Postoperative period

Now consider inexpedient the prophylactic administration of antibiotics with abdominal operations. Not only in the preoperative period, but after operations carried out in aseptic conditions. Unfortunately, the latter does not belong to resection, neither removing stomach cancer. When the disease by reducing gastric secretion, ulceration and tumor breakdown of stagnation and decay of food residues, in the contents of the stomach is always a rich and often highly pathogenic flora. Therefore, even though neither was carried out during operation, all the rules upgrades, to avoid the imposition of anastomosis of infection to surrounding tissues surgeon cannot. At least will be infected with the edges of the incision is stitched bodies, i.e. will be infected with the most responsible - all line joints of the anastomosis.
In order to avoid the severe consequences of antimicrobial struggle here should be started on the operating table. Before suturing wounds in the abdomen we introduce 1000000-2 000 000 UNITS of penicillin and, if there are no contraindications,- 1.0 streptomycin. When smooth over benzylpenicillin entered after surgery intramuscularly every 4 h, 500 000 IU, for 4-6 days, and for suspected infection 10 000000-12 000000 IU per day or more. The appropriate use and semisynthetic penicillins.
After a particularly difficult and long resections and always after removing the stomach should continue intravenous drip infusion fluids. This must be done as long as the patient's condition will not cease to impress any concerns about the possibility of the development of post-operative shock. Intravenous infusion after removing the stomach to continue not less than 24 hours after the operation, even if the patient's condition appears to be satisfactory. In this period of time necessary transfusion of blood, at least in the amount of 250 ml. After resection of the stomach transfusion is indicated always, if after the first half of the day the patient's condition is still grave. It is advisable simultaneous use of the various tools that improve cardio-vascular tone.
During the first days after the operation should not be administered intravenously over 2,000 ml of liquid. However, the amount that the patient received intravenous during surgery (1000-1500 ml), it will be more than 3000 ml per day, which is usually enough.
Shock can develop as during surgery and immediately after graduation or at a later date - in for the first night and even in the first half of second. Relapses of the shock can be and in a more distant time. Insufficient observation of patients is very easy to miss the initial signs of this complication. The fact that the patient's health in the development of the shock is not always worse. Many patients however do not have any complaints, and some even claim that they have become much better, despite the obvious deterioration. Therefore, in aftercare period should carefully monitor the hemodynamics, systematically measuring the heart rate and blood pressure.
In the fall of arterial pressure should immediately start the protivosokovh activities, the intensity of which shall correspond to the degree of deterioration of the patient. One must always remember that the earlier applied protivosokovh activities, so they are more efficient. Necessary here events held in conformity with the modern rules of intensive therapy and reanimation.