Post Operative Assessment and Management in Anaesthgesia

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Scottish Intercollegiate Guidelines Net work

Postoperative management in adultsA practical guide to postoperative care

for clinical staff

1 ntroduction 1

2 Clinical assessment and monitoring 3

3 Cardiovascular management 11

4 espiratory management 20

5 luid, electrolyte and renal management 28

6 Management of sepsis 34

7 ostoperative nutrition 39

8 nformation for discussion withpatients and carers 44

9 evelopment of the guideline 45

Abbreviations 48

Annexes 49

References 52

ugust 2004

77

COPIES OF ALL SIGN GUIDELINES ARE AVAILABLE BY CALLING 0131 247 3664 OR ONLINE AT WWW.SIGN.AC.UK


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cottis Interco egiate Gui e ines Networ

First published 2004

SIGN consents to t e p otocopying of t is gui e ine for t e purpose of imp ementation in NHSScot an

Scottis Interco egiate Gui e ines Networ

Roya Co ege of P ysicians9 Queen Street, E in urg EH2 1JQ

www.sign.ac.uk

SIGN IS FUNDED BY NHS QUALITY IMPROVEMENT SCOTLAND

CONSENSUS STATEMENTS

CS Statements developed from structured discussion, informed by any existing evidence

and the groups clinical experience, and validated using a formal scoring system.

LEVELS OF EVIDENCE

1++ igh quality meta-analyses, systematic reviews of randomised controlled trials(RCTs), or RCTs with a very low risk of bias

1+ ell conducted meta-analyses, systematic reviews of RCTs, or RCTs with a lowisk of bias

1 - Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias

2 igh quality systematic reviews of case control or cohort studiesigh quality case control or cohort studies with a very low risk of confounding or

bias and a high probability that the relationship is causal

2+ ell conducted case control or cohort studies with a low risk of confounding orbias and a moderate probability that the relationship is causal

2 - Case control or cohort studies with a high risk of confounding or biasand a signicant risk that the relationship is not causal

3 on-analytic studies, eg case reports, case series

Expert opinion

GRADES OF RECOMMENDATION

Note: The grade of recommendation relates to the strength of the evidence on which therecommendation is based. It does not reect the clinical importance of the recommendation.

t least one meta-analysis, systematic review of RCTs, or RCT rated as 1and directly applicable to the target population or

body of evidence consisting principally of studies rated as 1 , directly applicableo the target population, and demonstrating overall consistency of results

body of evidence including studies rated as 2 , directly applicable to the targetpopulation, and demonstrating overall consistency of results or

Extrapolated evidence from studies rated as 1 or 1

body of evidence including studies rated as 2 , directly applicable to the target

population and demonstrating overall consistency of results or

Extrapolated evidence from studies rated as 2

Evidence level 3 or 4; or

Extrapolated evidence from studies rated as 2


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DATEPostoperative Monitoring Chart

Name Hosp. Number DOB Weight Consultant

TIME

40

39.5

39

38.5

38

37.5

TEMPERATURE 37

36.5

36

35.5

35

210

200

BLOOD 190

PRESSURE 180

170

ADMISSION 160

BP 150

140

130

Plus 30% 120

110

100

Less 30% 90

80

70

60

50

CVP

170160

150

140

130

120

110

HEARTRATE 100

90

80

70

60

50

40

30

20

SaO2

FiO2(l/minor%)

40

35

30

25

RESP.RATE 20

15

10

5

0

URINE >0.5mls/kg

Volume


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Documents

Post Operative Assessment and Management in Anaesthgesia