The postoperative period in children

In the first hours after the operation, you must install a careful monitoring of the child. It is necessary to pay attention to prevention of vomiting and complications associated with it (aspiration!). Patient is placed in a horizontal position without a pillow, in the future, in a few hours you can make a normal position. Children in the first time after the surgery under General anesthesia should be fixed in bed cuffs limbs. Of great importance in the postoperative period has anesthesia, which is especially necessary after extensive surgery. Most often, using 1 % solution of morphine (0.1 ml of 1 year of life). In some cases, enough of destination painkillers for the night (for example, after appendectomy), in others - appointed promedol 2-3 times a day (surgical interventions on the organs of the chest, the esophagus and other). Recently for pain in the postoperative period in children are introduced techniques such as postoperative anesthesia, nitrous oxide with oxygen, epidural anesthesia.
After a serious surgical interventions on the organs of the chest and abdominal cavity it is necessary to ensure a sufficient supply of oxygen; the latter is served in the hydrated form via a nasal cannula in the nasopharynx; newborns and infants are placed in an oxygen tent. Frequent and serious complication of postoperative period in children is hyperthermia. With the purpose of timely detection it is necessary to measure the temperature every 2 hours. If there hyperthermia carry out the same activities as in the preoperative period (see the Preoperative period in children). In the postoperative period it is necessary to control over the heart rate, breathing rate, blood pressure, hemoglobin content in the blood. Possible delay (reflex) urine that the appointment of a heating pad on the area of the bladder; sometimes expedient to give to the patient poluciaetsea position. Patients with burns of the body, with the brutal conditions, after operations on the urogenital organs to control urination catheter into the bladder.
Feeding after surgery is prescribed individually. During surgery on the digestive tract, in most cases, children in day operations are not fed. After operations on the esophagus, about peritonitis, intestinal obstruction for more or less long period of time is parenteral nutrition intravenously injected glucose, plasma, isotonic solution of sodium chloride, ringer's solution, etc.
After surgery in children should pay special attention to prevention of pneumonia (oxygen therapy, antibiotics, mustard plasters, heart, and so on). After surgical interventions on the abdominal organs, especially in young children, often develop bowel paresis. In these cases, appoint exhaust tube (30-40 minutes), if no effect put hypertensive enema, enter neostigmine, hypertonic solution of sodium chloride intravenously. In persistent cases, it is advisable to flush the stomach, perirenal novocaine blockade. In the postoperative period should also pay attention to the state of the operating wounds: in the early hours of may drench bandages blood, in the next can begin wound suppuration, which is manifested by infiltration and hyperemia.

The postoperative period in children. Necessary conditions for management of postoperative period in children create in a specially organized the emergency room or the house. Registration of physiological parameters and the administration of medications produced taking into account age, guided by the data of tables age standards (pulse rate, respiration, blood pressure and other), age dosage of medicinal substances and calculating daily dosage introduction of fluid, depending on the weight of the child. Registration in a special card every 6-4-2 hours of core indicators (pulse, temperature, respiration, blood pressure and other) allows to diagnose the onset of complications.
The position of the baby in the bed depends on the nature of the operation. Position on Fedorov helps to relax the abdominal wall, facilitates breathing excursion, prevents pneumonia. The situation on the healthy side after the intervention on a light reduces the likelihood of atelectasis. Intravenous infusion of medicinal fluids, fluids, nutrients helps combat post-operative shock, reduces intoxication, solves the problem of parenteral nutrition. In order to reduce post-transfusion reactions before each infusion of intravenous 0.25% solution novokaina. When pain is prescribed analgesic funds, promedol, pipolfen. In complex cases, conduct analgesic anaesthesia nitrous oxide. Oxygen therapy helps prevent pulmonary insufficiency, shock reactions, reduces bloating. Permanent gastric probe is inserted after each laparotomy for 24 to 72 hours before recovery of gastric peristalsis avoid vomiting and aspiration. Children who suffer severe interference, in particular on the thoracic and abdominal cavity organs, locomotor apparatus shown physiotherapy and massage.
Complications after surgery, children develop rapidly, often in the first 2-3 days, and are accompanied by high rates of mortality. Pneumonia first manifested microcinema. The lung atelectasis accompanied by respiratory failure and confirmed by x-ray. Pulmonary edema occurs most often in connection with overdose of liquid during infusion. Treatment of pulmonary complications carried out vigorously, comprehensively: oxygen therapy, antibiotic therapy. When edema increase dehydration therapy (intravenous administration of hypertonic solutions, intramuscularly - 25% solution of magnesium sulfate). When lung atelectasis stimulate cough, deep breathing. Shows the early laryngo - and bronchoscopy for pumping slime. A rhythm and stop breathing occur more often in newborns and infants. Treatment is fast extraction of the contents of the nasopharynx and upper respiratory tract, artificial respiration, intravenous respiratory stimulants (lobelin, tsititon, kordiamin).
Hyperthermia occurs in children younger age group often no direct link with the severity of the operation. Treatment of symptomatic: physical and medical hypothermia, autonomic blockade, neurologice. Dynamic intestinal obstruction occurs hard and stopped using procaine blockades, intravenous injection of hypertonic solutions, hypertension and siphon enemas, diathermy stomach, the appointment prozerina.
The child closely monitored in order to identify intercurrent infections. Medical gymnastics, massage improves the General tone, trophic reaction beneficial effect on the psyche of a patient.
Cm. also care for the sick.