Gastrointestinal Complications
Following administration of anesthesia or pain medication, patients may experi-
ence nausea, vomiting, constipation, or paralytic ileus.
WHAT WENT WRONG?
Nausea is a common side effect of both anesthesia and pain medications. Apatient’s
reaction to anesthetic agents varies. Some patients have a lot of nausea after anes-
thesia that may last for several hours. Abdominal surgery may cause direct visceral
afferent stimulation, resulting in nausea and vomiting. Medications may act upon
the chemoreceptor trigger zone, located within the medulla outside the blood-brain
barrier. Once the patient begins vomiting, antiemetic medication may be necessary
to break the cycle. Opiod-based medications and decreased activity can both cause
slowing of peristaltic activity, leading to constipation. Patients having abdominal
procedures are at greater risk for paralytic ileus as a postoperative complication.
SIGNS AND SYMPTOMS
• Nausea as a side effect of medication
• Vomiting due to visceral afferent stimulation or activation of chemoreceptor
trigger zone
• Mild, generalized abdominal discomfort and distention with paralytic ileus
due to decreased intestinal motility
• Slow bowel sounds with constipation; absent bowel sounds with paralytic
ileus due to changes in intestinal motility
TEST RESULTS
• Electrolyte abnormality due to vomiting.
• Abdominal flat and upright x-ray shows stool in constipation, gas-filled intes-
tinal loops in paralytic ileus.
TREATMENT
• Monitor abdomen for distention; listen for bowel sounds.
• Assess for dehydration as a result of prolonged vomiting.
• Restrict oral intake in paralytic ileus or if nausea and vomiting are present.
• Nasogastric (NG) tube connected to suction to prevent vomiting in paralytic
ileus.
• Progress diet as tolerated once bowel sounds return and patient is passing
flatus rectally.
• Administer intravenous fluids.
• Administer total parenteral nutrition.
• Administer antiemetics as required.
NURSING DIAGNOSES
• Risk for imbalanced nutrition: less than what body requires
• Risk for imbalanced fluid volume
• Risk for delayed surgical recovery
• Risk for constipation
• Altered bowel elimination
NURSING INTERVENTIONS
• Ask patient about presence of nausea.
• Monitor vital signs for changes.
• Listen to bowel sounds; assess abdomen for distention.
• Monitor intravenous site for signs of infiltration, pain, and redness.
• Monitor intake and output.
• Monitor color and amount of fluid drained from NG tube.
• Ask patient if he or she is passing any flatus rectally or having bowel move-
ment.
The skin is the body’s first line of defense against infection. During surgery this
line of defense is penetrated. Even though the surgical procedure is performed in
as aseptic an environment as possible, the possibility of infection still exists.
WHAT WENT WRONG?
Wound infections can develop in the postoperative period. The wound may be
contaminated before surgery, such as with penetrating trauma, or may become
infected during healing. The surface of the skin has bacteria that are naturally
present, referred to as normal flora. These bacteria may enter the wound and cause
infection. Nosocomial infections can also occur at the surgical site, caused by
bacteria found elsewhere in the hospital. Infection within the surgical wound will
slow approximation of the wound edges, delaying wound healing.
SIGNS AND SYMPTOMS
• Increase in pain at surgical wound due to inflammatory process early in
infection
• Redness at wound edges that spreads if untreated
• Drainage from wound site due to body’s response to bacterial presence (change
in color and odor of drainage)
• Fever due to infection
• Elevated white blood cell count
TEST RESULTS
• Elevated WBC due to body’s response to bacterial presence.
• Elevated erythrocyte sedementation rate due to inflammation.
• Culture of wound area will identify organism.
• Sensitivity test will identify appropriate antibiotic treatment.
TREATMENT
• Obtain culture and sensitivity test of wound.
• Administer appropriate antibiotics intravenously.
• Keep wound site clean and dry.
NURSING DIAGNOSES
• Risk for infection
• Impaired skin integrity
• Impaired tissue integrity
• Delayed surgical recovery
NURSING INTERVENTIONS
• Monitor vital signs; look for fever.
• Assess surgical wound for redness, drainage.
• Ask patient about pain at surgical site.
• When obtaining wound culture, remove surface drainage with gauze, then
obtain specimen from within wound edge (this will ensure that the organism
is actually from the wound and not from the skin).
Patients with preexisting respiratory disorders, obesity, or thoracic or upper abdom-
inal surgical procedures are at greater risk of developing respiratory complications
postoperatively.
