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PubMed1999

Postoperative care and monitoring.

Pneumonectomy remains one of the more risky and morbid procedures routinely performed by the thoracic surgeon. Patients are often frail, with poor underlying pulmonary function and minimal physiologic reserve. Attentive, meticulous postoperative care and monitoring are required to minimize the incidence and severity of complications.

Analgesia↗
PubMed2005

Complications and postoperative care in patients undergoing treatment for unruptured intracranial aneurysms.

Endovascular treatment has become a feasible alternative in the management of aneurysmal subarachnoid hemorrhage. After endovascular or surgical treatment of patients with unruptured intracranial aneurysms (UIAs), little is known about the practices of observation or need for intensive care. We analyzed retrospectively perioperative complications that were associated with the procedure and postoperative care in patients undergoing management of UIAs. A total of 53 patients underwent endovascular treatment and 105 patients surgical treatment. Location of the aneurysm was the main determinant of the modality of treatment. In the endovascular group, 34 patients were conscious during the procedure and 19 were under general anesthesia. Six patients in the endovascular and 9 in the surgical group experienced complications during the procedure. After the procedure, complications were more common in the surgical group than in the endovascular group (11 versus 0 patients, P = 0.015). Six of the postoperative complications of surgically treated patients occurred in the intensive care unit. Two patients in the endovascular group and five in the surgical group had major neurologic deficits as a consequence of complications. One surgically treated patient died. Both endovascular and surgical treatment of UIAs carry risks that may result in severe neurologic impairment. Patients should be observed with equal vigilance with either treatment option. Surgical treatment is associated with emergencies that require prompt interventions postoperatively and therefore close observation in an ICU setting may be preferable in patients who have undergone surgical treatment of UIAs. Complications after uneventful endovascular procedures seem to be rare.

Adult↗
PubMed1990

[Pre- and postoperative care of living relative patients for renal transplantation].

Between 1966 and 1989, 54 kidney transplants were performed at our institute. We present our experience about pre- and postoperative care of the patients for renal transplantation. 1) Donors 1) Pre- and postoperative function of the kidneys and urinary tract must be evaluated carefully. Renal transplantation can be done successfully if preoperative renal function is good even if the donor is older than 60 years old. 2) Preoperative evaluation of the donor renal artery is necessary. Four kidneys with renal artery anomalies and one kidney with renal artery aneurysm were used for renal transplantation uneventfully after they were repaired. 2) Recipients 1) We had 4 recipients who demonstrated abnormality of the urinary tract. They all received successful renal transplantation after appropriate urological management before renal transplantation. 2) Imaging diagnostic technique is useful when graft function is deteriorated. Acute rejection can be diagnosed more objectively using renal scintiscan and echogram. They are also useful for early detection of postoperative urological complications. In this paper, the diagnostic strategy using various imaging techniques was outlined.

Aged↗
PubMed1983

A comparative study of postoperative care with phenol nail procedures.

This study was made to evaluate a new method of postoperative care in phenol nail procedures. The authors believe Debrisan to be as effective as any procedure in current use. They state that there is a scarcity of literature to substantiate many of the existing treatment regimens.

Administration, Topical↗
PubMed1996

Hypospadias repair: the influence of postoperative care and a patient factor on surgical morbidity.

More than 200 surgical techniques have been advocated for hypospadias repair and perfection is still eluding us. The purpose of this paper is not to comment on a surgical technique, but to highlight the importance of postoperative care on the eventual surgical outcome. Two hundred six children undergoing primary hypospadias surgery from 1984 to 1994 at Mount Vernon Hospital were analyzed. The mean age of surgery was 3.8 years (range, 8 months-17 years) and our mean follow-up was 6.1 years. Various surgical techniques were used. During 1989, we changed our postoperative regime and patients were mobilized early (within 48 hours) compared to the strict-bed rest-till-catheter-out regime before 1988. This significantly reduced our fistula rate from 22% to 9.8% (chi squared p = 0.0016). Patient factors such as pulling on the catheter, urinary obstruction/blocked catheter, erections, straining due to constipation, and interference with dressings influence surgical outcome negatively. One of these patient factors was documented in all of our 33 patients who developed fistulas. In 6 patients (3.5%), a patient factor was present without any complication. This is highly significant statistically (chi squared p < 0.0001). The type of urinary diversion, period of urinary diversion, type of dressing, catheter size, and anesthetic regime did not influence outcome significantly.

Adolescent↗
PubMed2001

Incidence and indications for reintubation during postoperative care following orthotopic liver transplantation.

STUDY OBJECTIVE: To analyze the incidence and indications for reintubation during postoperative care following orthotopic liver transplantation (OLT). DESIGN: Retrospective chart review. SETTING: Large metropolitan teaching hospital. PATIENTS: 546 adult liver transplant recipients. MEASUREMENTS AND MAIN RESULTS: The medical charts of 546 patients who underwent OLT at our institution between January 1992 and September 1996 were reviewed for the incidence and indications of reintubation throughout primary hospitalization. Eighty-one of 546 patients (14.8%) required one or more episodes of reintubation after OLT. In the majority of cases, reintubation was performed for pulmonary complications (44.6%), followed by cerebral (19.1%) and surgical (14.5%) complications. Cardiac (9.1%) and peripheral neurologic (2.7%) complications were less frequent reasons for reintubation. Overall patient survival, according to the Kaplan-Meier estimates, was 89.9%, 87.5%, 86.5%, and 82.2% after 1, 2, 3, and 5 years, respectively. In patients with one or more episodes of reintubation, overall survival decreased to 62.5% after 1, 2, and 3 years, and to 56.4% after 5 years (p < 0.001). CONCLUSIONS: The main indications for reintubation after OLT were pulmonary, cerebral, and surgical complications. These reintubation events had a considerable influence on the patient's postoperative recovery, and were associated with a significantly higher rate of mortality, than for OLT patients who did not undo reintubation.

Anti-Infective Agents↗
PubMed1989

Liver resection. Preoperative and postoperative care.

Liver resection is an increasingly common procedure. Despite a wide variety of indications, the preoperative and postoperative care required is similar. Experience with liver resection and transplantation has brought to light the significant alterations in fluid and electrolytes, hemostasis, metabolism, and pulmonary function that may result. A thorough understanding of these changes is required to minimize the morbidity and mortality rates of these procedures. Postoperative hepatic failure is a devastating complication, and careful patient selection is required to avoid this. More work is needed to identify better methods of evaluating functional hepatic reserve.

Age Factors↗
PubMed1990

The role of the high dependency unit in postoperative care: an update.

The current experience of a high dependency unit established 5 years ago for the postoperative care of high-risk patients undergoing surgery is reported. The resource implications and contributions to the safety and quality of post-operative care, particularly pain relief, are described.

Adolescent↗
PubMed2004

The postoperative care of the adult renal transplant recipient.

Advances in transplantation immunology management have contributed to more frequent transplants and better long-term graft survival. Nurses must consider many issues facing the transplant recipient such as medication management, infection prevention, chronic disease management, fluid balance, urine output, and the many psychological issues that surround receiving a transplant. Important guidelines of care of complex transplant patients in the postoperative period are provided.

Adult↗