Peri-operative care

Preoperative evaluation

As described in Patient Assessment, a thorough evaluation of patient factors influencing whether to proceed with surgical therapy is relevant.
Depending on the tpe of surgery prescribe pre-operative medication (for example antibiotic coverage), if applicable.

Peri-operative measures immediately prior to surgery

The following list describes important steps to be followed to inform the patient and prepare them properly for imminent surgery:

• Brief information about procedure to ensure that the patient understands and can ask questions about the surgical procedures
• Short acting benzodiazepine can be useful for ambulatory surgery
• If conscious sedation is provided, ensure that an accompanying, responsible adult person will be present with the patient for approx. 3 hours after surgery
• Disinfection of the operative field
• Preferrably cover patient’s nose with a perforated cap to allow for easy breathing and cover face and body with sterile drapes to limit/avoid use of antibiotics
• Use appropriate surgical safety checklist (http://www.for.org/checklists)

Peri-operative care during surgery

The following list describes the important steps to be followed while surgery is being performed:

• Gentle conversations and smooth movements improve patient’s confidence and comfort
• Avoid external pathogens especially from nose by ensuring that the entire team wears masks properly
• The entire surgical team should be trained in asepsis
• If conscious sedation is being provided, the patient's vital signs should be continuously monitored
• If the patient panics, remove surgical fields and interrupt the surgery
• Use appropriate surgical safety checklist (http://www.for.org/checklists)

Peri-operative management immediately after surgery

The following list describes actions and considerations for the patient who has just completed surgery:

• Relaxing seat for ambulatory patients in a quiet environment, which is under supervision, until the premedication effect is over if not accompanied (3 - 4 hours)
• If conscious sedation was provided, ensure that an accompanying, responsible adult person will be present with the patient for at least 3 hours
• Before anesthesia is over, prescribe and/or administer analgesics that do not interfere with coagulation, such as paracetamol or ibupofen 
• If significant edema is expected, non-steroidal anti-inflammatory medications are indicated. Opioids should be prescribed/administered only for intractable pain
• Prescribe/administer antibiotic coverage if necessary. If preventive antibiotic therapy has been started before the surgical intervention, this needs to be continued after surgery for 1-4 days and completed according to the antibiotic type used
• Consider to prescribe an antiseptic mouth rinse (e.g. Chlorhexidine)
• Provide brief verbal instructions, including for nutrition. Provide a written summary and 24-hour telephone number to call in an emergency
• Schedule post-operative appointments
• Use appropriate surgical safety checklist (http://www.for.org/checklists)