Postoperative Care

Recommended postoperative observation period

Postoperative monitoring recommended times

Neurosurgical proceduresRecommended time for postoperative monitoring
Baclofen pump with start-upOvernight (Control of arm strength and RLS)
Rear skull pit surgeryOvernight
ChiariOvernight
Embolization of aneurysmOvernight
Embolization AVM + vascular malformationOvernight. Note bed position 1st day.
Epilepsy surgeryOvernight
Extirpation of AVM transcraniallyOvernight
Fenestration of intracranial cystOvernight
Tethered cordOvernight
Pituitary glandOvernight
Cranioplastic surgeryOvernight
Shunt Vp/Va childrenOvernight
Shunt Vp/Va removalOvernight
Skull angiography with interventionOvernight
Sterotactic brain electrode in Parkinson's diseaseOvernight
SAH Subarachnoid hemorrhageOvernight
TCOvernight
TMSOvernight
Vagus nerve stimulator placementOvernight
Balloon compression7 h
Chronic subdural hematoma> 7 h and 1 h after drains have been removed
Hydrocephalus ventriculostomy>6 h + CT
Shunt Vp / Va post>6 h + CT
Shunt Vp/Va revisionSee memo
Baclofen pump insertion without start4 h
Battery replacement in stimulation system4 h
SCS-system Battery replacement 4 h
SCS-system Battery removal 4 h
Vagus nerve stimulator battery replacement4 h
Floating 22 h
Skull angio without intervention2 h note check angiography puncture site
Spinal angiography2 h obs check angiography puncture site
Orthopedics
Rear cervical decompression6 h
Anterior cervical disc herniation one level3-4 h
Anterior cervical disc herniation several levelsExtended wake-up time
Cervical decompression front one level2 h
Cervical decompression front multiple levels6 h
Lumbar disc herniationSimple wake up
Rear spinal fusion with fusion/fixation electively6-8 h
Intrathecal pain treatmentOvernight
Lumbar decompression2 h
Mutar prosthesis hip12 h
Osteotomy - BackOvernight
HemipelvectomiOvernight
Sacrum amputationOvernight
Neuroscoliosis2 days
Scolios6 hours
General surgery
Thyroid surgery2 h
Gastroplasty4 h
Adrenalectomy-pheochromocytoma laparotomy / open4-6/6-10 h
Thoracic abdominal surgery (esophageal resection)2 days
Whipple operation1 days
IleusSimple wake up (2-3 hours) in good health
Nephrectomi donatorSimple wake up (2-3 hours)
Kidney transplantationSimple wake up (2-3 hours)
Plastic surgery
Diep (double)Overnight
Lefort I3 h
Lefort I complicated6 h
Sagital split3-6 h
Plastic surgery with vascularized transplantVarying (Overnight)
ENT surgery
Tonsil2 h
Radical neckOvernight
Radiological procedures (X-ray)
Chemo embolization2-4 h
Hyperterm extremity cytostatics perfusion6-8 h
EVAR uncomplicated4-6 h
CarcinoidOften Night
Liver artery embolization10-12 h
Liver artery embolization chemo2 h
Hepatic portal vein embolization2 h
Renal artery embolization10 h
RF-Ablation liver-kidney2 h
TIPS simplesimple wake up (2-3 h)
PTCsimple wake up (2-3 h)
Vascular surgery
Femoral by pass6-8 h
TEA carotis artery6 h
Urological procedures
Ralph (Robot assisted prostatic )2 h
Nephrectomy open6-12 h
Nephrectomy laparoscopic6 h
Kidney resection6-12 h
Adenoma enucleation6-12 h
Bricker bladder deviationOvernight
Cystectomy and ileocystoplasty6-12 h
Kocks reservoir/nipple auditOvernight
Nephroureterectomy6-12 h
Transvesical adenoma enucleation12 h
Kidney pelvic plastic surgery6-12 h

Postoperative post spinal anesthesia monitoring

  Respiratory monitoringMonitoring of motor skills according to BromageBromage-scale
Bupivacaine-8 hours0 = can lift the leg with the knee stretched
Fentanyl 6 hours-1 = can bend at the knee joint
Morphine 12 hours-2 = can bend at the ankle
Clonidine- 10 hours3 = can not bend the ankle, paralysis


Assessment of patient ready for discharge

Discharge criteria

  • Respiratory rate 10-20/min
  • Awakening score ≤ 2 for patient over 12 years of age
  • No sub-points in the awakening curve 2 or higher
  • No intravenous opioids given within 15 minutes of discharge
Vigilance 
Completely awake0
Waking up to indictment1
Responds to appeals2
Pulsoxymetry
> 93% without oxygen supply0
>90% with oxygen supply1
<90% without oxygen supply2
Circulation
SAP ± 20 mmHg compared to before anesthesia0
SAP ± 20-50 mmHg compared to before anesthesia1
SAP ± 50 mmHg compared to before anesthesia2
Mobility on demand
Mobility of all extremities0
Mobility of 2 extremities (patients with spinal mobility should correspond to Bromage 0-1)1
No mobility in extremities2
Temperature
>36.0°C or <38.0°C0
>35.5°C or <38.5°C1
>35.5°C or <38.5°C2
Pain Score
VAS 0-10
VAS 2-31
VAS >32

NEWS points should be documented in the data journal under a separate heading. NEWS points > 5 should be followed by a comment and action, which is a doctor’s prescription.

Monitoring of vital parameters with NEWS

Physiological parameters3210123
Respiratory rate≤ 89-1112-2021-24≥ 25
Oxygenation≤ 9192-9394-95≥ 96
Oxygen supplyYesNo
Temperature≤ 35.035.1-36.036.1-38.038.1-39.0≥ 39.1
Systolic blood pressure≤ 9091-100101-110111-219≥ 220
Heart rate/pulse≤ 4041-5051-9091-110111-130≥ 131
Level of consciousnessAV, P or U