MindMap Gallery Medicine - Perioperative Management
This is a mind map about perioperative management. The perioperative period refers to the entire stage before, during and after the patient undergoes surgical treatment. Perioperative management refers to the various medical measures and care performed at this stage to ensure the smooth progress of the operation and the safety of the patient.
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The ice hockey schedule for the Milano Cortina 2026 Winter Olympics, featuring preliminary rounds, quarterfinals, and medal matches for both men's and women's tournaments from February 5–22. All game times are listed in Eastern Standard Time (EST).
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The ice hockey schedule for the Milano Cortina 2026 Winter Olympics, featuring preliminary rounds, quarterfinals, and medal matches for both men's and women's tournaments from February 5–22. All game times are listed in Eastern Standard Time (EST).
Perioperative management
perioperative period
From the time when surgical treatment is decided to until the treatment related to this surgery is basically completed
Purpose
Improve patient tolerance to surgery
Classification of surgeries
emergency surgery
Liver and spleen rupture, strangulating intestinal obstruction
Time-limited surgery
malignant disease
Radical resection of rectal cancer Radical resection of gastric cancer and thyroid adenocarcinoma
elective surgery
benign disease
Gastric ulcer, thyroid adenoma, subtotal thyroidectomy for hyperthyroidism, cholecystectomy, inguinal hernia repair
Preoperative preparation
General processing
psychology
physiological
Preoperative training
Stop smoking 2 weeks before surgery
Infusion and rehydration
Blood typing and cross-match testing
Antibiotic prevention indicators
Involved in infection, close to infection
Long-lasting, invasive surgeries
Open trauma, long interval between trauma and debridement, and long debridement time
gastrointestinal surgery
Surgery involving large blood vessels
cancer surgery
Artificial implants, organ transplants
Use once before and during surgery, and continue for 1-2 days after surgery
Gastrointestinal tract preparation
Fasting before surgery
Fasting 8-12 hours before surgery and no drinking for 4 hours → Prevent and treat suffocation or aspiration pneumonia caused by anesthesia/vomiting
gastrointestinal surgery
Eat liquid food for 1-2 days
Pyloric obstruction: Gastric lavage with 3% saline in advance
colorectal surgery
Liquid food for 2-3 days before surgery; oral intestinal bacteriostatic drugs; enema
other
The night before surgery, sedatives can be given to ensure a good sleep.
Detection of an elevated temperature not related to the disease/Women menstruating: postpone the date of surgery
Long operation time, pelvic surgery: indwelling urinary catheter
Shaving: before surgery begins
special preparation
Malnutrition
Albumin is less than 30g/L; transferrin is less than 0.15g/L
Cardiovascular disease
Most common
Below 160/100mmHg: no special preparation required
>180/100mmHg: Use antihypertensive drugs
AMI: no surgery within 6 months
HF: No surgery within 4 weeks
pulmonary dysfunction
second most common
Maximum expiratory volume in 1s (FEV1) <2L: dyspnea FEV1<50%: severe pulmonary insufficiency
Breathing training: Reduce lung complications
Acute respiratory tract infection: elective surgery/postponed until 1-2 weeks after cure
Obstructive Respiratory Disease: Bronchodilators
cerebrovascular disease
Rare
Recent stroke: delayed by at least 2 weeks and finally 6 weeks
kidney disease
If dialysis is required, it needs to be performed within 24 hours of the planned surgery.
DM
Preoperative blood sugar should be controlled to a mildly elevated state (5.6-11.2mmol/L): add insulin to the glucose solution
Oral hypoglycemic drugs: Continue taking them until the night before surgery
Taking long-acting hypoglycemic drugs such as chlorpropamide: discontinue 2-3 days before surgery
Normal use of insulin: Discontinue it early in the morning on the day of surgery
Blood sugar control in critically ill patients: 7.77-9.99mmol/L
Coagulopathy
Antiplatelet drugs (ticlopidine and clopidogrel) were stopped 10 days before surgery. 7 days before surgery, stop aspirin 2 to 3 days before surgery, stop taking non-steroidal anti-inflammatory drugs PLT<50×10^9/L: platelet transfusion For major surgery or surgery involving blood vessels, platelets should be maintained at 75×10^9/L For neurological surgery, the PLT critical point is not less than 100×10^9/L
Prevention of deep vein thrombosis of lower limbs
Prophylactic low molecular weight heparin, intermittent bag compression of the lower limbs, and oral warfarin
Thrombus loss → pulmonary embolism
Postoperative treatment
body position
shock position
Lower limb elevation 15-20, head and trunk elevation 20-30
cranial surgery
15-30 Head high and feet low
Neck (thyroid) and chest (esophageal) surgery
High semi-recumbent position
Abdominal surgery (stomach)
Low semi-recumbent position
Spine and hip surgery
prone position
Before you wake up from general anesthesia: Lie on your back with your head tilted to one side to prevent foreign bodies from being inhaled into your organs. Subarachnoid block: supine/head-down position for 12 hours to prevent and treat cerebrospinal fluid extravasation headaches Obesity: Side-lying position facilitates breathing and venous return
Treatment of various discomforts
pain
Narcotic analgesics: morphine, pethidine, fentanyl
Epidural anesthesia: indwelling catheter, connected to analgesic pump, suitable for lower abdominal surgery and lower limb surgery
hiccup
Early stage: compression of the supraorbital rim, short-term inhalation of carbon dioxide, and aspiration of gastric and fluid accumulation in the stomach.
