionisabout30%ifanoperationisperformedduringthefirst3monthsAt6monthstheriskisabout10~15%whichmaybeacceptableforimportantelectivesurgeryAnginaAnginaandPreviousInfarctionAdequatePreparationforHeartDiseaseTocorrectthefluidandelectrolytesimbalance.Tocorrectanaemiathroughseveralbloodtransfusionwithsmallamount.Tocontrolthecardiacarrhythmias.(Atrialfibrillation,Tachycardia,Bradycardia)AdequatePreparationforHeartRespiratorydysfunctionRespiratorycomplicationsoccurinupto15%ofsurgicalpatientsandaretheleadingcauseofpostoperativemortalityintheelderly.RespiratorydysfunctionRespiraRiskFactorsforRespiratoryComplicationChronicobstructivepulmonaryorairwaysdiseaseChronicbronchitis,emphysema,bronchiectasis,pneumoconiosis,pulmonarytuberculosesCigarettesmokingCurrentrespiratoryinfectionsAsthmaRiskFactorsforRespiratoryCPreoperativeInvestigationAchestX-rayCTscanifnecessaryEKGSpirometerBloodgasmeasurementPreoperativeInvestigationAPerioperativemanagement`PreoperativephysiotherapyteachingthepatientbreathingexercisesandcorrectpostureDrugtherapyTheophyllinesProphylacticantibioticsPreoperativebronchodilatorAdequatehydrationPerioperativeManagementPerioperativemanagement`PreopEncouragetostopsmokingfromthetimeofbookforelectivesurgeryAlternationmethodsofanesthesia
Local,regionalorspiralanesthesiashouldbeconsideredEarlypostoperativephysiotherapy
toenhancedeepbreathing,coughingandgeneralmobility
PerioperativeManagementEncouragetostopsmokingfromLiverDisorderThetolerancetooperationdependsupontheseverityofliverfunctionimpairment.TheliverfunctioncouldbeestimatedbyChildstagingorMELDscoreMalnutrition,ascitesandjaundicearecontraindicationsexceptforemergencysurgery.
LiverDisorderThetolerancePreoperativeAssessmentandManagementHBVandHCV,CBCClottingscreenandplateletcountElectrolytesLiverandrenalfunctionWhenprothrombintimeisprolonged,vitaminKshouldbegivenforseveraldaysbeforeoperation.PreoperativeAssessmentandMaRenalDisordersPreoperativeassessmentplasmaurea,electrolytes,creatinineandBicarbonateshouldbecheckedMildchronicrenalfailure
DrugsshouldbegiveninsmallerdosesFluidandelectrolytehomeostasisModerate-to-severechronicrenalfailure
Operationsshouldbeperformedunderhaemodialysis
RenalDisordersPreoperativeasDiabetesMellitusAtspecialriskfromgeneralanesthesiaandsurgery
Patientswithdiabetesfallintothreegroups1.Insulindependent2.Takingoralhypoglycaemicmedication3.Diet-controlledDiabetesMellitusAtspeciaAttempttomaintainbloodglucoselevelbetween4and10mmol/Lavoidhypoglycemiainparticular.Bloodglucoselevel＞13mmol/LAnunreceptibleriskofketoacidosisorahyperosmolarnon-ketoticstate.PerioperativeManagementAttempttomaintainbloodglEstablishgooddiabeticcontrolbeforeoperationGiveninsulinasacontinuousintravenousinfusionduringtheoperativeperiodGivenaninfusionofdextrosethroughouttheoperativeperiodtobalancetheinsulingivenandtomakeupforlackofdietaryintakePerioperativeManagementEstablishgooddiabeticcontroPatientswithdiabetes:
whatpre-operativeassessmentisimportant?DocumentthefollowingTypeofdiabetesLengthoftimesincediagnosisCurrentmanagementCurrentglycemiccontrolHgBA1cGlucometerdtaPresenceofcomplicationsNeuropathyNephropathyRetinopathyAutonomicneuropathyincreaseriskofpostopgastroparesisandurinarytractinfectionPatientswithdiabetes:
whatp外科学教学课件：PerioperativeManagementPerioperativeanagementAddpotassiumtothedextroseinfusionMonitorbloodglucoseandelectrolytesfrequentlythroughouttheoperativeandearlypostoperativeperiodPerioperativeanagementAddpot
Recoveryroomisnecessary
ICUisoptimalifpossibleMonitoring