WHAT WENT WRONG?
After surgery, patients are not as mobile. This lack of physical activity leads to
diminished chest wall and diaphragmatic movement, resulting in a decreased
amount of air exchange. Alveolar sacs can collapse, leading to areas of atelectasis.
Pain medications can adversely affect respiratory status by decreasing respiratory
drive. Patients at increased risk for respiratory complications may develop pneu-
monia in the postoperative period due to diminished airflow, increased respiratory
secretions, and inflammatory processes. Patients with increased risk for clotting or
DVT, or those with hypercoagulable states are at risk for developing a pulmonary
embolism.
SIGNS AND SYMPTOMS
• Shortness of breath due to diminished airflow and resultant decreased oxy-
genation
• Chest pain in the area of atelectasis due to collapse of the alveolar sacs within
that area of the lung
• Productive cough due to pneumonia
• Fever due to infection in pneumonia
• Sudden onset chest pain and shortness of breath in pulmonary embolism as
clot blocks arterial blood flow within the lung
• Diminished oxygen levels as gas exchange is impaired in atelectasis, pneu-
monia, or pulmonary embolism
TEST RESULTS
• Pulse oximetry shows diminished oxygenation.
• Chest x-ray shows area of collapse in atelectasis, infiltrate in pneumonia,
wedge infiltrate in pulmonary embolism.
• CT scan shows alveolar collapse in atelectasis, area of infiltrate in pneumonia.
• Spiral CT or helical CT shows clot in pulmonary embolism.
• WBC elevated in bacterial pneumonia.
TREATMENT
• Administer supplemental oxygen.
• Administer antibiotics for pneumonia—initially intravenously, then orally:
• macrolides
• fluoroquinolones
• Administer blood-thinning agents to prevent enlarging of clot or developme
of new clots in pulmonary embolism.
• Mechanical ventilation if necessary.
NURSING DIAGNOSES
• Ineffective breathing pattern
• Ineffective airway clearance
• Impaired gas exchange
• Ineffective cardiopulmonary tissue perfusion
NURSING INTERVENTIONS
• Monitor vital signs for changes.
• Monitor respiratory status: check respiratory rate, rhythm, and depth; check
skin color; listen to breath sounds.
• Monitor pulse oximetry level for oxygenation.
• Monitor intravenous site for signs of infiltration.
• Encourage coughing and deep breathing exercises.
• Encourage incentive spirometer use.
• Encourage early ambulation.
WHAT WENT WRONG?
Patients may develop cardiovascular complications due to the physiological stress
of surgery, side effects of the anesthesia or other medications, or comorbidities.
Myocardial infarction (MI), cardiac arrhythmias, or hypotension are likely during
or in the immediate postoperative period. When getting the patient out of bed for
the first time after surgery, it is good practice to have the patient sit on the side of
the bed for a minute or two before standing up to ascertain if the patient feels dizzy
due to a drop in blood pressure associated with position change. Deep vein throm-
bosis (DVT) is a later vascular complication associated with inflammation and
decreased mobility after surgery.
SIGNS AND SYMPTOMS
• Chest pain which may radiate to back, neck, jaw, or arm due to ischemia in MI
• Shortness of breath due to altered cardiac output and tissue perfusion
• Dizziness or lightheadedness due to diminished cardiac output and cerebral
tissue perfusion or cardiac arrhythmia
• Palpitations due to cardiac arrhythmia
• Cardiac arrhythmias due to myocardial irritability—possibly due to ischemia,
medication side effect, or electrolyte imbalance
• Low blood pressure due to diminished cardiac output
• Unilateral calf pain and lower extremity swelling due to DVT
TEST RESULTS
• Cardiac monitor or EKG shows arrhythmia.
• BP below normal level.
• Doppler ultrasound of extremity shows clot within blood vessel.
TREATMENT
• Monitor cardiac rhythm.
• Administer antiarrhythmic medications to stabilize cardiac rhythm.
• Administer intravenous fluids to expand circulating blood volume to raise
blood pressure.
• Administer blood-thinning medications to decrease likelihood of clot enlarg-
ing or additional clots forming:
• heparin
• low–molecular weight heparin
• warfarin
NURSING DIAGNOSES
• Decreased cardiac output
• Ineffective cardiopulmonary tissue perfusion
• Ineffective peripheral tissue perfusion
• Impaired physical mobility
NURSING INTERVENTIONS
• Monitor vital signs for changes.
• Check blood pressure lying down and sitting up for orthostatic change.
