What are some post op complications I should be aware of?

Fever

Fever is a vague symptom that can be normal and even expected after surgery; up to 90% of surgical patients have a low grade fever due to the body’s inflammatory response to injury. However, it can also be a sign of something more serious, such as atelectasis (collapse of small air sacs in the lung), urinary tract infection (especially if you had a foley catheter placed for surgery), wound infection, or blood clots.

A slight fever in the first two days after surgery is most likely nothing to be concerned about. However, if you develop other symptoms or if your fever worsens or persists, contact your doctor. The best way to deal with post-op fever is by preventing the more serious causes, as described in the following.

Atelectasis (collapse of air sacs in the lung)

Atelectasis can stem from the effects of anesthesia as well as a decrease in physical activity and shallow breathing after surgery. It can lead to pneumonia and other more serious respiratory complications. Depending on your procedure, coughing and deep breathing exercises may cause discomfort, but they play an important role in your recovery. Splinting (holding a pillow firmly against your incision) and adequate pain control can help make deep breathing less painful, especially if your surgery involved your chest or upper body.

You may also be sent home with an incentive spirometer. This is a device you’ll use to help expand your lungs thoroughly and gives a give visual representation of your breathing. Not everyone will need an incentive spirometer but everyone should practice some form of deep breathing and coughing to prevent atelectasis during recovery.

Urinary Retention or UTI

Blood Clots

Blood clots can form in the larger veins, commonly in the arms or legs; they can also break loose and travel, making them potentially life threatening. However, proper surveillance and preventive techniques can help reduce the risk. We screen every patient with a deep vein thrombosis (DVT) risk assessment tool and certain patients are required to have a pre-op ultrasound of their legs to check for existing blood clots.

There are also a number of techniques surgeons can use to help reduce the risk of clot formation, including “blood thinners” – anti-thrombotic medications given to help keep blood from clotting; the use of compression or ted hose during and after surgery; and the use of sequential compression devices that massage the calves to keep the blood from pooling.

While recent data call into question these risk reducing techniques for DVTs, the easiest and cheapest form of prevention during recovery is early ambulation. Ambulation, or walking, has several benefits besides blood clot prevention; it also helps promote deep breathing and helps with gas, bloating, and constipation. We want our patients up and walking by the evening of their surgery day, but always follow your surgeon’s instructions for activity limitations.

Written by Jennifer “Coop” Cooper MS, APRN, AGACNP-BC, Sergeant, US Army (veteran)

Click here for the original blog post written by Jennifer Cooper MS, APRN for BuildMyHealth.

The post Preventing Post Op Complications first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

During plastic surgery, one of the biggest concerns patients and their surgeon’s have is the potential for the development of blood clots in the patient’s legs. These are referred to as a DVT or Deep Vein Thrombosis. The pathophysiology, or the reason these clots develop, has to do with three possible factors. 1) Stasis, or lack of movement of blood in the legs during surgery, 2) Hypercoagulability, increased clotting in the blood which could be due to genetic disorders, or 3) Injury to the blood vessels themselves.

Under normal circumstances, when a patient is not under anesthesia, their calf muscles act as a pump to keep blood moving. But during general anesthesia, the “calf pump” doesn’t function to the same degree. So blood pools in the deep veins of the leg, leading to an increased risk of the blood developing into a blood clot. By itself, the development of the clot isn’t deadly. But that clot could subsequently travel to the heart and lungs in what’s referred to as a pulmonary embolism. A “small” pulmonary embolism (ie a small clot traveling to the heart/lungs), could lead to mild shortness of breath that passes with time. On the other end of the spectrum, a pulmonary embolism consisting of a large clot could lead to sudden death. This is why DVT’s and pulmonary embolisms are of such great concern for the surgeon and their patient.

How do you reduce DVT’s in surgery?

This is a controversial question. For almost two decades, one option was to give patients chemoprophylaxis, or medications like blood thinners, to reduce the risk of forming a DVT in the leg. However, these medications are not without risks. In an amazing book chapter on the subject by Dr. Eric Swanson, he explains why blood thinners aren’t the answer. The annual risk of an adult having a DVT is 0.1-0.3%. But the risk of having a major bleeding complication (hematoma) from a blood thinner is 3% annually. So the risk of having a hematoma is higher than the risk of having a DVT.

