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Perioperative Care

Intraoperative Care

At York Teaching Hospital, during major elective procedures the Consultant Anaesthetist will aim to:

  • Provide goal directed fluid therapy
  • Use Hartmanns solution 250ml fluid boluses
  • Fluid optimise to stroke volume variation <12%
  • Use meteraminol infusions to maintain mean arterial pressure >65

At the end of surgery, the Anaesthetist will discuss with the surgeons the requirement for maintenance fluid. The aim is to have patients taking oral fluids post-operatively but if this is not possible or tolerated the current preference is for an intravenous fluid infusion of 1ml/kg/hr dextrose saline (+/- KCL 20mmol),

A surgical APGAR score is performed at the end of surgery. If a patient has perviously been assessed as low risk and has a APGAR score that suggests high risk, they are immediately upgraded to an enhanced perioperative protocol.

 
Estimated blood loss   >1000 601-1000  101-600   

≤100

 
 Lowest MAP  <40  40-54  55-69  

≥70

 
 Lowest HR  >85*  76-85  66-75  56-65  

≤55

*Pathological bradycardia also scored as a 0

(0-4 points = very high risk 14% mortality, 75% major complications, 97% specific for ICU, 5-6= high risk, 4% mortality, 16% major complications, 7-8 = moderate risk, 1% mortality 6% major mortality, 9-10 Low risk 0% mortality, <4% major complications)

Recovery

Patients on a fluid optimisation protocol will have this commenced in recovery. Pulse contour analysis cardiac monitoring will continue in recovery. A lactate is measured prior to discharge from recovery and if this is >3mmol/L patients must be reviewed by an Anaesthetist.

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