Postoperative management | BSAVA Library
1887
Postoperative management
British Small Animal Veterinary Association , 148 (2012); https://doi.org/10.22233/9781905319756.13
/content/chapter/10.22233/9781905319756.chap13
  1. Home
  2. Manuals
  3. BSAVA Manual of Canine and Feline Surgical Principles
  4. Chapter

Postoperative management

image of Postoperative management
GBP
Online Access: £ 25.00 + VAT
BSAVA Library Pass Buy a pass

Abstract

The goals of the immediate postoperative period are to: Recover the patient from anaesthesia; Prevent and manage postoperative complications; Provide ongoing treatment for pre-existing disease; Identify new problems rapidly and treat them appropriately; Support the patient's physiology effectively, promoting rapid recovery; Ensure patient welfare. To achieve these goals, close patient monitoring and regular assessment are required to alert the clinician to changing patient needs and permit timely intervention. The completion of a surgical procedure never constitutes the conclusion of a patient's veterinary care. The following are addressed: Repeated physical examination; Monitoring; Postoperative use of clinical pathology; Management of drains, tubes and catheters; Respiratory care; and Care of the recumbent patient.

Preview this chapter:
Loading full text...

Full text loading...

/content/chapter/10.22233/9781905319756.chap13

Figures

/content/figure/10.22233/9781905319756.chap13.ch13fig1
13.1
A detailed complete intensive care unit sheet from a patient’s medical record. Note the extensive problem list, list of therapeutic procedures with scheduled administration times and the use of clinician notification parameters towards the bottom of the sheet. The sheet should also facilitate recording of all ‘ins and outs’, i.e. urine output, faecal production and drain effusion volumes. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_1_thumb.gif
10.22233/9781905319756/fig13_1.png
Image of 13.1
13.1 A detailed complete intensive care unit sheet from a patient’s medical record. Note the extensive problem list, list of therapeutic procedures with scheduled administration times and the use of clinician notification parameters towards the bottom of the sheet. The sheet should also facilitate recording of all ‘ins and outs’, i.e. urine output, faecal production and drain effusion volumes.
/content/figure/10.22233/9781905319756.chap13.ch13fig2
13.2
A normal pulse profile. Pulse profiles in hypovolaemia. In early shock, physical examination findings are characterized by tachycardia, tall and narrow pulses and a brisk capillary refill time. With clinical deterioration, inappropriate bradycardia may occur accompanied by short and narrow pulses, pale or grey mucous membranes and a sluggish capillary refill time. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_2_thumb.gif
10.22233/9781905319756/fig13_2.png
Image of 13.2
13.2 A normal pulse profile. Pulse profiles in hypovolaemia. In early shock, physical examination findings are characterized by tachycardia, tall and narrow pulses and a brisk capillary refill time. With clinical deterioration, inappropriate bradycardia may occur accompanied by short and narrow pulses, pale or grey mucous membranes and a sluggish capillary refill time.
/content/figure/10.22233/9781905319756.chap13.ch13fig3
13.3
A cat in severe respiratory distress demonstrating characteristic open-mouth breathing and anxiety. The patient is in a paediatric incubator being monitored with telemetric ECG. Oxygen is being supplemented via tubing visible in the background. (Courtesy of H Wilson) © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_3_thumb.gif
10.22233/9781905319756/fig13_3.png
Image of 13.3
13.3 A cat in severe respiratory distress demonstrating characteristic open-mouth breathing and anxiety. The patient is in a paediatric incubator being monitored with telemetric ECG. Oxygen is being supplemented via tubing visible in the background. (Courtesy of H Wilson)
/content/figure/10.22233/9781905319756.chap13.ch13fig4
13.4
Monitoring the post-surgical patient with a bedside ECG monitor. The multiparameter monitor is also displaying a direct arterial blood pressure tracing. A telemetric ECG monitoring screen mounted within the intensive care unit nurses station. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_4_thumb.gif
10.22233/9781905319756/fig13_4.png
Image of 13.4
13.4 Monitoring the post-surgical patient with a bedside ECG monitor. The multiparameter monitor is also displaying a direct arterial blood pressure tracing. A telemetric ECG monitoring screen mounted within the intensive care unit nurses station.
/content/figure/10.22233/9781905319756.chap13.ch13fig5
13.5
A blood pressure recording being taken by Doppler sphygmomanometry from the plantar metatarsal artery in a cat following thoracotomy. Oscillometric blood pressure reading from a dog using a multiparameter monitor. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_5_thumb.gif
10.22233/9781905319756/fig13_5.png
Image of 13.5
13.5 A blood pressure recording being taken by Doppler sphygmomanometry from the plantar metatarsal artery in a cat following thoracotomy. Oscillometric blood pressure reading from a dog using a multiparameter monitor.