• Monitor cardiovascular status for cardiac rhythm, heart sounds, peripheral
pulses, capillary refill, and pulse deficit.
• Assess for peripheral edema.
• Ask patient about calf pain or tenderness.
• Monitor intravenous site for signs of infiltration.
• Encourage ambulation and leg exercises to prevent development of DVT.
• Monitor proper use of elastic stockings or sequential compression devices
postoperatively.
After the surgery, the patient enters the postoperative period. The immediate post-
operative period requires close monitoring as the patient emerges from anesthesia.
The patient will then be transferred to either a same-day surgery area for discharge
home that day or an inpatient surgical unit for care. After discharge from the hospi-
tal, the patient may need home care. Return to full activities may take several weeks.
POSTANESTHESIA CARE
The patient is transferred from the operating room to the postanesthesia care unit
(PACU) for close monitoring in the immediate postoperative period. Initial assess-
ment is focused on ABC: airway, breathing, and circulation. Monitor the patient’s
airway, gas exchange, pulse oximetry, oxygen delivery, accessory muscle use, and
breath sounds. The patient can develop stridor due to edema or bronchospasm. The
cardiovascular status is checked next. Vital signs are checked every 15 minutes
until stabilized; pulse, blood pressure, and cardiac rhythm are monitored.
The surgical wound is checked for signs of drainage or bleeding. The dressing
is checked. The drains are checked for output and patency. Tubes that need to be
connected to suction (such as nasogastric tubes) are connected. Intravenous fluids
are monitored.
Neurologic assessment is performed to check level of consciousness. Following
general anesthesia, the patient follows a predictable progression in the return to
consciousness. Initially there is muscular irritability, and then restlessness followed
by pain recognition and the ability to reason and control behavior. Pupil responses
are monitored, looking for bilaterally equal responses to light. Motor responses are
monitored, looking initially for purposeful response to painful stimuli and later for
response to command. Pain management is begun during this time. As the anes-
thetic agent wears off, it is important to assess the patient’s level of pain. This may
be assessed through subjective information in patients who are conscious, or through
more objective signs in patients who are still in semiconscious states. Monitor for
changes in vital signs (elevated pulse and BP), changes in movement, and moan-
ing. Expected pain levels can be estimated from the type of surgery and give a start-
ing point for those patients as they begin to come out of the anesthesia.
Gastrointestinal status is monitored for presence of nausea or vomiting. This
may be a reaction or side effect to anesthesia. Check for abdominal distention and
presence of bowel sounds. Monitor drainage from nasogastric tube; note amount
and color of drainage.
Monitor laboratory results as indicated. Electrolyte levels, hemoglobin or hema-
tocrit levels, BUN and creatinine, arterial blood gases (ABGs), or other studies may
be necessary in the immediate postoperative period. The diagnostic studies neces-
sary will depend on the patient’s history, the estimated blood loss during surgery,
and the type of procedure performed.
After the initial recovery time, the stable patient who is transferred from the
PACU to the same-day surgical area continues to be monitored. Vital signs are
taken, although not as frequently. Respiratory and cardiovascular functions are
monitored. Cardiac rhythm is no longer monitored. The dressing is checked for
any drainage. Bowel sounds are checked. Clear fluids are given if the patient is not
experiencing nausea. Patients are monitored for urinary output prior to being dis-
charged to home.
Patients who are admitted to the hospital are transferred from the PACU to a
surgical unit. Vital signs, respiration, and cardiovascular status are checked. The
dressing is monitored for drainage; drainage tubes are monitored for output. Intra-
venous lines are monitored for signs of infiltration and proper flow rates. Bowel
sounds are monitored.
Patients who are unstable or who have had extensive procedures are transferred
to intensive care for close monitoring. Nurses who are used to caring for complex,
unstable patients care for these patients. Their vital signs are closely monitored.
Some patients will still be on mechanical ventilation.
POSTOPERATIVE COMPLICATIONS
The focus of care that is common for all of these postoperative patients is identi-
fication of complications. Common complications involve the cardiac, respiratory,
and gastrointestinal areas, and infections.
The intraoperative period is the time involved with the surgical procedure. The
focus during this time is on asepsis and protection of the patient. Within the oper-
ative suite, the staff wears scrub suits. They change into the scrub shirt and pants
when they get to the locker room within the surgical area. A surgical cap covers
hair. Shoe covers are worn to prevent tracking bacteria or dirt from other areas into
the operating rooms.
