Trans-oral surgery: post-operative management of patients

Patients undergoing this procedure frequently present with tumour or congenital anomalies. The postoperative management is very specific and the following guidelines should ensure the safety and well-being of the patient. The need for trans-oral surgery is rare. Treatment needs to be tailored to each patient.

Immediately post-operatively and usually for at least 24 hours the patient will be nursed in ITU.

Airway management

Patients will return from theatre intubated and should only be extubated once the patient is fully awake and the airway is patent and on advice of the paediatric intensivist. This will normally be for a few days. (Minumum 24 hours).

Nasal and oral airways should never be inserted. In the event of oral and/or airway swelling the consultant intensivist must be informed. Neurosurgeon should be informed.

Humidified oxygen is discontinued as soon as the patient is fully awake, maintaining own airway and with oxygen saturations over 95% on air with satisfactory blood gas analysis.

Nutrition

The patients remain nil by mouth until the neurosurgeon informs nursing staff otherwise and no swallowing difficulties are experienced. Hydration is maintained with 0.9% saline for the first 24hours and TPN commenced for up to 4-5 days post operatively.

The nasogastric tube will have been inserted in theatre and sutured in place. It should be on free drainage with 1-2 hourly aspiration for the first 24-48hours then decreased to 4 hourly depending on volume of gastric aspirate.

Day 2 -3

If extubated:

Clear oral fluids may be allowed and the nasogastric tube aspirated 4 hourly. Neurosurgeon to advise.

Day 3-4

Soft diet, clear fluids and cool tea /coffee may be allowed. The patient is encouraged to drink a glass of soda water 4 hourly. Neurosurgeon to advise.

Day 5 onwards

IV fluids and TPN may normally be discontinued, the nasogastric tube removed and soft diet and free cool fluids are allowed. Neurosurgeon to advise.