Postoperative care begins at the end of the operation goes on in the recovery room and extends over the entire recovery process in the hospital and outpatient back. Particularly urgent, it depends on one protecting the respiratory tract, a controlling pain, the alertness and orientation degree as well as wound healing. Also important is the prevention of urinary retention, constipation, deep vein thrombosis (DVT) and blood pressure fluctuations in both directions. In diabetic patients, blood glucose is postoperatively closely monitored by means of test strips every 1-4 hours until the patient is awake and able to take food, since a control of blood sugar levels improves the result. Respiratory Most patients extubated still in the operating room and can immediately cough up secretions. Patients should only be moved from the recovery room if they can cough and protective reflexes are present, unless they are moved to an intensive care unit. After intubation patients may experience a normal trachea and normal lung a slight cough over a period of 24 hours after extubation; in smokers and in patients with a history of bronchitis symptoms these stops outside longer. Most of the patients with general anesthesia, particularly smokers and those with lung disease, benefit from breathing exercises. Postoperative dyspnea can (be hypoxic dyspnea s. A. Oxygen saturation caused) by pain following abdominal or thoracic intervention (not hypoxic dyspnea) or by hypoxemia. Hypoxemia due to pulmonary dysfunction is usually accompanied by dyspnea, tachypnea, or both; However, a oversedation can cause hypoxemia blunt dyspnea, tachypnea, or both. Therefore sedated patients should be monitored by pulse oximetry or capnography. Hypoxic dyspnea can of atelectasis or, particularly in patients with a history of congestive heart failure or chronic kidney disease, resulting from a volume overload. The differentiation between hypoxic and non-hypoxic respiratory distress is based on the pulse oximetry and sometimes a BGA; A chest x-ray may help to differentiate between volume overload and atelectasis. Hypoxic dyspnea is treated with O2. A non-hypoxic-induced dyspnea is treated by anxiolytics and analgesics. Pain A pain therapy may be required from the moment in which the patient is conscious are back (pain treatment). As the first choice opioids are typically employed, namely, oral or parenteral. Often 1 or 2 tablets oxycodone / paracetamol (each tablet can be 2.5-10 mg oxycodone and 325-650 mg paracetamol included) p.o. every 4-6 h given as an initial dose of morphine or 2-4 mg i.v. every 3 h, with a demand-oriented subsequent dosing; individual needs and tolerances can vary widely. In a less frequent administration a breakthrough pain may occur, should be avoided. Against more pain, the PCA has (patient-controlled analgesia, dosage as needed, iv) proved best option (s. Dosing and titration). With an empty Patient history regarding kidney disease or gastrointestinal bleeding, administration of NSAIDs may reduce the breakthrough pain at regular intervals and help reduce the opioid dose. Psychological findings Any patient awakens from anesthesia, the short term is confused. Elderly patients, particularly those with dementia are predisposed to a postoperative passage syndrome, which may delay the release and increases the risk of Exitus. The risk of delirium is particularly high when using anticholinergic agents. These are sometimes used before or during surgery to reduce secretions in the upper airway, but should be just if possible avoided. Postoperatively given opioids can be just as high doses of H2 blockers also lead to delirium. The brain function of older patients should be checked frequently during the postoperative period. If there is a transitional syndrome, oxygen should be given and the non-essential medication should be discontinued. Patients should, as soon as they are able, be mobilized; any disturbance of the volume and fluid balance should be corrected. Wound care The surgeon must take care to individually to every wound, but the scale in the operating room sterile dressing is left usually 24 to 48 hours intact, if there are no signs of infection (eg. As increased pain, redness, drainage ) develop. After the operation dress was removed, the site should be 2 times checked daily for signs of infection. If these signs on, an investigation and drainage of the wound, systemic antibiotic therapy, or both may be necessary. Topically given antibiotics usually do not help. If a drainage tube is located, it must be monitored for the amount and type of the collected liquid. Suture, skin clips, and other means for wound closure are usually left depending on the findings and patient 7 days or longer on the wound. Wounds in the area of ??the face and neck can heal superficially within 3 days, whereas wounds of the lower extremity sometimes take weeks to achieve the same degree of healing. Prophylaxis of deep vein thrombosis (DVT) The risk of DVT after surgery is small, but because the consequences can be severe and the risk is even higher than in the general population, prophylaxis is often regarded as justified. The surgery itself increases the coagulability and also requires a longer immobilization, which is another risk factor for DVT (pulmonary embolism (PE) and peripheral venous disease). The prophylaxis of DVT usually begins already in the operating room (see table: risk of deep vein thrombosis and pulmonary embolism in surgical patients). Alternatively, shortly after the procedure, when the risk of bleeding is reduced, will be started with heparin doses. Patients should move as soon as possible their extremities. Fever A common cause of post-operative fever is an inflammatory or hypermetabolic response to an operation. Other causes include pneumonia, urinary tract infections, wound infections, and DVT. Other options include drug-induced fever and infections that affect implantable devices and drainage. Common causes of fever in the days or weeks after surgery are the so-called “six Ws”: wound infections water (eg urinary tract infections.) Wind (such as atelectasis, pneumonia.) Walking (eg DVTs.) Miracle drugs (z. B. drug-induced fever) widgets (z. B. implantable devices, sewerage) Optimal postoperative care (eg. as early ambulation and removal of bladder catheter, careful wound care) can reduce risks of DVT, urinary tract infections and wound infections. Inspiratory deep breathing exercises and regular cough can help to reduce the risk of pneumonia. Urinary retention and constipation urinary retention and constipation are common after surgery. Causes include: anticholinergics opioids immobility Decreased oral intake urine output must be monitored. Just catheterization have needed in patients who have a full bladder and feel uncomfortable or 6 to 8 hours after surgery, not urinating in general; the Crede maneuver sometimes helps and can catheterization can be unnecessary. A chronic Verhalt is best treated by allowing avoids favoring medication and the patient sits as often as possible. Bethanechol can p.o. in doses of 5-10 mg be used in patients who have no obvious vesical obstruction and who have not undergone laparotomy; the administration can be repeated every hour up to a maximum dose of 50 mg / day. Sometimes a reclining catheter must be placed, especially in patients with a history of, or retention of a significant initial quantity of urine by rigid catheterization. Constipation is common and usually the result of anesthetics, bowel surgery, post-operative immobility and opioids. Constipation is treated if the patient had no intervention on the gastrointestinal tract through reduced administration of opioids and other Konstipationsmitteln, by starting earlier mobilization and by administration of laxatives (bisacodyl, senna, cascara). Stool softener can not relieve postoperative constipation. Loss of muscle mass (sarcopenia) Loss of muscle mass (sarcopenia) and force can in all patients, the longer time in bed, occur. With complete bed rest young adults lose about 1% of their muscle mass per day, in the elderly, however it is 5% because of the reduced age concentration of growth hormone. The prevention of sarcopenia is therefore an essential prerequisite for the recovery. For this reason, patients should, as soon as it is possible for safety, sitting in bed, get up, stand up and, as far as may be permitted from surgical and general medical point of view, be be├╝bt. Malnutrition can also contribute to sarcopenia. Thus, food intake should be optimized in patients with bed rest. Oral feeding should be encouraged, and tube feeding or (rarely) parenteral nutrition may be required. Other aspects Certain operations require extra precautions. For example, the patient must be stored so at hip surgery, that the hip does not move. Often the instructions are best given by the nurse. Every doctor who for some reason always moving such a patient (for example, for respiratory sounds) must know the exact storage in order to avoid damage.


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