Postoperative measures

There are several practices that are of value to the surgical patient in the postoperative period:

• nasogastric suction evacuates swallowed air which potentiates postoperative ileus
• intravenous fluids
• antibiotic treatment; this is discontinued with resolution of peritonitis
• treat postoperative shock; this complication is unlikely if earlier measures have been successfully carried through, although it is prudent to monitor and correct the fluid balance and operative blood losses
  • in the elderly, monitor blood gases to guard against metabolic acidosis and hypoxia
  • carefully used, dopamine can increase cardiac output and renal blood flow
• sedation
• respiratory complications:
  • promote the cough reflex by injecting bupivacaine into the wound for 48-72 hours in those with existing respiratory disease
  • be wary of ARDS, liase with the anaesthetist if there was major sepsis and respiratory signs are worsening
• watch for paralytic ileus and consider metabolic abnormalities, residual intraperitoneal abscess or mechanical adhesive obstruction
• residual abscesses are common and may need drainage