When the patient emerges from the operating room, there are three main interests at play. The first are those of the patient who has a major desire to get rid of the significant discomfort in his or her nose and would like to have it unblocked as well so as to be able to breathe normally. He or she is also thirsty.
The second interest is that of the surgeon. His or her major concern is that the operation has been done properly, no worsening of the condition has occurred, and any endocrine condition for which the operation has been done has been cured.
From: Management of Pituitary Tumors: The Clinicians Practical Guide, Second Edition Edited by: M. P. Powell, S. L. Lightman, and E. R. Laws, Jr. © Humana Press Inc., Totowa, NJ
The third interested party is the endocrinologist. His or her wish is to ensure the continuing normal function of the remainder of the pituitary gland and to check that the surgeon has done his work adequately.
These interests can be dealt with in the following categories:
(1) Pain management.
(2) Fluid balance.
(3) Perioperative endocrine management.
(4) Nonendocrine complications.
(5) Discharge planning.
Where to manage the patient postoperatively is also a matter of debate. In our unit, the patient recovers in a recovery area for approx 1 h and then returns to the ward for routine postoperative monitoring and general nursing care. However, in many units, the patient is managed in an intensive care unit. Whereas this strategy is admirable for absolute safety, it is almost certainly unnecessary overtreatment. Invasive monitoring and multiple observations in the context of recovery from a relatively simple transsphenoidal procedure are probably unwarranted, unless there are questions of nursing quality.
Was this article helpful?