/content/figure/10.22233/9781905319756.chap13.ch13fig6
13.6
Direct arterial blood pressure monitoring in a postoperative patient. Simultaneous paper tracings of ECG, direct arterial blood pressure and central venous pressure from a patient following cardiopulmonary bypass surgery. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_6_thumb.gif
10.22233/9781905319756/fig13_6.png
Image of 13.6
13.6 Direct arterial blood pressure monitoring in a postoperative patient. Simultaneous paper tracings of ECG, direct arterial blood pressure and central venous pressure from a patient following cardiopulmonary bypass surgery.
/content/figure/10.22233/9781905319756.chap13.ch13fig7
13.7
Frank–Starling law of the heart, demonstrating the curvilinear relationship between ventricular preload and cardiac output. A hypovolaemic patient, represented by A, is likely to be volume-responsive, i.e. a small increase in ventricular preload leads to a large increase in cardiac output. In contrast, a patient with high filling pressures consistent with heart failure, represented by B, is not likely to be volume-responsive, i.e. a large increase in ventricular preload produces a minimal increase in cardiac output. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_7_thumb.gif
10.22233/9781905319756/fig13_7.png
Image of 13.7
13.7 Frank–Starling law of the heart, demonstrating the curvilinear relationship between ventricular preload and cardiac output. A hypovolaemic patient, represented by A, is likely to be volume-responsive, i.e. a small increase in ventricular preload leads to a large increase in cardiac output. In contrast, a patient with high filling pressures consistent with heart failure, represented by B, is not likely to be volume-responsive, i.e. a large increase in ventricular preload produces a minimal increase in cardiac output.
/content/figure/10.22233/9781905319756.chap13.ch13fig10
13.10
In-house cytology of abdominal fluid from a patient with septic peritonitis. Multiple rod-shaped bacterial organisms are visible and there are a large number of degenerate neutrophils. Erythrocytes are also visible in the background. (X 400 original magnification, rapid Romanowsky staining). Blood gas, electrolyte and metabolite analyses performed on the fluid demonstrated a very low pH, low O and low glucose concentration with high CO and high lactate concentration. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_10_thumb.gif
10.22233/9781905319756/fig13_10.png
Image of 13.10
13.10 In-house cytology of abdominal fluid from a patient with septic peritonitis. Multiple rod-shaped bacterial organisms are visible and there are a large number of degenerate neutrophils. Erythrocytes are also visible in the background. (X 400 original magnification, rapid Romanowsky staining). Blood gas, electrolyte and metabolite analyses performed on the fluid demonstrated a very low pH, low O and low glucose concentration with high CO and high lactate concentration.
/content/figure/10.22233/9781905319756.chap13.ch13fig13
13.13
A finger-trap suture securing an oesophagostomy tube in a dog. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_13_thumb.gif
10.22233/9781905319756/fig13_13.png
Image of 13.13
13.13 A finger-trap suture securing an oesophagostomy tube in a dog.
/content/figure/10.22233/9781905319756.chap13.ch13fig14
13.14
A dressing incorporating a jugular catheter and an oesophagostomy tube in a post-surgical feline patient. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_14_thumb.gif
10.22233/9781905319756/fig13_14.png
Image of 13.14
13.14 A dressing incorporating a jugular catheter and an oesophagostomy tube in a post-surgical feline patient.
/content/figure/10.22233/9781905319756.chap13.ch13fig17
13.17
All adaptors should be inserted firmly with at least three ridges of the connector within the chest drain or encircled with cerclage wire for additionally security. A minimum of two forms of tube security should be fitted. Typically this includes a clamp and a three-way tap with injection port bungs securing the openings. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_17_thumb.gif
10.22233/9781905319756/fig13_17.png
Image of 13.17
13.17 All adaptors should be inserted firmly with at least three ridges of the connector within the chest drain or encircled with cerclage wire for additionally security. A minimum of two forms of tube security should be fitted. Typically this includes a clamp and a three-way tap with injection port bungs securing the openings.
/content/figure/10.22233/9781905319756.chap13.ch13fig20
13.20
Calculation of the A–a gradient. © 2012 British Small Animal Veterinary Association
10.22233/9781905319756/fig13_20_thumb.gif
10.22233/9781905319756/fig13_20.png
Image of 13.20
13.20 Calculation of the A–a gradient.
/content/figure/10.22233/9781905319756.chap13.ch13figt1-1
Untitled
© 2012 British Small Animal Veterinary Association
10.22233/9781905319756/figp165_2_thumb.gif
10.22233/9781905319756/figp165_2.png
Image of Untitled
/content/figure/10.22233/9781905319756.chap13.ch13figt1-2
Untitled
© 2012 British Small Animal Veterinary Association
10.22233/9781905319756/figp165_1_thumb.gif
10.22233/9781905319756/figp165_1.png
Image of Untitled
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error