Postoperative period

The cephalosporins also may be used perioperatively, that is, during the preoperative, intraoperative, and postoperative periods, to prevent infection in patients having surgery on a contaminated or potentially contaminated area, such as the gastrointestinal tract or vagina In some instances, a specific drug may be recommended for postoperative prophylactic use only. 

Remifentanil (Ultiva) is used for induction and maintenance of general anesthesia and for continued analgesia during the immediate postoperative period. This drug is used cautiously in patients witii a history of hypersensitivity to fentanyl. 

Control of blood pressure in perioperative hypertension and in immediate postoperative period, CHF associated with acute Ml, angina pectoris unresponsive to recommended doses of nitrates or beta blockers... 

In patients with peritonitis, hypovolemia is often accompanied by acidosis, so large volumes of a solution such as lac-tated Ringers may be required initially to restore intravascular volume. Maintenance fluids should be instituted (after intravascular volume is restored) with 0.9% sodium chloride and potassium chloride (20 mEq/L) or 5% dextrose and 0.45% sodium chloride with potassium chloride (20 mEq/L). The administration rate should be based on estimated daily fluid loss through urine and nasogastric suction, including 0.5 to 1.0 L for insensible fluid loss. Potassium would not be included routinely if the patient is hyperkalemic or has renal insufficiency. Aggressive fluid therapy often must be continued in the postoperative period because fluid will continue to sequester in the peritoneal cavity, bowel wall, and lumen. 

Venous thrombectomy may be performed to remove a massive obstructive thrombus in a patient with significant iliofemoral venous thrombosis, particularly if the patient is either not a candidate for or has not responded to thrombolysis. Full-dose anticoagulation therapy is essential during the entire operative and postoperative period. These patients need indefinite oral anticoagulation therapy targeted to an INR of 2.5 (range 2.0 to 3.0). 

Pain - For analgesic action of short duration during anesthesia (premediaction, induction, maintenance) and in the immediate postoperative period (recovery room) as needed. 

Not indicated for pain in the immediate postoperative period (the first 12 to 24 hours following surgery), or if the pain is mild or not expected to persist for an extended period of time. Oxycodone controlled-release tablets are only indicated for postoperative use if the patient is already receiving the drug prior to surgery or if the postoperative pain is expected to be moderate to severe and persist for an extended period of time. Individualize treatment, moving from parenteral to oral analgesics as appropriate. 

Continuation as an analgesic Into the immediate postoperative period -Remifentanil infusions may be continued into the immediate postoperative period for select patients for whom later transition to longer-acting analgesics may be desired. The use of bolus injections of remifentanil to treat pain during the postoperative period is not recommended. When used as an IV analgesic in the immediate... 

Patients 13 years of age and older- 0.3 mg IM or slow IV, every 6 hours, as needed. Repeat once (up to 0.3 mg) if required, 30 to 60 minutes after initial dosage, giving consideration to previous dose pharmacokinetics use thereafter only as needed. In high-risk patients (eg, elderly, debilitated, presence of respiratory disease) or in patients where other CNS depressants are present, such as in the immediate postoperative period, reduce dose by about 50%. Exercise extra caution with the IV route of administration, particularly with the initial dose. 

Neurosurgery (prophylactic dosage) - 100 to 200 mg IM at approximately 4 hour intervals during surgery and the postoperative period. 

Renal homotransplantation Initial dose is usually 3 to 5 mg/kg/day, given as a single daily dose on the day of transplantation, and in a minority of cases, 1 to 3 days before transplantation. It is often initiated IV, with subsequent use of tablets (at the same dose level) after the postoperative period. Reserve IV administration for patients unable to tolerate oral medications. Maintenance levels are 1 to 3 mg/kg/day. 

Postoperative inflammation Apply 1 to 2 drops into the conjunctival sac of the operated eye(s) 4 times daily beginning 24 hours after surgery and continuing throughout the first 2 weeks of the postoperative period. MEDRYSONE Shake well before using. Instill 1 drop into the conjunctival sac up to every 4 hours. 

Opioids play an important role in anesthetic practice. Opioid analgesics potentiate the efficacy of anesthetics. They can be given as part of the premedication as well as during the operation. Examples of short acting agents with high potency are fentanyl, sufentanyl, alfentanil and remifentanil. Because of their hemodynamic stability these agents can be used for patients with compromised myocardial function. Respiration must be maintained artificially and may be depressed into the postoperative period. They are usually supplemented with inhalation anesthetic, benzodiazepines or propofol. 

Opioid analgesics have always been important for the control of pain in the preoperative and postoperative periods. They are also used to supplement anesthesia... 

Although opioid anesthesia is particularly useful in patients with compromised myocardial function, the opioids depress respiration by inhibiting the responsiveness of the medullary respiratory center to PCO2 and alter the rhythm of breathing. Consequently, it is necessary to assist ventilation intraoperatively. Since respiratory depression may extend into the postoperative period as a result of drug accumulation in the tissues, the use of opioids whose clearances are slow, remain most appropriate for patients who are expected to require postoperative ventilatory care. 

It causes antiemetic action by blocking dopamine (D receptors and it also increases gastric motility. It is absorbed orally but bioavailability is 15% due to first pass metabolism. It is completely biotransformed and metabolites are excreted in urine. It is used in nausea and vomiting in postoperative period, drug induced, radiation, uraemia, hepatitis, peptic ulcer. It is also useful in reflex oesophagitis. 

It is known that the development of complications in postoperative period and their severity mostly depend on patient s adaptation capabilities to cope with the anaesthetic stress. Complications associated with anesthesia can be aggravated by the influence of other concomitant pathology, including the progression of hver tissue hypoxia [1 ]. 

We investigated homeostasis in patients with hver cirrhosis in the pre- and postoperative period, which has allowed us to reveal clinical pathological mechanisms of complications developed in the postoperative period and to study the effect of hyperbaric oxygenation to prevent these complications. 

Since 1995, to improve rehabilitation in our Centre, the hyperbaric oxygenation method has been used in the postoperative period in patients with liver cirrhosis. HBO was carried out in a single barocamera BLKS-3-01 in pure oxygen (purity 99.5%) at pressure of 1.6-2.0 kg-force cm . The duration of a session was 40-60 min, and 8-10 sessions were required for one course of treatment. All patients had a determined individual indication for HBO. 

Based on our studies, it is possible to recommend HBO in postoperative period for patients with Uver cirrhosis to increase the efficacy of the Uver detoxification function. Depending on the type of the morphological form of liver cirrhosis, this would help to optimise the process of surgical treatment of patients with fiver cirrhosis. 

Patients with abdominal sepsis received usual drug therapy combined with biospecific hemosorption with Lyposorb. All patients were urgently operated. After operative procedure patients were transferred to intensive care unit for recovery, where all the necessary treatment and observations were carried out during critical postoperative period. 

The use of propofol is associated with a feeling of well-being during early recovery and nausea and vomiting is less common in the postoperative period than with some other intravenous agents. Subanaesthetic doses of propofol have been used to treat early postoperative nausea and emesis. Cardiovascular system... 

Neurologic disorders Cerebral edema (large doses of dexamethasone are given to patients following brain surgery to minimize cerebral edema in the postoperative period), multiple sclerosis... 

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