Can Postoperative Care be Facilitated by Preoperative Preparation?

Summary

The experience in postoperative intensive care has shown that the pa­tient who is prepared physically and psychologically has a greater facility to adapt to the situation immediately after coronary artery surgery and will collaborate actively to achieve complete recovery.

Among the most important factors to assure a rapid recovery and to avoid postoperative complications are the nutritional status, the pulmonary function, fluid and electrolyte balance. A precise assess­ment of the fluid and electrolyte status before surgery will allow a pre- and peroperative correction of important disturbances. In particular, the estimation of total body sodium and potassium can direct the postoperative treatment and help to avoid cardiac dysfunc­tion due to inadequate intravascular volume or arrythmias secondary to a potassium deficit. Preoperative drug therapy must be adapted to the individual patient’s needs.

Obesity or malnutrition and hypoproteinemia are associated with an increased postoperative morbidity secondary to problems related to weakness and lack of coordination of respiratory muscles, edema for­mation, and a decrease in the defense mechanisms against secondary infection. Chronic obstructive pulmonary disease and bronchitis must be treated aggressively to avoid postoperative pulmonary infection and to spare the respiratory forces of the patient at a time when his cardiovascular system may not be able to adapt to increased re­spiratory work.