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MRCOG PART 2 SBAs and EMQs

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EMQ1478
SBA2084
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essay 153

essay 153 Posted by Farzana N.
Postoperative infection is a major cause of morbidity and mortality associated with gynecological surgery.Preventive measures should be taken in the preoperative period and continued through perioperative and postoperative period.
Preoperative measures include ?a thorough assessment of patient and identification of any risk factors ,which would predispose to infections.General measures such as stopping smoking and alcohol would improve general health and immunity to infections.h/o menorrhagia would suggest possibility of anemia which should be corrected by FeSO4 or BT, depending on Hb levels.H/o concurrent medical illnesses and treatment taken to ensure they are optimally controlled before the surgery.e.g DM-if uncontrolled added with the hyperglycemia of operation would predispose to various opportunistic infections and poor wound healing. Respiratory infections will reduce the efficiency of gas exchange in the lungs.URTI combined with immunosuppressive effect of anesthesia,inhibition of postoperative cough and sedative effects of narcotic agents used for pain relief increases the risk of developing post op pneumonia.
H/o Cardiac diseases,-congenital cyanotic heart lesions,prosthetic cardiac valves, h/o endocarditis shd prompt use of prophylactic antibiotics to prevent post op eendocarditis.
H/o of pelvic infection shd be taken and in suspected cases swabs from vagina cervix and urethra shd be sent for culture and sensitivity.Mid stream urine specimen should be sent for microscopy and culture to rule out any urinary infection.
Drug.hist taken if the patient is on any corticoteroids or immunosuppressants .
General examination done. If the bmi is high,>30, she is advised to reduce wt .Obesity puts her at increased risk of post op complications including resp infections such as atelectasis. Any infective skin lesions shoul be treated to prevent wound infection.
PERIOPERATIVE measures include good surgical technique and scrupulous sterile techniques in the theatre and in the ward.
All major gynecological surgeries either vaginal or abdominal carry risk of infection ~20%.PROPHYLACTIC antibiotics reduce this risk by 50%.Single dose at the time of induction of anesthesia would suffice for surgery that lasts for 1hr.If surgery lasts for >1hr ,2further doses shd be given post op.Combination of Metronidazole 1gm orally or rectally with a single i.v dose of first or second generation cephalosporins is given.In those allergic to cephalosporins gentamicin or clindamicin are appropriate.
Bladder catheterization reduces the risk of bladder injury and post operative urinary retention.Fastidious hemostasis and placement of abdominal pelvic drains reduce incidence of hematoma. Vault hematoma is cause in 2/3 of cases of post operative pyrexia.
POSTOPERATIVE Detection and early correction of anemia would improve general health...Risk of RTI is reduced by optimizing lung functions by cessation of smoking .medications and physiotherapy.Cessation of smoking early mobilization with good pain control.Attention should be paid to indication for the use and duration of indwelling catheter that may influence the frequency of UTI.Wound should be kept clean and dry to prevent infection and rapid wound healing.