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Postoperative fever -hamad

complication of post operation

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Postoperative fever -hamad

  1. 1. POSTOPERATIVE FEVER Hamad Emad Hamad Dhuhayr
  2. 2. Contents  Define  Pathophysiology  Causes  Treatment
  3. 3. Define  Pyrexia is a common feature of postoperative infections,  although it may be absent in immunologically compromised patients.  Its important features are: • time of onset; • degree of pyrexia and type (persistent, intermittent); • accompaniments, particularly rigors (shivering) and haemodynamic change.  In the first 24 hours after an operation, 27-58% of patients may develop fever.
  4. 4. Pathophysiology  Fever >38ºC is common after surgery  Usually inflammatory stimulus of surgery and resolves spontaneously  Fever = response to cytokine release  Fever-associated cytokines are released by tissue trauma and do not necessarily signal infection.  Cytokines produced by monocyte, macrophages, endothelial cells.  Fever-associated cytokines = IL-1, IL-6, TNF-alpha, IFN- gamma.
  5. 5. What are the common causes? 1. Wind Atelectasis, pneumonia 2. Water UTI, anastomotic leak 3. Wound Wound infection, abscess 4. Walking DVT / PE 5. Wonder-drug
  6. 6. Evaluation  ABCs  Resuscitate  History of Present Illness : anesthesia record, operative note, nursing report, flowchart  PE:  Complete exam  Look at wounds - take off dressings  Look at drain output  Check peripheral intravenous line sites, Central venous line, Foley, tubes
  7. 7. Labs/Studies  Labs to order if concerned for infection:  CBC, sputum Cx, UCx, Blood Cx x2  Imaging:  CXR (for pneumonia)  Lower extremity venous duplex (for DVT)  CT scan (for abscess, leak, pancreatitis, PE)
  8. 8. Management Intervention needed? Remove/replace sources of infection  Foley catheter, central lines, or peripheral IV’s  Open, debride, and drain infected wounds If suspect pneumonia, bacteremia, UTI, sepsis – start broad spectrum antibiotics Anticoagulation for DVT/PE CT guided drainage of abscess
  9. 9. Take-home message  Fever can appear for both infectious and non-infectious reasons after an operation.  In the first 24 hours after operation, 27% to 58% of patients may develop fever.  Physical examination should include the respiratory, cardiovascular, urinary, and gastrointestinal systems, as well as an examination of the skin.  Thrombophlebitis can often be treated with warm compresses and anti- inflammatory agents.
  10. 10. References  Bailey & love’s  Clinical Surgery SECOND EDITION  The Canadian Journal of CME / May 2004

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