Postoperative Care

Postoperative Care - PACU Priorities!

• PACU: Initial Assessment (ABCDE)
  • Airway: Patency, SpO2 > 92%.
  • Breathing: Rate, depth, air entry.
  • Circulation: HR, BP (±20% baseline), rhythm.
  • Disability: LOC, Aldrete Score (target ≥ 9).
  • Environment: Temp > 36°C; pain (VAS < 4), PONV, surgical site.
• Monitor for: Key Concerns
  • Hypoxemia, hypotension/hypertension.
  • Pain, PONV, shivering.
• PACU Discharge Criteria
  • Aldrete Score ≥ 9 (or pre-op baseline).
  • Stable vital signs.
  • Pain & PONV controlled.
  • No active bleeding or new surgical issues.

⭐ Aldrete Score components: Activity, Respiration, Circulation, Consciousness, O2 Saturation (each 0-2; total 10). Target ≥ 9 for discharge.

Postoperative Care - Complication Combat

• PACU Priorities
  • Airway: Obstruction (tongue, spasm), hypoxemia (atelectasis).
  • Hemodynamics: Hypotension (bleed, vasodilation), hypertension (pain), arrhythmias.
  • Hypothermia: Shivering (↑O₂ demand).
• Ward Watch-outs
  • Pain: Multimodal analgesia.
  • PONV: Prophylaxis & treatment (e.g., ondansetron).
  • Fever: 📌 5 W's
    • Wind (atelectasis, pneumonia): Day 1-2
    • Water (UTI): Day 3-5
    • Wound (infection): Day 5-7
    • Walking (DVT/PE): Day 7+
    • Wonder drugs (drug fever)
  • Oliguria: Assess volume status, catheter.
  • Ileus: NGT for distension.
• Delayed Dangers
  • Surgical Site Infection (SSI).
  • DVT/PE: Prophylaxis (LMWH, SCDs), early ambulation.

⭐ Atelectasis is the most common cause of fever in the first 24-48 hours post-operatively.

Postoperative Care - Pain Relief Playbook

• Goal: Optimal pain relief for early mobilization & ↓ complications.
• Assessment: Regular pain scores (VAS, NRS).
• Multimodal Analgesia: Core strategy. Combine agents with different mechanisms.
  • Paracetamol: Max 4g/day.
  • NSAIDs: e.g., Diclofenac. Caution: Renal, GI, bleeding risk.
  • Opioids: e.g., Morphine, Fentanyl. Monitor sedation, respiratory depression, PONV.
  • Regional Anesthesia: Epidural, nerve blocks (e.g., TAP block).
  • PCA (Patient-Controlled Analgesia): Opioids, empowers patient.
• WHO Ladder Adaptation: Stepwise approach.

⭐ Multimodal analgesia aims to provide superior pain relief with fewer side effects by combining different analgesic agents acting on various pain pathways.

Postoperative Care - ERAS & Discharge Dash

• ERAS (Enhanced Recovery After Surgery) Protocols: Multimodal approach to ↓ surgical stress & accelerate recovery.
  • Key elements: Preoperative counselling, optimal nutrition, opioid-sparing analgesia, early mobilization.

  ⭐ Core ERAS principle: Early oral intake (within hours post-op) reduces ileus & hospital stay.

• Discharge Criteria (Post-Anesthesia Discharge Scoring System - PADSS):
  • Vital signs stable (e.g., Aldrete score ≥ 9)
  • Pain controlled
  • Nausea/vomiting minimal
  • Surgical bleeding minimal
  • Able to ambulate & void

High‑Yield Points - ⚡ Biggest Takeaways

• Prioritize airway maintenance and oxygenation immediately post-op.
• Employ multimodal analgesia for optimal pain control and faster recovery.
• Manage Postoperative Nausea and Vomiting (PONV) with prophylaxis and timely treatment.
• Monitor closely for hemorrhage, respiratory depression, and early infection signs.
• Implement early mobilization and DVT prophylaxis to prevent clots.
• Manage postoperative shivering promptly to prevent ↑O2 consumption.
• Assess for PACU discharge using criteria like Aldrete score (vitals, activity, respiration, consciousness, O2 saturation).