THE SURGICAL TEAM
Members of the surgical team include the surgeon, a surgical assistant, an anesthesi-
ologist or anesthetist, a circulating nurse, a scrub nurse or surgical tech, and a hold-
ing area nurse. The surgeon is the doctor who will perform the surgery. The surgical
assistant may be another surgeon, a surgical resident, an RN first assist, or a physi-
cian’s assistant. The person providing anesthesia and monitoring the vital signs of
the patient is either an anesthesiologist (a physician) or a certified registered nurse
anesthetist (CRNA). The circulating nurse is a registered nurse who acts as the
patient advocate, obtains the necessary supplies for the procedure, makes sure diag-
nostic studies and blood products are available if necessary, prepares the operative
table, positions the patient (padding bony prominences if necessary), and cleanses
the skin in the operative area before positioning surgical drapes. The scrub nurse or
surgical tech sets up the sterile field, assists with draping the patient, and hands ster-
ile supplies into the operative field and takes used instruments from the surgeon. The
circulating nurse and scrub nurse (or surgical tech) together count all instruments,
sponges, and sharps used in the surgical field. The count is performed before, dur-
ing, and after the procedure. The holding area nurse cares for the patients who have
been brought into the operating room suite but who are not yet ready to go into the
operating room. The holding area nurse may be managing several patients at one
time and can also help to transport and transfer the patient.
Before entering the operating room, the members of the surgical team scrub at
the sink just outside the room in which the surgery will be performed. Prior to start-
ing the scrub, the team member applies a mask with face shield or goggles. The
surgical scrub is usually timed and covers the area from the fingertips to 2 inches
above the elbows. The surgical scrub renders the skin clean, not sterile. After the
scrub, the skin is dried with a sterile towel. A sterile gown, then sterile gloves are
applied. The front of the gown is considered sterile in the front from two inches
below the neck to the waist and from the elbow to the wrist. The circulating nurse
applies the gown and gloves unassisted, and then assists the other members of the
team into their gown and gloves as they enter the room.
RISK FOR INJURY
During the surgery, the patient is anesthetized and cannot tell you if there is pres-
sure anywhere. The patient is positioned to allow for maximal access to the opera-
tive site. This sometimes causes unnatural positioning of the patient or the patient’s
extremities. The operative table is padded to decrease pressure on the patient. There
may be additional padding added to areas of flexion or bony prominences to reduce
the risk of pressure ulcer formation or nerve damage due to positioning.
Heat loss can occur during surgery. The patient is sent to the operating room in
a hospital gown, which may be pulled up or removed depending on the body loca-
tion of the surgery. The body is draped for privacy so that only the surgical area is
exposed. The temperature within the operating room is kept rather cool because
the air exchange rate is higher within the operating room than in other rooms
(to decrease bacterial counts), and the staff are wearing double layers of clothes.
Warmers can be set up for the patients during certain procedures when heat loss is
expected—a large, open operative site or a long duration of surgery.
At the end of the surgical procedure, the wound is closed. The closure is to hold
the wound edges together and to prevent contamination. Closure may be achieved
with sutures (either absorbable or nonabsorbable), staples, glue, or skin closure
tape. Nonabsorbable sutures and staples will have to be removed in the post-
operative period.
Drains may be inserted near the operative site if significant wound drainage is
anticipated. Some drains are attached to suction, some have self-suction, and some
will drain due to gravity. The wound site is covered with a sterile dressing before
the patient is transferred out of the operating room.
ANESTHESIA
Anesthesia can be administered via general or regional routes (for major proce-
dures) or conscious sedation (for minor procedures). General anesthesia renders
the patient unconscious and incapable of breathing on his or her own; pain recep-
tion is also blocked. These patients must be intubated and mechanically ventilated
for the duration of the anesthesia. Regional anesthesia can be achieved through
nerve blocks, or epidural or spinal anesthesia. Nerve blocks occur when an anes-
thetic agent is injected into an area immediately surrounding a particular nerve
or nerve bundle. The nerve tissue becomes anesthetized, effectively causing the
tissue that it supplies to become pain-free. With epidural anesthesia, an anesthetic
agent is injected into the epidural space surrounding the spinal column, usually in
the lower lumbar area. The nerves become anesthetized as they leave the spinal
column, causing the area of the body supplied by these nerves to become pain-free.
