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28 Guidelines for Postoperative Medical

Care of the Neurosurgical Patient

Debbie Reynolds and Brigitte A. Brisson

Introduction
The level of postoperative care required for neurosurgical patients
depends on the type of surgery performed and the neurological sta-
tus of the patient. Important components of management include
provision of adequate analgesia, meeting nutritional and fluid
requirements, providing adequate bladder and defecation manage-
ment, nursing care to prevent respiratory and skin complications,
and physical therapy to limit muscle mass loss, maintain joint range
of motion and health, and improve circulation.

Immediate Postoperative Care
In the immediate postoperative period it is important to provide
appropriate analgesia maintain appropriate body temperature,
oxgenation and hydration (Figure 28.1). Patients should be closely
monitored to ensure that they are recovering without evidence of
seizures (especially after myelography or intracranial surgery),
hypotension, or inappropriate ventilation. Bladder and nutritional
management should also be considered in this period.

Intravenous Fluids
Postoperative fluid therapy is important for maintaining hydration,
replacing insensible losses, and allowing easy administration of
medications until the patient is eating and drinking. A balanced
electrolyte solution is selected, with the rate of administration based
on the type and amount of fluids needed to correct dehydration
over a 24‐hour period, provide for maintenance and insensible
losses, and to correct electrolyte and acid-base imbalances. Patients
who receive corticosteroids or osmotic diuretics, such as mannitol, Figure 28.1 Postoperative patient with nasal cannula for oxygen supple-
have higher fluid losses and this should be considered when mentation and intravenous catheter for fluid administration.

Current Techniques in Canine and Feline Neurosurgery, First Edition. Edited by Andy Shores and Brigitte A. Brisson.
© 2017 John Wiley & Sons, Inc. Published 2017 by John Wiley & Sons, Inc.
Companion website: www.wiley.com/go/shores/neurosurgery

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