PreoperativeandPostoperativeCare.ppt

Preoperative and Postoperative Care Lisong Teng MD, PhD The Department of Oncological Surgery 1st Affiliated Hospital of ZJUMC Preoperative Care Judging precisely which patient will survive, or succumb to, any specific operation for a disease, or diseases, is impossible. The many obvious variables such as age, seriousness of the primary disease, and coexisting diseases, account for the intangible nature of risk in any operation. When asked to guarantee an operation, the experienced surgeon refuses to guarantee anything but his professional concern and competence. Estimation of surgical risk is at best an educated guess based on experience. Assessment of Surgical Risk Surgical risk involves three main elements: The Patient The Disease The Treatment The Patient Age Heart Lungs Kidney Liver Blood Endocrine system Preoperative Treatment of Diabetes Dehydration States Nutritional Status Age Infant prematurity and extreme old age are associated with increased operative risk. With operations of greater magnitude, involving increased physiological stress, the mortality is substantially greater in older patients. Heart “A man is as old as his arteries,” “especially his coronary and cerebral arteries.” When life-threatening disease arises in a patient with serious cardiac disease, even a few hours of intensive cardiac care—to control hypertension, arrhythmias, or heart failure—can increase survival. Lungs Pulmonary disfunctions—inability to move air in and out of the lungs, to clear the bronchial tree by coughing, and to perfuse the lungs—often underlie postoperative pulmonary complications. Heavy cigarette smoking—major cause How many flights of stairs can the patient climb? How many blocks can he walk without dyspnea? Can he comfortably carry out routine tasks? If Normal exertion prompts shortness of breath: Pulmonary Ventilation Tests Arterial Blood Gases Kidneys Chronic renal failure increases operative risk. Urine creatinine concentrations should exceed by 10-fold th