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Postoperative monitoring

Specific signs that may be important in the early postoperative period:

Sign Possible meanings

Respiratory distress Hypoxia

Tachypnoea

Cyanosis

CNS depression Over-sedation

CO₂ retention

Agitation Blood loss

Hypoxia

Pain

Disorientation Inappropriate sedation

Hypoxia

Severe inappropriate pain Local complication at site of operation

e.g. bleeding, ischaemia, leakage of secretions

Wound

Bleeding Uncontrolled blood vessel

Soft tissue haematoma Clotting disorder

Irregular pulse Unrecognised cardiac disorder

Hypoxia

Skin pallor, empty veins, Hypovolaemia

Hypotension, tachycardia

Routine postoperative monitoring of clinical signs:

Measurement Possible significance

Temperature

Low Excessive heat loss during surgery

Reduced metabolic rate (possibly from poor peripheral perfusion)

High Core but not peripheral – peripheral vasoconstriction, possibly from blood loss

Core and peripheral – 1-2˚C normal in first 24 hours but thereafter may mean sepsis

Pulse rate, BP Changes beyond minor variations imply possible circulatory instability

CVP Sensitive guide to venous return to the heart

Respiratory rate

Increased CO₂ retention, hypoxia

Decreased Over-sedation

Urine output (hourly) Indirect measure of renal perfusion

Fluid intake/output Ensures that neither over- or under-perfusion occurs

Additional vital signs often measured in the ICU:

Measurement Possible significance

Arterial manometry Earlier detection of changes in BP

Continuous CVP monitoring Assessment of venous return

Pulmonary artery pressure Detection of left heart strain

Pulse oximetry Arterial oxygen saturation

Continuous ECG Detection of arrhythmias


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	Postoperative monitoring Specific signs that may be important in the early postoperative period: Sign Possible meanings Respiratory distress Hypoxia Tachypnoea Cyanosis CNS depression Over-sedation CO₂ retention Agitation Blood loss Hypoxia Pain Disorientation Inappropriate sedation Hypoxia Severe inappropriate pain Local complication at site of operation e.g. bleeding, ischaemia, leakage of secretions Wound Bleeding Uncontrolled blood vessel Soft tissue haematoma Clotting disorder Irregular pulse Unrecognised cardiac disorder Hypoxia Skin pallor, empty veins, Hypovolaemia Hypotension, tachycardia Routine postoperative monitoring of clinical signs: Measurement Possible significance Temperature Low Excessive heat loss during surgery Reduced metabolic rate (possibly from poor peripheral perfusion) High Core but not peripheral – peripheral vasoconstriction, possibly from blood loss Core and peripheral – 1-2˚C normal in first 24 hours but thereafter may mean sepsis Pulse rate, BP Changes beyond minor variations imply possible circulatory instability CVP Sensitive guide to venous return to the heart Respiratory rate Increased CO₂ retention, hypoxia Decreased Over-sedation Urine output (hourly) Indirect measure of renal perfusion Fluid intake/output Ensures that neither over- or under-perfusion occurs Additional vital signs often measured in the ICU: Measurement Possible significance Arterial manometry Earlier detection of changes in BP Continuous CVP monitoring Assessment of venous return Pulmonary artery pressure Detection of left heart strain Pulse oximetry Arterial oxygen saturation Continuous ECG Detection of arrhythmias
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