ppt on pre-operative and post-operative care

1. Preoperative & Postoperative
Care
Presented By: Khadija Anwar

2. Pre-operative care
Care provided to patient before surgery (either elective or
emergency) consists of the following three important
components:
● Pre-operative assessment
● Preoperative preparation
● Premedication

3. Preoperative Assessment
Pre - operative assessment consists of history taking, physical examination and
ordering relevant investigations, it is ideally done 2-4 weeks before an elective
procedure.
● History taking: co-morbids, past medical & surgical history, family history,
gynaecological and obstetrics history, socioeconomic history, systemic review,
drug history, hypersensitivity, allergies.
If the patient is pregnant and an elective procedure is required the surgery is
postponed after the delivery as anesthetics are teratogenic and can induce
spontaneous abortion in the first trimester.
Important drugs that must be stopped before surgery are warfarin, contraceptive
pills , monoamine oxidase inhibitors (MAOI).

4. N
Physical Examination:
● Examination is done to assess the patient's fitness prior to a surgical
procedure.
● During the examination the patient's general assessment is done including
the examination of the CNS, CVS, respiratory system, gastrointestinal
system, renal and excretory system, musculoskeletal system, reproductive
system.
● Airway assessment and anesthetic examination is also done prior to
surgery.
Investigations:
● CBC, Urine analysis, ECG, chest X-Ray, UCE, Coagulation profile
(PT/PTT), ABO typing, LFT, spirometry,
● Some specific tests are done such as HBA1C, thyroid profile
● The patient is also screened for HIV, HBV, HCV.

5. dd
dd

6. Pre-operative Management
Care given before surgery when physical and psychological preparations are made for the
operation, according to the individual needs of the patient. The preoperative period runs from the
time the patient is admitted to the hospital to the time that the surgery begins.
● The patient is advised to go NPO 6 hours before surgery, clear fluids can be taken till 2
hours before the surgery, to decrease the risk of aspiration of gastric contents.
● Drug Management: some medications are stopped, some altered and some are started prior
to a surgery.
● Oral contraceptives and HRT is stopped 4 weeks before due to risk of DVT.
● Warfarin stopped 7 days before and clopidogrel 7 days before surgery, dosage of insulin and
steroids are altered,
● LMWH and prophylactic antibodies are given to patient before surgery
● Finally the patient's consent is taken for the procedure and the patient, it is important to
ensure the patient is fully aware of the care and follow up plan.

7. Post-operative Care
Time period beginning from when the patient leaves the operating room till the follow
up visit, post-operative care is done to ensure the proper recovery of patient, reduce
mortality and hospital stay and increase the quality of care provided.
Post-op care is divided into 3 stages:
● Immediate (post anesthetic) PHASE 1
● Intermediate (hospital stay) PHASE 2
● Convalescent (after discharge till full recovery)

8. PHASE 1 ( POST ANESTHETIC)
It is the immediate recovery phase and requires constant monitoring, First 48-72 hours post
surgery.
Patients level of consciousness, early signs of any complications and vitals should be
monitored.
● Airway, breathing and circulation maintenance
● Respiratory rate
● Blood pressure
● Chest and abdominal examination
● Bleeding per vagina
● Hourly urine input and output (30-50 ml)
● Temperature and pulse
● Fluid and electrolytes via IV

9. Investigations Pain Management
● CBC
● Urea, creatinine, electrolytes
● RBS
● LFTS
● Chest X-RAY (if required)
● Ultrasound (for severe pelvic or
abdominal pain)
● ECG (chest pain)
The patient is given analgesics
● Narcotics (morphine
● Non-narcotic analgesics
(diclofenac)

10. Post operative medications & wound
management
● To prevent surgical site infection the patient is given broad spectrum antibiotics
as prophylaxis
● 3 doses, after 5-7 for 24 hours
● The wound is cleaned and dressed regularly, debridement is done if the wound
gets infected.
● To prevent DVT and PE LMWH is administered 5000 units 2 hours pre op
continued for 5 days

11. Catheterization
● It is done in c-section to empty the bladder, removed after 24-48 hours.
● Prolonged catheterization might be required in the following cases:
● Obstructed labour (14-21 days)
● Bladder injury (7-10 days)
● Vaginal Hysterectomy (2 days)
● Radical Hysterectomy (14 days)

12. Intermediate phase (hospital stay)
● The patient is shifted to the ward and usually discharged after 48
hours if there are no complications.
● Patient is allowed to take food orally, and is mobilised immediately
to prevent complications

13. Convalescent Phase (discharge to recovery)
● Patient is advised to not lift heavy weights 3 months post op
● Avoid sexual contact for 4-6 weeks
● Avoid coughing, straining, constipation
● Take medications and supplements prescribed by the doctor
● Follow up regularly

14. Postoperative management in Gynae &
Obstetrics
C-section
● Ensure there is no bleeding
● Monitor urine output
● Monitor vitals
● Analgesics, antibiotics and
thromboprophylaxis
● Take proper care of sutures.
Vaginal Delivery:
● Ensure there is no loss of blood
● Manage soreness due to episiotomy with
ice packs
● Constipation: laxatives
● Discharge: maternity pads
● Hemorrhoids: OTC cream or suppository
containing hydrocortisone

15. Thank you for listening :)