This anesthesia is most commonly associated with childbirth but is used for many
surgical procedures. Spinal anesthesia is not commonly used; the anesthetic agent
is injected into the cerebrospinal fluid. Patient positioning is very important, as
gravity will cause the anesthetic agent to travel. The patient must remain flat after
the procedure to prevent leakage of cerebrospinal fluid from the puncture site.
The preoperative period, the time prior to surgery, is used to prepare the patient for
surgery both physically and psychologically. Ideally there is time to correct as many
abnormalities as possible prior to the surgical procedure. For patients having a
scheduled procedure with a significant anticipated blood loss, this is the time to
donate blood to be banked for use in their surgery and begin to take iron, folic acid,
vitamin B12, and vitamin C to aid in red blood cell production. Preoperative clear-
ance is given, informed consent is obtained, and preoperative teaching occurs dur-
ing this time.
PREOPERATIVE CLEARANCE
The patient’s primary care provider typically gives preoperative clearance for sur-
gery. This physician, nurse practitioner, or physician’s assistant is familiar with
the patient’s medical history and current medications and is able to adequately
assess the impending risk of the surgery to the patient. Things to consider when
providing clearance for the patient include the type of surgical intervention planned,
the potential for blood loss during surgery, the patient’s age, general health
and comorbidities, past medical and surgical history, current medications, use of
herbal remedies or supplements, alcohol use, smoking history, substance use,
allergies, family history including problems with surgery, and diagnostic testing
results. Diagnostic studies often include a CBC (to identify anemia or signs of
infection), a chemistry panel (to identify electrolyte imbalance, abnormal glu-
cose, liver or renal function), a urinalysis (to identify infection, protein, glucose),
PT/INR/PTT (to identify blood clotting disorders), an EKG (to identify abnormal
cardiac rhythms or damage to myocardium), chest x-ray (to identify pulmonary
pathology or enlargement of cardiac silhouette), or pulmonary function testing
(for patients with respiratory disorders such as asthma or emphysema). CT scans,
MRIs, PET scans, or stress testing may be ordered for individual patients depend-
ing on their medical history, type of surgical procedure planned, and results
of other diagnostic studies.
INFORMED CONSENT
An informed consent is obtained prior to any invasive or dangerous procedure.
The reason for the surgery, type and extent of surgery to be performed, the risks of
the procedure, the person to perform the procedure, alternative options and their
associated risks, and the risks associated with anesthesia are all explained to the
patient. It is the surgeon’s responsibility to make sure this information is explained
to the patient. The patient must be a competent adult in order for his or her signa-
ture to be valid. If the patient has been given medications that alter his or her abil-
ity to reason or to make judgments, the consent will not be valid. The nurse witnesses
the patient’s signature on the consent form.
PREOPERATIVE TEACHING
Explaining normal preoperative routines to the patient can be very helpful, so the
patient knows what to expect. The nurse needs to be familiar with the types of
surgical procedures and what the expected postoperative course will entail. The
extent of the procedure, type of incision, presence of any tubes or drains, and antic-
ipated pain level after the surgery will help guide the type of teaching necessary
for the patient.
Preoperatively the patient can expect to be NPO, or not allowed to eat or drink
anything for several hours prior to the procedure. The time frame will depend on
the extent and location of procedure, the type of anesthesia, and the scheduled time
of surgery. An exception to this nothing-by-mouth rule would be for patients who
need to take oral medications the morning of surgery. Cardiovascular, diabetic, and
certain other medications may need to be taken even though the patient is not to
eat or drink anything else.
An intravenous access site will be obtained prior to the surgery. Fluids can be
administered to the patient in this way. The access also allows for giving the patient
medications intravenously for rapid action. Fluids are routinely given in the oper-
ating room and in the immediate recovery period. The patient may have continued
intravenous fluids for more extensive procedures.
Skin preparation may only involve washing of the surgical site in the operating
room with an antimicrobial solution. Other patients may need to have removal of
hair from the surgical site. This may be with a razor or a depilatory agent. It is
important not to cut the skin if you are shaving a surgical site; small cuts or abra-
sions on the skin allow for potential sites of infection. Depilatory agents can be
caustic on the skin of some patients, causing irritation or a rash. A small spot test
away from the surgical area is a good idea in a patient with known skin sensitiv-
ity or history of allergies.
For patients having planned surgery involving the intestinal tract, a bowel
preparation will be completed prior to the surgery. This is done to decrease the bac-
terial count within the intestinal tract. Cleansing of the bowel is also completed to
empty the intestine of stool before the surgeon plans on cutting into either the small
or large intestine. Both of these preparations help to reduce the possibility of
infection in the postoperative period. For patients who will have tubes or drains in
place in the postoperative period, a simple explanation of what to expect can help
to alleviate some anxiety.
