Postoperative Management

Bizzarre M, Gross I, Bizzarre M. Inhaled nitric oxide for the postoperative management of pulmonary hypertension in infants and children with congenital heart disease. Cochrane Database Syst Rev. 2005 CD005055. 

The careful monitoring of lOP with applanation tonometry at each follow-up visit is an important aspect of postoperative management. lOPs that are either elevated or depressed outside the expected range for a particular patient are considered to be a postoperative complication and should be managed accordingly (see Managing Complications, below). 

Trauma or surgery Initially 100%, then 50% until wound healing complete Perioperative and postoperative management plan must be in place preoperatively evaluation for inhibitors is crucial prior to elective surgery... 

Unlike other parenteral anesthetics, ketamine increases cerebral blood flow and ICP with minimal alteration of cerebral metabolism. These effects can be attenuated by concurrent administration of thiopental and/or benzodiazepines along with hyperventilation. However, given that other anesthetics actually reduce ICP and cerebral metabohsm, ketamine is relatively contraindicated for patients with increased ICP or those at risk for cerebral ischemia. The effects of ketamine on seizure activity are mixed. Emergence dehrium characterized by hallucinations is a frequent comphcation of ketamine that can result in serious patient dissatisfaction and can complicate postoperative management. Delirium is most frequent in the first hour after emergence and appear to occur less frequently in children benzodiazepines reduce the incidence of emergence delirium. 

In one patient respiratory syncytial virus pneumonia complicated his postoperative management. In contrast, this patient responded to inhaled nitric oxide with an increase in saturation from 48% to 87%, and the transpulmonary gradient decreased from 12 to 4 mm Hg without a change in left atrial pressure. He was subsequently managed for 93 hr on low-dose nitric oxide at doses of 3-10 ppm. Following resolution of his pneumonia, he made a good recovery. 

Yahagi, N., Kumon, K., and Tanigami, H. (1994). Inhaled nitric oxide for the postoperative management of Fontan-type operations. Ann. Thorac. Surg. 57, 1371-1372. 

The key point in postoperative management of patients undergoing TLE is proper monitoring, which includes admission to the intensive care unit immediately after the procedure. Good monitoring depends on several factors (Table 3.3). 

Table 3.3 Transvenous lead extraction check list 3 postoperative management...

In our practice, we consider three different settings in postoperative management of TLE ... 

J. S. Tweddell, N. S. Ghanayem, and G. M. Hoffman, Pro NIRS Is "Standard of Care" for Postoperative Management, Semin. Thoraa Cardiovasa Surg. Pediatr. Cardiac Surg. Annu., 13(1), 44 (2010). 

Mandy S 1986 Tretinoin in the preoperative and postoperative management of dermabrasion. Journal of the American Academy of Dermatology 15(4] 878-879, 888-889... 

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