CloselymonitorthelifesignsasaroutineCVPmonitoringisnecessaryifhemodynamicunstableduringoperationOtheritemsmonitoredaccordinglyFluidbalancePost-operativeManagementRecoveryroomisnecesPositionandGetting-upSupinepositionforspiralanaesthesiaSemirecliningpositionforneckandchestoperation.Lateralpositionforobesitypatients.GetupasearlyaspossibleandmakemovementsasmuchaspossiblePositionandGetting-upSupinDietandTransfusionPeriodoffastdependsuponthetypeofoperation.Enteralandparenteralnutritionshouldbetakenintoconsideration.Fluidandelectrolyteshomeostasisshouldbemaintained.DietandTransfusionPeriodoManagementofDrainageDifferentdrainagefordifferentpurpose(infectionfocus,leakagepreventionandmassiveexudation)Nasal-gastrictubeUrinarycatheterManagementofDrainageDiffere外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagementWoundHealingandSutureRemovingClassificationofincision
cleanincisioncontaminatedincisioninfectedincisionTypeofhealing
TypeAperfecthealingBsomeinflammationCinfectedWoundHealingandSutureRemovPostoperativepain
anymotionsincreasingtensionswillincreasepainAnalgesiaisobligatoryPyrexia
commonpostoperativeobservationasearchbemadeforafocusofinfectionnon-infectivecausesofpyrexiaManagementofPostoperativeComplaintsPostoperativepainManagementoNauseaandVomitingDrugsopiates,antibiotics,metronidazoleBowelobstructionmechanicalobstructionAdynamicbowelHypokalaemiafaecalimpactionSystemicdisorderselectrolytedisturbancesUraemiaraisedintracranialpressureNauseaandVomitingDrugsAbdominalDistensionMorecommonafterabdominalsurgeryHiccupDiaphragmirritationorcentralnervoussystemstimulatedSubphrenicinfectionshouldbesuspectedforcontinuoushiccupAbdominalDistensionMorecommoRetentionofUrineThereisapalpablesuprapubicmasswithdulltopercussion.Urinarycatheterisindicatedwhendiagnosed.RetentionofUrineThereisaThemainpostoperativecomplicationsAtelectasisChestinfectionAspirationpneumonitisPneumoniaThemainpostoperativecomplicPostoperativeHaemorrhageCausesinadequateoperativehaemostasisatechnicalmishapasslippedligatureManagementre-operationtostopbleedingsomepreparationisnecessaryPostoperativecomplicationsPostoperativeHaemorrhageCauseWoundDehiscence(BurstAbdomen)Causesbloodsupplyispoorexcesssuturetensionlong-termsteroidtherapyimmunosuppressivetherapymalnutritioninfectioncoughingorabdominaldistensionManagementre-suturingwithtensionsuturesthewholethicknessoftheabdominalwallWoundDehiscence(BurstAbdomeMinorwoundinfectionslocalizedpain,rednessandaslightdischargeWoundCellulitisandAbscesscellulitistreatedbyantibioticsabscesstreatedbysurgical drainage
WoundInfectionMinorwoundinfectionsWoundIn外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagementAtelectasis
AirwayobstructedairisabsorbedfromtheairspacesdistaltotheobstructionBronchialsecretionsarethemainPreventionandtreatment
perioperativephysiotherapyisthebestwayforpreventiondeepbreathingexercisesregularadjustmentsofposturevigorouscoughingflexiblebronchoscopytoaspirateoccludingmucusplugsAtelectasisAirwayobstructedUrinaryTractInfectionsCausesreducedurinaryoutputreducing“flushing”ofbladderincompletebladderemptyinginadequateperinealhygieneTreatment
ensuringadequatefluidinputappropriateantibioticsUrinaryTractInfectionsCausesCauses
bedboundafteroperationvenousstasisplasmaconcentratedduedehydrationviscosityincreasedManifestationsswellingofthelegtendernessofthecalfmuscleincreasedwarmthofthelegcalfpainonpassivedorsiflexionofthefootDeepVeinThrombosisCausesbedboundafteroTreatment
Anticoagulation:
Systemicthrombolytictherapy:
