Patients, post-operative

Patients immediate post-operative pain is lower compared to a standard operation and healing and rehabiUtation more rapid. Patients can resume near-normal activities in just days. In some cases athletes, who are in prime physical condition, can return to challenging athletic activities within a few weeks. CompHcations are rare, but do occur on occasion. Most complications associated with this surgery are infection, phlebitis, excessive swelling or bleeding, blood clots, or damage to blood vessels or nerves. 

Gentian violet solution is used to delineate the areas to be treated. Refrigerant topical anesthesia is used to freeze the skin prior to the procedure. Holding the skin taut, the dermabrader treats one anatomic unit at a time. Post-operatively, patients may have an open or closed dressing system, use antiviral agents, antibacterials and corticosteroids. The re-epithelialization is complete in 5-7 days and residual erythema is common for up to 4 weeks. 

Active labial HSV infection. Prescribe prophylaxis with oral antivirals in patients with relapsing HSV (2 days pre- and 5 days post-operatively)... 

I have used the following "rule-of-thumb" formulas to predict the expected P02 values under room air conditions in normal (equation 1) and post-operative (equation 2) patients the "variation" of the prediction formulas is t 5. 

Equations 3 and 4 are used when 100% oxygen is given to normal and post-operative patients, respectively in this case the "variation" is t25. 

The Center for Disease Control and Prevention conducted a randomized epidemiological study on patients who had received morphine nerve paste post-operatively for pain management purposes. Ninety-four percent of the patients used in the cohort presented themselves with surgical-site comphcations such as edema and inflammation 24 days (median) post-operation. Upon culturing of the wounds, 64% tested positive for bacterial infection. It is important to note that aU of the patients were found to have residual morphine paste on board indicative of a chronic morphine state (Sacerdote et al. 2000). 

The patient should be monitored for signs and symptoms of infection post-operatively. These could include pus, erythema, and fever. If signs consistent with SSI appear, cultures should be taken and additional antimicrobial therapy should be considered. 

Ng, B. and J. Dimsdale, "The Effect of Ethnicity on Prescriptions for Patient Controlled Analgesia for Post-Operative Pain," Pain 66(1), 9-12 (1996). 

One definition of post-operative paralytic ileus is the failure of the patient to pass faeces or flatus within 60 hr. of the termination of a surgical abdominal operation . A somewhat similar condition may arise in cases of gross mechanical obstruction of the gut. It is well known also that operations involving handling of the gut or the peritoneum are especially liable to cause paralytic ileus. Peritonitis and post-operative pain, inadequately treated with morphia, also precipitate paralytic ileus. Pneumonia, meningitis and typhoid predispose to paralytic ileus, whilst severe hypothyroidism can also be complicated by a paralytic ileus. 

The term post-operative fatigue describes the state of overall drowsiness felt by patients who have undergone surgery it can last for many days after the operation. 

Pentazocine has been successfully used to relieve labour pain [201] and its obstetric use in place of pethidine is favoured by,its apparent inferior ability to pass the placental barrier [206]. A clinical trial of (+)- and (-)-pentazocine adds to the rare number of examples in which optical enantiomorphs have been evaluated [207]. In post-operative patients, response to 60 mg of the dextro isomer was less than that to 5 mg of morphine, while 25—29 mg of (-)-pentazocine was as effective as 10 mg of morphine. Hence most of the activity of the race-mate resides in the laevo isomer, as anticipated from results in animals [208]. Several studies of the distribution, excretion and metabolism of pentazocine have been made. Peak levels of the tritium-labelled drug (and its c/s-3-chloroallyl analogue) were present in the C.N.S. of a cat within 40 minutes of intramuscular administration [209], the comparable figure for morphine being 2 hours [210]. 

Consider a second example. A surgeon devises a new method of carrying out a surgical procedure and pilots the technique in 10 patients of which none suffer a post-operative infection. Can he claim therefore that the new technique is safe The answer again is no because in this case the upper end of the 95% confidence for the true infection rate is 0-26 % so that infection rate could be as high as one in four. (Hanley and Lippman-Hand developed a simple approximation for the 95% confidence for cases in which the observed data are of the form 0 out of n. They show that approximately the interval is 0-3 / n %. This is known as the rule of three. 

Stephens RJ, Girling DJ, Bleehen NM, et al. The role of post-operative radiotherapy in non-small-cell lung cancer A multicentre randomized trial in patients with pathologically staged Tl-2, Nl-2, MO disease. Medical Research Council Lung Cancer Working Party. BrJ Cancer 1996 74 632-639. 

After a 40-month mean follow-up period (range 3-66 months after removal of the heavy oil), total retinal reapplication was achieved in 16 cases. Three patients suffered from RD recurrence under silicone oil by proliferative vitreretinopathy (PVR) and one after silicone oil removal. Post-operative visual acuity, better than quantitative vision, making deambulation possible, was achieved in 10 patients with a mean acuity of 1/20 and at least 3/10 in 3 patients. 

In our series, full retinal reapplication was achieved in 16 of 17 patients (95%). There was only one case of major emulsification immediately after surgery. This was consistent with Wolfs results [47], who reported no case of emulsification with Oxane Hd . Only once did we note silicone passage into the anterior chamber. Wolf reported the post-operative passage of heavy silicone oil (1.03 g/cm ) into the anterior chamber in two aphatic patients despite superior peripheral iridectomy. The incidence of post-operative glaucoma was lower in our series than that reported by Wolf [47] and other publications on standard silicone oil complications [16,17]. Heavy oil removal was uneventful in all patients in Wolfs series, who used 1.03 g/cm density silicone oil. Likewise, in all our patients operated on with the same density (1.03 g/cm ) heavy silicone oil (17 eyes), active extraction with the extraction module of the vitrectomy apparatus posed no problem. 

It is an anionic detergent which softens the stool by water accumulation in intestinal lumen and emulsifies the colon contents. It is indicated in obstetric, habitual, geriatric, paediatric constipation or when straining is to be avoided (recent myocardial infarction, severe hypertension, post-operative cases, abdominal hernia), fissures, haemorrhoids and bed ridden patients. Dose 100-200 mg/day. 

Alon E, Jaquenod M, Schaeppi B. Post-operative epidural versus intravenous patient-controlled analgesia. Minerva Anestesiol. 2003 69 443—4-46. 

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