Intractable hiccup: Be alert for subdiaphragmatic fluid accumulation/infection
Suture removal time
After head, face and neck surgery
4-5 days
Lower abdomen, perineum
6-7 days
Upper abdomen, chest, buttocks, back
7-9 days
limb surgery
10-12 days
Tension reducing sutures after joint surgery
14 days
Electrosurgical incision is delayed for 1-2 days
Postoperative eating time
What to eat after a local anesthesia surgery; what to eat after a non-gastrointestinal general anesthesia surgery if there is no vomiting
3-4 hours after spinal anesthesia, 2-4 days after major surgery
After gastrointestinal surgery, fast for 1-2 days, liquid food after anal exhaust for 3-4 days, semi-liquid food for 5-6 days, and normal food for 7-8 days.
incision
Incision classification
Category 1 incision (clean)
Thyroid, breast, simple hernia removal, laparoscopic hernia repair
Body surface, solid
Class 2 incision (possible contamination)
Subtotal gastrectomy, posterior gastric wall perforation, simple small bowel obstruction, cholecystectomy, appendectomy for appendicitis
Category 3 incision (contamination)
Purulent and perforated appendicitis, perforated appendicitis, intestinal root obstruction, strangulation and necrosis, radical resection of colorectal cancer, resection after small intestinal perforation
Incision healing
Class A healing
Heal perfectly
Class B healing
There is inflammation, but no suppuration
Class C healing
Purulent infection & fissure
Postoperative complications
postoperative bleeding
Shock within 24 hours of abdominal surgery indicates internal bleeding
If the amount of blood drawn out of the chest drainage tube exceeds 100ml per hour, it indicates internal bleeding.
fever
Most common
If high fever (>39°C) occurs in the first 24 hours after surgery, if a transfusion reaction can be ruled out, streptococcal or clostridial infection, aspiration pneumonia, or existing infection may be considered.
hypothermia
1. Anesthetics block body temperature regulation 2. Loss of heat due to laparotomy or thoracotomy 3. Infusion of cold liquid or banked blood When infusing a large amount of cold liquids and stored blood, the body cavity should be lavaged repeatedly with warm saline if necessary through a heating device.
respiratory complications
Atelectasis
Upper abdominal surgery, often occurring within 48 hours
Slap on the back, cough, take a deep breath *The postoperative thoracoabdominal incisions are tightly fixed/tied (X)
postoperative pneumonia
People with abdominal infection who require long-term assisted breathing have a high incidence rate
G-
pulmonary embolism
postoperative infection
Abdominal abscess and peritonitis
Fever, abdominal pain, leukocytosis
Abdominal abscess: abdominal drainage and antibiotic treatment
fungal infection
Urinary system complications
urinary retention
urinary tract infection
Incision complications
Incision hematoma, blood accumulation, blood clots
Most common
Defects in hemostasis technology (incomplete hemostasis)
incisional seroma
Not pus and not blood; cutting too many lymphatic vessels will delay healing and increase the risk of infection.
treat
Subcutaneous empty needle aspiration, pressure under the armpit, and groin to allow it to absorb on its own
Continue to exist: exploration of incision in operating room, ligation of lymphatic vessels
Wounds open
Wound pain and light red fluid oozing after coughing; usually occurs within 1 week
Often occurs in the abdomen and around joints
Partially cracked: The skin is not cracked but the inside is cracked
Complete dehiscence: full-thickness dehiscence with intestinal/omentum prolapse
prevention
Use full-thickness abdominal wall tension-reducing sutures Suture the incision under good anesthesia and abdominal wall relaxation Treat abdominal bloating promptly When the patient coughs, it is best to lie down Proper abdominal compression dressing
Incision infection
Clean Surgery: Staphylococcus, Streptococcus
Perineal and intestinal surgery: intestinal flora, anaerobic flora