streptokinaseLocalthrombolyticdrugsismorepromisingintravenousheparinsubcutaneousheparinoralwarfarintherapyDeepVeinThrombosisTreatmentintravenousheparinDepostoperativemobilizationadequatehydrationavoidingcalfpressurePreventionHighRiskCaseslowdosesubcutaneousheparincalfcompressiondevicesgraded-compression‘anti-embolism’stockingsIntravenousdextranWarfarinanticoagulationDeepVeinThrombosispostoperativemobilizationPSamplePreoperativeChecklistOperativepermit,appropriatelysignedandwitnessedDietaryconsiderationsForabdominaloperation,liquiddietandlaxativestoensureclean,collapsedbowelNothingbymouthatleast6hrbeforeoperationSamplePreoperativeChecklistReviewoflife-supportsystemsVitalsignsrecordedoftenenoughtoestablishnormalvaluesPulmonarysystem:chestfilms;OtherstudiesasindicatedCardiacfunction:electrocardiogram;OtherstudiesasindicatedSamplePreoperativeChecklistReviewoflife-supportsystemsRenalfunction:urinalysis;BloodureanitrogenandpossiblybloodcreatininedeterminationsAdequatehydrationuptotimeofoperation,especiallytocompensateforlaxativesandfastingAreaofoperationwashedwithappropriategermicidaldetergentandshaved,clipped,orcleansedwithdepilatoryagentBloodtransfusionspreparedasanticipatedSamplePreoperativeChecklistRenalfunction:SamplePreoperaOrderforpatienttovoidoncalltooperatingroomPreoperativemedications:vagolyticandsedativedrugsSpecialmedications:digitalis,insulin,etc.SamplePreoperativeChecklistOrderforpatienttovoidoncFast—trackrehabilitationinsurgery(外科快速康复方法)Enhancedrecoveryaftersurgery(促进外科手术后康复程序)Fast-trackSurgeryFast—trackrehabilitationinsSurgeonsNamedNobelLaureates
inMedicineandPhysiologySurgeon(Dates)
Country
Field(YrofAward)
TheodorKocher(1841-1917)AllvarGullstrand(1862-1930)AlexisCarrel(1873-1944)RobertBarany(1876-1936)FrederickBanting(1891-1941)WalterHess(1881-1973)WernerForssmann(1904-1979)CharlesHuggins(1901-1997)JosephMurray(born1919)SwitzerlandSwedenFranceandU.S.AAustriaCanadaSwitzerlandGermanyUnitedStatesUnitedStatesThyroiddisease(1909)Oculardioptrics(1911)Vascularsurgery(1912)Vestibulardisease(1914)Insulin(1922)Midbrainphysiology(1949)Cardiaccatheterization(1956)Oncology(1966)Organtransplantation(1990)SurgeonsNamedNobelLaureatesQuestions?Questions?ThankYou!ThankYou!PerioperativeManagementPerioperativeManagementPerioperativePeriodDefinitiondependsonmultiplefactorsImportancedirectlyrelatedtotheoutcomeofsurgeryitselfCompositionpreoperativepreparation&postoperativemanagementPerioperativePeriodDefinition
1.Electivesurgery2.Restrictivesurgery3.EmergentsurgeryPreoperativePreparationTheprincipleDifferentpreparationfordifferentproceduresTheclassificationofoperationsaccordingtothecharacteristicsofoperationsElectivesurgeryRestrictivesurgeryEmergentsurgery1.ElectivesurgeryPreoperativElectiveSurgeryElectiveSurgeryRestrictiveSurgeryRestrictiveSurgeryEmergentSurgeryEmergentSurgeryDr.EvilSays….$$$$????Dr.EvilSays….$$$$TheodorKocher(1841-1917)WithTheodorBillrothestablishedlargeclinicsinEuropeand,throughdevelopmentofskilledsurgicaltechniquescombinedwithneweranestheticandantisepticprinciples,providedsurgicalresultsthatprovedthesafetyandefficacyofthyroidsurgeryforbenignandmalignantproblemsTheodorKocher(1841-1917)WitWilliamStewartHalsted(1852-1922)ASCENTOFSCIENTIFICSURGERYResearchbasedonanatomic,pathologic,andphysiologicprinciplesandemployinganimalexperimentationHalstedianprinciples
