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Post-operative management 

Post-operative management
Chapter:
Post-operative management
Author(s):

Dr Jonathan P. Thompson

, Dr Simon J. Howell

, and Dr Richard J. Telford

DOI:
10.1093/med/9780199594429.003.0011
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date: 23 October 2019

Postoperative management of the vascular surgical patient may involve complex decision-making. Planning is required before surgery in order to institute appropriate care with the aim of detecting, preventing and treating potential postoperative complications. Some considerations apply to all elderly patients undergoing different types of major surgery, some are specific to those with cardiovascular or respiratory disease, and some are specific to those undergoing vascular surgical procedures. This chapter details the essential knowledge required by the vascular anaesthetist and all others involved in perioperative care. It addresses several important issues, including: Which patients require intensive postoperative monitoring? What monitors should be used? How should I monitor for cardiac ischaemia or ventricular dysfunction? The style is succinct, yet practical and authoritative, with an emphasis on diagnosis, investigations and immediate management: ‘What you need to know and what you should do’. Guidance and algorithms for the assessment and management of common clinical scenarios are presented in a logical manner, in accordance with best current practice. These include postoperative hypotension, hypertension, perioperative myocardial infarction, oliguria and bleeding after vascular surgery. The section on postoperative intensive care covers all the basic knowledge needed by the ICU trainee for managing the vascular surgical patient, including the specific considerations relating to care after thoracic aortic surgery. Another section is dedicated to the assessment and management of acute postoperative limb ischaemia. The last section of the chapter, on long term outcome after vascular surgery, provides vital details to inform discussions with your vascular patient of what to expect after their procedure.

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