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POST-OPERATIVE INSTRUCTIONS FOR SINUS SURGERY
These instructions are provided in order to answer questions frequently asked during the post-operative period, and to insure that you get the best possible outcome from your sinus surgery. Please read over them before having surgery, and refer to them in the post-operative period as situations arise. The following items should be purchased prior to the date of surgery and do not need a prescription or a written order: Hydrogen Peroxide Q-Tips Saline spray, such as Ocean or Ayr spray Afrin nasal decongestant spray A Waterpik Machine A humidifier is helpful On the day of surgery, you will be receiving intravenous antibiotics and steroids. Some medications are prescribed post-operatively. If steroids are prescribed for the post-operative period, they should be started on the first post-operative day. They should be taken with food, and may cause excitement and/or stomach upset. If these symptoms cannot be tolerated or controlled with medications such as Benadryl for sleep or Maalox for stomach upset, the steroids can be discontinued or taken in decreased doses. Antibiotics should be started the first night after surgery, and then continued as directed thereafter. Please report any unusual problems with these medications. Pain medications can be started at any time during the post-operative period. All pain medications can cause sedation, and nausea is a frequent side effect as well. A nausea medication can be prescribed if the medications are causing these symptoms. Most of the time, sinus surgery patients are sent home on the same day with no packing in the nose. The most frequent reasons for the physician to place packing in the nose are due to significant septal deviation requiring splinting the septum, and/or nasal bleeding requiring splinting the septum, and/or nasal bleeding requiring physical packing to reduce the bleeding. Some bleeding is a normal occurrence after sinus surgery. The bleeding can be controlled by placing ice packs across the nose or by squirting Afrin nasal spray in each nostril. Significant bleeding not responding to these measures should be reported to Dr. Hoffman. Due to the bleeding that may occur after surgery, crusting may occur in the nose. If you do have crusting around the nasal opening you can clean it by dipping a Q-Tip in peroxide, and gently roll the Q-Tip over the crusted area. DO NOT PUT THE Q-TIP INSIDE YOUR NOSE. Saline spray should be started immediately after the surgery in order to keep the cavities clean and reduce the chances of post-operative infections. The over-the-counter saline sprays should be used for the first two days. Starting 2 days after the surgery date, the Waterpik machine should be used more aggressively to irrigate the nose. You will be provided with a set of instructions by our office on how to irrigate correctly. The reservoir should be filled with saline solution (preferably warm), and the nose irrigated at least two times a day until further notice is given. Please see the following sheet on instructions on how to make your own saline. The irrigation is begun on the lowest setting, then can be turned up as tolerated. There is essentially no limit as to how often the saline irrigations can be used. Believe it or not, most patients eventually feel rather soothed by the irrigations. It will be up to Dr. Hoffman if you will be allowed to blow your nose after the surgery. If blowing your nose is fine with D. Hoffman, then please blow your nose GENTLY. It is best to avoid sneezing with the mouth closed, as this can result in significant pressure being built up in the sinus cavity. A humidifier is a good idea to use, particularly at night, until the nose is open enough to allow normal nasal breathing. This may eliminate some of the sore throat and dry mouth commonly associated with mouth breathing. A debridement, in the office is usually scheduled for a week after the surgery, and then follow-up debridements are done as necessary. During the first one in particular, the nose is often still tender. For this reason, it is recommended that a pain pill be taken before this visit, if transportation can be arranged. Medicines to avoid for the first ten days post-op are anything that can raise the blood pressure or cause bleeding. Most commonly, these are Sudafed, ibuprofens such as Advil or Motrin, aspirin, and other anti-inflammatory medications. If you have a question, please ask! Similarly, activities that raise the blood pressure or heart rate should be avoided in the first ten days. I hope that this helps answer the questions most frequently asked in the post-operative period, and helps you to understand how to have the best possible result from your surgery. Please review these instructions before the surgery, and keep this with you during the post-operative period as well. Thank you,
Anunt de atribuire numarul 154338/22.06.2012 Data transmiterii in SEAP: 21.06.2012 13:47 Data acceptarii ANRMAP: 22.06.2012 15:25 Observatii ANRMAP: Transmis dupa intrarea in vigoare a Legii 279/2011, publicata in Monitorul Oficial nr.872/09.12.2011. Data publicarii in SEAP: 22.06.2012 15:25 Adresa: STR. SPITALULUI, NR. 2 , Localitatea: Aiud , Cod postal: 515200 , Alba , Romania , Email: aiud
LC-MS in environmental trace analyses – a challenge for reliable data monitoring Sebastian Zuehlke Introduction The fate of pharmaceutical residues, personal care products and endocrine disrupting compounds has be en recognized as an emerging issue in environmental research [Heberer, 2002; Kümmerer, 2001; Daughton & Ternes 1999]. Thus, reliable data on occurrence and fate of