WilliamStewartHalsted(1852-ToconfirmthediagnosisToassesstheriskofoperationToassessthegeneralconditionandfunctionofimportantorgansToevaluatethepatientsendurancetotheoperationandriskofoperationPreoperativeAssessmentToconfirmthediagnosisPreoEssentialStepsHistorytakingPhysicalexaminationArranginganyfurtherdiagnosticinvestigationMakingspecialpreparationsfortheparticularoperationInvestigatinganyintercurrentoroccultillnesssuggestedbymedicalclerkingEssentialStepsHistorytakingEssentialStepsDiscussingtheoperationwiththepatientandhisfamilyandobtainingsignedconsentMarkingtheoperationsiteMakingarrangementsfortheoperationwiththeoperatingtheatrestaffArrangingandinformingtheanesthetistsPrescribingmedication:prophylacticantibioticsetc.PlanningrehabilitationandconvalescenceEssentialStepsDiscussingthePsychologicalpreparation
talkfranklyandappropriatelytopatientsandfamiliesPhysiologicalpreparationAdaptiveexerciseTransfusionPreventionofinfectionGastro-intestinaltractpreparationMaintenanceoffluid,electrolytesandnutritionGeneralPreparationPsychologicalpreparationAdaMalnutritionanddysfunctionofimmunesystem
MalnutritiondramaticallyincreasesthemorbidityandmortalityPreoperativenutritionalsupportismorevaluableSpecificPreparationMalnutritionanddysfunctionoHypertension
Mild-to-moderateessentialhypertension
systolicpressure＜180mmHg
diastolicpressure＜110mmHg
Atminimalriskofcardiaccomplication
AntihypertensivedrugsshouldbeusedalltimeSuddenwithdrawalofdrugsisdangerousHypertensionMild-to-moderaSevereorPoorlyControlledHypertensionAthighriskofperioperativecardiacfailureorstroke.Thistypeofpatientsshouldnotundergogeneralanaesthesiaandsurgeryuntiladequatelytreated.Thebloodpressureshouldbereasonablycontrolledunder160/100mmHg.SevereorPoorlyControlledHyCardiovascularDiseasesIschemicheartdiseaseCardiacfailureArrhythmiasValvularheartdiseaseCerebrovasculardiseaseCardiovascularDiseasesIscheAnginaandPreviousInfarctionPreviousinfarctionStableanginaposeslittleincreasedriskduringoperationbutunstableanginaisasdangerousasrecentmyocardialinfarctionTheriskofreinfarctionisabout30%ifanoperationisperformedduringthefirst3monthsAt6monthstheriskisabout10~15%whichmaybeacceptableforimportantelectivesurgeryAnginaAnginaandPreviousInfarctionAdequatePreparationforHeartDiseaseTocorrectthefluidandelectrolytesimbalance.Tocorrectanaemiathroughseveralbloodtransfusionwithsmallamount.Tocontrolthecardiacarrhythmias.(Atrialfibrillation,Tachycardia,Bradycardia)AdequatePreparationforHeartRespiratorydysfunctionRespiratorycomplicationsoccurinupto15%ofsurgicalpatientsandaretheleadingcauseofpostoperativemortalityintheelderly.RespiratorydysfunctionRespiraRiskFactorsforRespiratoryComplicationChronicobstructivepulmonaryorairwaysdiseaseChronicbronchitis,emphysema,bronchiectasis,pneumoconiosis,pulmonarytuberculosesCigarettesmokingCurrentrespiratoryinfectionsAsthmaRiskFactorsforRespiratoryCPreoperativeInvestigationAchestX-rayCTscanifnecessaryEKGSpirometerBloodgasmeasurementPreoperativeInvestigationAPerioperativemanagement`PreoperativephysiotherapyteachingthepatientbreathingexercisesandcorrectpostureDrugtherapyTheophyllinesProphylacticantibioticsPreoperativebronchodilatorAdequatehydrationPerioperativeManagementPerioperativemanagement`PreopEncouragetostopsmokingfromthetimeofbookforelectivesurgeryAlternationmethodsofanesthesia
Local,regionalorspiralanesthesiashouldbeconsideredEarlypostoperativephysiotherapy
toenhancedeepbreathing,coughingandgeneralmobility
PerioperativeManagementEncouragetostopsmokingfromLiverDisorderThetolerancetooperationdependsupontheseverityofliverfunctionimpairment.TheliverfunctioncouldbeestimatedbyChildstagingorMELDscoreMalnutrition,ascitesandjaundicearecontraindicationsexceptforemergencysurgery.