You might think, well if it reduces my risk of a DVT to any extent during surgery, maybe it’s worth the risk? Despite conventional wisdom, there’s very little evidence that these blood thinners actually reduce the risk of DVT during surgery. So do you just accept the risk of a DVT by avoiding blood thinners because you don’t want a hematoma?

The alternative to blood thinners

Luckily there are alternative methods to reduce your risk of a DVT and ultimately, pulmonary embolisms. Dr. Swanson describes SAFE anesthesia. This is an acronym for Spontaneous breathing, Avoid inhalation gases, Face up and Extremities mobile.

Spontaneous breathing – avoidance of paralyzing the patient during surgery with medications called paralytics. If paralyzed during surgery, the patient is dependent on the ventilator to breathe. Paralyzing a patient for general anesthesia can also reduce blood pressure. If the anesthesiologist avoids paralytics, then the patient can spontaneously breathe on their own, blood pressure doesn’t drop and the calf muscle pump continues to work, thereby reducing stasis and DVT formation.

Avoid inhalation gases – think stronger versions of laughing gas. By using propofol (yes, the Michael Jackson drug) instead of gas to keep the patient asleep, the risk of DVT is lower.

Face up when possible, meaning keeping the patient on their back with their face up. This is obviously difficult in situations where the surgeon needs to operate on the patients back wherein they’re laying face down. But switching the patient from side to side, to always avoid being face down is one option.

Extremities mobile. Moving the limbs at some point during surgery, either by turning the patient, or repeated checking of limb position, can reduce stasis and DVT’s forming.

Checking for DVT’s preoperatively

Many offices, including ours, utilizes Doppler ultrasound surveillance to determine if someone has a deep venous thromboses before surgery. By knowing the patient doesn’t have a DVT ahead of time, they’re that much safer going into surgery.

What about those squeezers?!

SCDs (sequential compression devices) are the “squeezers” doctors use to reduce DVT formation in the legs. Some patients even rent or purchase these machines after surgery for home use. All in an effort to reduce the formation of a DVT and thereby a pulmonary embolus.

In truth, there is no evidence that sequential compression devices affect the frequency of deep venous thromboses in plastic surgery patients.

It may not be profound, and certainly not technically advanced, but the best way to avoid DVTs after surgery is to get up and walk around. In our office, we recommend showering hours after the procedure to force the patient to get up out of bed and take a walk to the bathroom.

Concerned about too much activity? Our mantra is, “If it hurts, stop doing it. If it doesn’t hurt, you can do it!” Listen to your body so you don’t overdo it. Don’t push through the pain. But stay out of bed as much as possible and get back to regular activity. The muscles in the calves were designed to reduce the risk of blood clots. So let them do their job but getting up and walking around rather than depending on devices like SCDs that are not proven to work.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Avoiding blood clots in the legs during and after surgery first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Travel after surgery: is it safe?

One of the more curious questions I get is whether it’s safe to fly after a breast augmentation. I think they’re asking because at higher elevations, the atmospheric pressure is lower so maybe the implants could expand and pop? I’m guessing here so I welcome comments below as to the reasoning behind this question. Regardless, it’s not true.

Modern airplanes have pressurized cabins so the atmospheric pressure isn’t changing. More importantly, even if the atmospheric pressure did change, I’m guessing it would have to change a lot (as in going into space without a pressurized cabin) for the implants to expand enough to pop. But if you’re in that situation, the state of your implants is probably not the most pressing issue!

The other concern about traveling after surgery which may not be obvious, is the risk of sitting for long periods of time. Whether you’re in a car or plane, sitting or being sedentary can lead to blood clots in the legs. This is known as a deep vein thrombosis (DVT). These blood clots, in the worst of circumstances, can break loose and travel to the heart and lungs. That can lead to shortness of breath, damage to the lung or even block the heart leading to sudden death.

To avoid these blood clots forming during your surgery, your doctor will place sequential compression devices (SCD’s) on your legs. SCD’s squeeze the leg veins, release the chemical nitric oxide and keep the blood flowing rather than clotting. After surgery, at home, or when traveling, simply get up and walk around to exercise your legs. Walking is the most effective way to decrease your risk of forming blood clots. So on a long road trip, stop frequently at a rest stop and walk around. And if you’re flying, wait for the fasten seat belt sign to turn off and walk about the cabin!

Again, as long as you’re feeling well, your incisions are healing nicely, there’s no carte blanche prohibition against traveling after surgery. But of course, ask your surgeon just to be safe. And if you’re looking for a doctor near you, as well as their pricing, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post How soon can I travel after surgery? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.