Availability of pain medication in the postoperative period should be explained
to the patient. In many instances the patient is able to manage his or her own pain
medication. For outpatient procedures, patients may be given a prescription for an
oral pain medication prior to the procedure. This way the medication is available
when the patient gets home from the surgery. For postoperative patients in the
hospital, many patients have an intravenous patient-controlled analgesia, known
as PCA, for pain management, where pain medication is delivered via a pump.
Typically a small basal dose of narcotic is delivered all the time. These patients
also have the ability to press a button whenever they are experiencing pain. The
pump will monitor the amount and timing of each dose of pain medication. If the
patient is due for medication, a dose will be administered; if the patient is not due
for medication, no dose will be administered.
TRANSFER OF THE PATIENT
Most facilities have a preoperative checklist to assist the nurse to make sure tha
all the needed components have been checked prior to sending the patient to the
operating room (OR). All pertinent documentation—the signed consent form
the patient’s chart, and current lab results—accompanies the patient to the OR.
Perioperative Care
The care of the surgical patient ideally begins when the patient is first informed of
the need for surgery. The surgical procedure may be a sudden, unexpected event for
the patient, resulting in stress and anxiety, such as necessary surgery following
trauma, or may be something that the patient has planned, such as a liposuction, far
in advance. The more time the patient has to prepare for surgery, both physically
and emotionally, the better able the patient is to cope with the physiological stresses
of the surgery. Nurses are in a position to care for the patient, provide necessary
education, act as patient advocate, and encourage health promotion behaviors.
Surgical Classifications
The American Society of Anesthesiology categorizes surgical procedures based on
the degree of risk to the patient. The urgency, location, extent, and reason for the
procedure are all considered, as well as the patient’s age; preexisting cardiovascular,
respiratory, and neurologic status; endocrine disorders; malignancies; nutritional,
fluid, and electrolyte status; abnormal laboratory findings; abnormal vital signs; and
presence of infection. The risks of doing the surgery are weighed against the risks of
not doing the surgery. There are some cases in which the risk of surgery is very high,
but the patient may certainly die if the surgery is not performed (patients with uncon-
trolled internal bleeding following a gunshot or stabbing, for example).
The anatomical location of the surgery will affect the degree of risk to the patient.
Surgical procedures performed within the thoracic cavity or skull are a greater risk
to the patient than procedures performed on the extremities. Surgical procedures
involving vital organs such as the heart, lungs, or brain carry a higher risk. The pro-
cedures that involve a greater potential for blood loss, such as vascular surgery, also
involve greater risk.
The degree of urgency of the procedure is described as emergent, urgent, or elec-
tive. Emergent procedures need to be performed immediately after identifying the
need for surgery. Examples include surgery to stop bleeding from trauma, shooting,
or stabbing, or a dissecting aortic aneurysm. Urgent procedures are scheduled after
the determination of surgical need is made. Examples include tumor removal and
removal of kidney stones. Elective procedures are scheduled in advance at a time
that is convenient for both patient and surgeon. Postponement of the surgery for
several weeks or even months will not cause harm to the patient. Examples include
joint replacement procedures and cosmetic procedures.
The extent of the surgery will affect the risk to the patient. The more extensive
the surgical procedure, the greater the potential risk to the patient. More exten-
sive surgical procedures cause more physical insult to the body and typically require
a longer duration of anesthesia. The anesthesia can also cause stress to the patient’s
system, interact with medications in the patient’s system, and must be metabolized
out of the body.
The reason for surgery is another way that surgical procedures are classified. The
purpose may be diagnostic, curative, restorative, palliative, or cosmetic. Diagnostic
procedures are performed to obtain a biopsy for definitive diagnosis of a mass.
Curative procedures are performed to remove a diseased area, such as a lumpec-
tomy for breast cancer or an appendectomy. Restorative procedures are performed
to restore function, such as joint replacements. Palliative procedures are proce-
dures are performed primarily for comfort measures, such as tumor debulking.
Cosmetic procedures are typically performed at the patient’s request; at times
some cosmetic procedures may fall into restorative (repairing damage or a con-
genital defect), curative, or diagnostic (in the setting of skin cancer).
The perioperative period can be broken down into the preoperative (time before
the surgery), intraoperative (time during the surgery), and the postoperative (time
following the surgery until recovery) periods.
