Post-Discharge Issues in Out-Patient Surgery
In out-patient surgery, preparing patients for post-discharge issues like pain, nausea, fatigue, cognitive dysfunction, orthostatic hypotension, and sleep disorders is crucial. Effective prophylaxis and treatments are available for managing concerns such as post-discharge nausea and vomiting, fatigue assessment, post-operative fatigue, orthostatic hypotension, and sleep disorders in surgical populations. Understanding and addressing these issues can enhance the overall recovery process for patients.
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Presentation Transcript
Post-discharge issues in out-patient surgery J.RAEDER We should prepare our patients: - What we do in the hospital - What we plan for discharge - Patient and/or relative information - Oral - Written - Web cites 1) Pain 2) Nausea and vomiting 3) Fatigue 4) Cogn. Dysfunction, Delirium 5) Orthostatic hypotention 6) Sleep disorders 7) Surgical Complications
Post Discharge Nausea and Vomiting PDNV Prophylaxis/treatment: - Non-opioid analgesia post-operatively - Residual effect of hospital given anti-emetics: - 5-HT3 block, neuroleptic, ephedrine up to 24 hr - Aprepitant, Palonosetron 48 hrs - Dexamethasone, scopolamine patch up 2-3 days - Non-pharmaocological measures: - Adjust fluid, food intake: timing amount - Resting, fresh air, cold forehead dressing, acupressure - Drugs taken at home: - Tablets? Mixtures? - Orally disintergrating ondansetron - Suppositories (neuroleptics, metoclopramide) Raeder J: ASA refresher course, 2017 in press
Fatigue Assessment in a Surgical Population Identity-Consequences Fatigue Scale (ICFS)1 Specifically developed for postoperative fatigue 31 items ICFS 10-ShortForm (10-SF)2 10 items Retains 98% of information in original ICFS Christensen Fatigue Scale3 Single-item scale NRS (1-10) with 4 anchors 1) Paddison J: J.Psycosom.Res. 2006 2) Nostdal T: J.Psycosom.Res. 2016 3) Christensen T: Br.J.Surg. 1982
Post-operative fatigue Day 1 Day 3 Day 6 day 30 POFS > 50 patient feel a significant impact on activities
Orthostatic hypotention Traditional fainting: Dehydration, pain, drugs (clonidine, pregabalin, gabapentin) Postoperative Orthostatic Tolerance In 12-60% of patients, more with extensive surgery, females,opioids, regular antihypertensive medication Resolves within 24-48 hrs Pathophysiology (tissue destruction? Inflammation?): Attenuated endogenous vasopressor response, increased vagal output - Testing? Subcutaneous ephedrine?
Sleep Disorders Low quality sleep first night Disturbed day-night rythme, less REM sleep (opioids) Increased day-time sleep Night 2-3: catch-up sleep with more REM sleep, dreams, movements (hypoxia?)