LiverDisorderThetolerancePreoperativeAssessmentandManagementHBVandHCV,CBCClottingscreenandplateletcountElectrolytesLiverandrenalfunctionWhenprothrombintimeisprolonged,vitaminKshouldbegivenforseveraldaysbeforeoperation.PreoperativeAssessmentandMaRenalDisordersPreoperativeassessmentplasmaurea,electrolytes,creatinineandBicarbonateshouldbecheckedMildchronicrenalfailure
DrugsshouldbegiveninsmallerdosesFluidandelectrolytehomeostasisModerate-to-severechronicrenalfailure
Operationsshouldbeperformedunderhaemodialysis
RenalDisordersPreoperativeasDiabetesMellitusAtspecialriskfromgeneralanesthesiaandsurgery
Patientswithdiabetesfallintothreegroups1.Insulindependent2.Takingoralhypoglycaemicmedication3.Diet-controlledDiabetesMellitusAtspeciaAttempttomaintainbloodglucoselevelbetween4and10mmol/Lavoidhypoglycemiainparticular.Bloodglucoselevel＞13mmol/LAnunreceptibleriskofketoacidosisorahyperosmolarnon-ketoticstate.PerioperativeManagementAttempttomaintainbloodglEstablishgooddiabeticcontrolbeforeoperationGiveninsulinasacontinuousintravenousinfusionduringtheoperativeperiodGivenaninfusionofdextrosethroughouttheoperativeperiodtobalancetheinsulingivenandtomakeupforlackofdietaryintakePerioperativeManagementEstablishgooddiabeticcontroPatientswithdiabetes:
whatpre-operativeassessmentisimportant?DocumentthefollowingTypeofdiabetesLengthoftimesincediagnosisCurrentmanagementCurrentglycemiccontrolHgBA1cGlucometerdtaPresenceofcomplicationsNeuropathyNephropathyRetinopathyAutonomicneuropathyincreaseriskofpostopgastroparesisandurinarytractinfectionPatientswithdiabetes:
whatp外科学教学课件：PerioperativeManagementPerioperativeanagementAddpotassiumtothedextroseinfusionMonitorbloodglucoseandelectrolytesfrequentlythroughouttheoperativeandearlypostoperativeperiodPerioperativeanagementAddpot
Recoveryroomisnecessary
ICUisoptimalifpossibleMonitoring
CloselymonitorthelifesignsasaroutineCVPmonitoringisnecessaryifhemodynamicunstableduringoperationOtheritemsmonitoredaccordinglyFluidbalancePost-operativeManagementRecoveryroomisnecesPositionandGetting-upSupinepositionforspiralanaesthesiaSemirecliningpositionforneckandchestoperation.Lateralpositionforobesitypatients.GetupasearlyaspossibleandmakemovementsasmuchaspossiblePositionandGetting-upSupinDietandTransfusionPeriodoffastdependsuponthetypeofoperation.Enteralandparenteralnutritionshouldbetakenintoconsideration.Fluidandelectrolyteshomeostasisshouldbemaintained.DietandTransfusionPeriodoManagementofDrainageDifferentdrainagefordifferentpurpose(infectionfocus,leakagepreventionandmassiveexudation)Nasal-gastrictubeUrinarycatheterManagementofDrainageDiffere外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagementWoundHealingandSutureRemovingClassificationofincision
cleanincisioncontaminatedincisioninfectedincisionTypeofhealing
TypeAperfecthealingBsomeinflammationCinfectedWoundHealingandSutureRemovPostoperativepain
anymotionsincreasingtensionswillincreasepainAnalgesiaisobligatoryPyrexia
commonpostoperativeobservationasearchbemadeforafocusofinfectionnon-infectivecausesofpyrexiaManagementofPostoperativeComplaintsPostoperativepainManagementoNauseaandVomitingDrugsopiates,antibiotics,metronidazoleBowelobstructionmechanicalobstructionAdynamicbowelHypokalaemiafaecalimpactionSystemicdisorderselectrolytedisturbancesUraemiaraisedintracranialpressureNauseaandVomitingDrugsAbdominalDistensionMorecommonafterabdominalsurgeryHiccupDiaphragmirritationorcentralnervoussystemstimulatedSubphrenicinfectionshouldbesuspectedforcontinuoushiccupAbdominalDistensionMorecommoRetentionofUrineThereisapalpablesuprapubicmasswithdulltopercussion.Urinarycatheterisindicatedwhendiagnosed.RetentionofUrineThereisaThemainpostoperativecomplicationsAtelectasisChestinfectionAspirationpneumonitisPneumoniaThemainpostoperativecomplicPostoperativeHaemorrhageCausesinadequateoperativehaemostasisatechnicalmishapasslippedligatureManagementre-operationtostopbleedingsomepreparationisnecessaryPostoperativecomplicationsPostoperativeHaemorrhageCauseWoundDehiscence(BurstAbdomen)Causesbloodsupplyispoorexcesssuturetensionlong-termsteroidtherapyimmunosuppressivetherapymalnutritioninfectioncoughingorabdominaldistensionManagementre-suturingwithtensionsuturesthewholethicknessoftheabdominalwallWoundDehiscence(BurstAbdomeMinorwoundinfectionslocalizedpain,rednessandaslightdischargeWoundCellulitisandAbscesscellulitistreatedbyantibioticsabscesstreatedbysurgical drainage
WoundInfectionMinorwoundinfectionsWoundIn外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科学教学课件：PerioperativeManagement外科
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