Mare Nostrum

Abdominal Surgery (Pre-op/Post-op Default)

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Abdominal Surgery (Pre-op/Post-op Default)

  • Type of surgery: elective vs emergency; open vs laparoscopic; degree of contamination (clean/clean-contaminated/contaminated/dirty)
  • Surgical risk assessment: ASA classification, cardiac/pulmonary/renal comorbidities, medications (anticoagulants, steroids, DM drugs)
  • Pre-op optimization: correct anemia, coagulopathy, electrolytes, glucose control, hold anticoagulants
  • VTE risk: Caprini score — determines LMWH prophylaxis timing + duration; เริ่ม LMWH 12h post-op ถ้า risk > benefit
  • ERAS (Enhanced Recovery After Surgery) protocol — early oral, mobilization, multimodal analgesia

🕐 One-Day Orders

🔬 Investigation

  • CBC, BUN, Cr, electrolytes, glucose — baseline surgical
  • LFT ถ้า hepatic/biliary surgery
  • PT/INR, aPTT, platelet — coagulopathy screen
  • Blood group + crossmatch (screen สำหรับ elective; crossmatch ถ้า expected blood loss)
  • CXR, ECG — ถ้าอายุ >45 หรือ cardiac/pulmonary Hx
  • Urine pregnancy test — หญิงวัยเจริญพันธุ์

💊 Medication

  • NPO: solid food ≥8h, clear liquid ≥2h pre-op
  • Hold anticoagulants per protocol (warfarin 5 days; DOAC 1-2 days before)
  • Pre-op prophylactic ATB (60 min before incision):
    • Clean abdominal: Cefazolin 2 g IV (single dose)
    • Colorectal/contaminated: Cefazolin 2g + Metronidazole 500 mg IV — หรือ Pip-Tazo
  • DVT prophylaxis pre-op (ERAS): TED stocking + pneumatic compression
  • Premedication per anesthesia order (if needed)

🔁 Continuous Orders

🔬 Investigation

  • CBC, BUN/Cr, electrolytes day 1 post-op
  • Drain output monitoring — สี, ปริมาณ, ลักษณะสรุป
  • Wound check daily — erythema, dehiscence, discharge

💊 Medication

  • IV fluid: ลด IV fluid เมื่อ tolerating oral; ERAS — early oral day 1
  • Multimodal analgesia (ERAS):
    • Paracetamol 1 g IV/PO q6h scheduled
    • NSAIDs (Ketorolac 30 mg IV q8h หรือ Ibuprofen PO) ถ้า renal OK
    • Tramadol 50-100 mg IV/PO q6h PRN (PCA ถ้า available)
    • Minimize opioid — ลด ileus, respiratory depression
  • LMWH (Enoxaparin 40 mg SC OD) — เริ่ม 12h post-op ถ้า hemostasis stable; ต่อตลอดเข้าใน hospital
  • Omeprazole 20 mg OD — GI ulcer prophylaxis (major surgery)
  • Early mobilization day 1 — reduce VTE + ileus

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