Durchgangssyndrom
A transitional syndrome is the limited ability of the patient to cooperate with the risk of self-endangerment due to postoperative, uncontrolled, motor restlessness, confusion or other variable accompanying symptoms. Depending on the extent of the limited cooperation, respiratory therapy can become ineffective and the uncontrolled restlessness can lead to sleep deprivation, which can lead to physical exhaustion after only about 2 days. Predisposing factors for a transit syndrome are, for example, alcohol and drug abuse, stress, sleep deprivation and the long immobilization period during the operation.
The symptoms usually begin acutely and progress very individually in their severity and intensity. They usually worsen towards night time and can lead to disorientation, panicky escape attempts and the forcible removal of catheters and probes. Therapy and prophylaxis consists of continuous administration of clonidine, which both lowers blood pressure and helps against restlessness, and continuous monitoring of blood pressure and heart rate.
Stress Ulcer
A stress ulcer is an acute lesion of the upper gastrointestinal tract. The cause is an expired shock phase, which can often be days in the past. Predisposing factors are major surgery, polytrauma, burns, septic complications or injuries to the central nervous system.
Clinically, bloody stomach contents occur, possibly with vomiting of blood. Sometimes the organ is perforated with acute abdominal pain and free air under the diaphragm. The therapy consists of gastric lavage with 14°C cold water and the attempt of endoscopic hemostasis.
If the attempt is unsuccessful, the bleeding must be stopped surgically.In order to avoid a stress ulcer, oral food is administered at an early stage, and a stomach tube is also inserted to relieve the stomach and control bleeding. Pharmacological prophylaxis with proton pump inhibitors is also possible. You can find out more about the ulcer and its various forms on our page Peptic Ulcer.
Fever after surgery
Since a postoperative temperature increase is part of the post-aggression metabolism, a slight temperature increase below 38.5°C up to 3 days postoperatively is not a cause for concern. Initially significantly elevated temperature as well as any temperature increase beyond these 3 days requires thorough clarification and, if necessary, therapy, as fever can be a clear sign of infection. The cause can be wound or urinary tract infections.
Both should be checked by regular monitoring of the wound and urine and, if the diagnosis is positive, antibiotic treatment should be administered. In case of a wound infection, it must be opened and cleaned. Pneumonia also leads to fever and should be clarified and treated urgently.
If there are central venous catheters, they are often the cause of infections, as bacteria can be deposited on the materials. In this case, the fever suddenly rises sharply, the entry site is reddened and there are no further symptoms. Initially, the catheter should be removed immediately and examined for bacteria.
A new catheter should only be inserted after 24 hours. Blood poisoning is the sowing of bacteria from a source of infection into the entire bloodstream. Since a fulminant sepsis can be fatal, the cause should be found and treated urgently.