Postoperative monitoring

Since up to 10% of pituitary tumors may recur within 15 years following surgery,6,14 continual postoperative monitoring is recommended. 

A. Repez, D. Oroszy, and Z. M. Amez, Continuous Postoperative Monitoring of Cutaneous Free Flaps Using Near Infrared Spectroscopy,. Plast. Reconstr. Aesihet. Surg., 61, 71e77 (2008). 

These new analytical probes are without rival in applications where continuous flow measurements are required, as in the cases of process monitoring, of kinetic measurements, or postoperative monitoring of pH, pNa and pK of blood. Their sturdy, largely maintenance-free construction and broad dynamic response range (3 to < 10" mol/1), together with the short response time (a few seconds) is especially valuable for industrial applications (process control, waste water monitoring), because subsequently coupled controlling devices can intervene with minimal delay. 

The nurse describes or explains immediate postoperative care, such as die postanestiiesia recovery room or a special postoperative surgical unit and die activities of die physicians and nurses during diis period. The nurse tells die patient tiiat his or her vital signs will be monitored frequentiy and diat odier equipment, such as intravenous fluids and monitors, may be used. 

Patients must be monitored to assess their response to treatment and to detect recurrent diseases. PSA as a specific marker for prostate cancer is most useful in monitoring patients who have been treated with radical prostatectomy, radiation therapy, or endocrine therapy. The concentration of PSA falls to undetectable levels following a radical prostatectomy because all prostate tissue has been removed. Generally, PSA is measured at periodic intervals. In studies, the extent of disease at the time of surgery correlated well with the postoperative PSA concentration. A significant measurable PSA concentration after prostatectomy indicates that residual tumor may be present. PSA concentrations decline gradually after radiation therapy (36). 

Pain intensity, pain relief, and medication side effects must be assessed on a regular basis. The timing and regularity of assessment depend on the type of pain and the medications administered. Postoperative pain and acute exacerbations of cancer pain may require hourly assessment, whereas chronic nonmalignant pain may need only daily (or less frequent) monitoring. 

Hypoventilation Monitor patients who have received flumazenil for the reversal of benzodiazepine effects (after conscious sedation or general anesthesia) for resedation, respiratory depression or other residual benzodiazepine effects for an appropriate period (120 minutes or less) based on the dose and duration of effect of the benzodiazepine employed, because flumazenil has not been established as an effective treatment for hypoventilation due to benzodiazepine administration. Flumazenil may not fully reverse postoperative airway problems or ventilatory insufficiency induced by benzodiazepines. In addition, even if flumazenil is initially effective, such problems may recur because the effects of flumazenil wear off before the effects of many benzodiazepines. 

Because of the anticholinergic action of these agents, use with caution and with appropriate monitoring in patients with glaucoma, obstructive disease of the Gl or GU tract, and in elderly males with possible prostatic hypertrophy. These drugs may have a hypotensive action, which may be confusing or dangerous in postoperative patients. 

Uses Minimize paralytic ileus, Rx postop distention Action Cholinergic agent Dose Adults. Relief of gas 2-3 tabs PO tid Prevent postop ileus 250-500 mg IM stat, repeat in 2 h, then q6h PRN Ileus 500 mg IM stat, repeat in 2 h, then q6h, PRN Caution [C, ] Contra Hemophilia, mechanical bowel obst Disp Inj, tabs, cream SE GI cramps EMS May cause bowel obstruction, monitor pt for abd pain and inquire about recent bowel habits OD Sxs unknown symptomatic and supportive... 

Naguib M, Kopman AF, Ensor JE Neuromuscular monitoring and postoperative residual curarisation a meta-analysis. Br J... 

Postoperatively, the anesthesiologist withdraws the anesthetic mixture and monitors the immediate return of the patient to consciousness. For most anesthetic agents, recovery is the reverse of induction that is, redistribution from the site of action rather than metabolism underlies recovery. The anesthesiologist continues to monitor the patient to be sure that there are no delayed toxic reactions, for example, diffusion hypoxia for nitrous oxide, and hepato-toxicity with halogenated hydrocarbons. 

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