#AskDrKK: Can a patient fly after surgery?

#DrKKAnswers:

1. Patients with significant comorbidities, pulmonary surgery, or postoperative anemia are at greater risk during flight and should be carefully assessed.

2. General anesthesia is not usually a concern, but postspinal headache has been reported seven days after a spinal anesthetic, possibly because changes in cabin pressure induced a dural leak.

3. Invasive procedures introduce air into isolated body cavities that could expand at altitude in a pressurized cabin and cause barotrauma.

4. Patients should postpone air travel until at least 10 to 14 days after most surgical procedures. This delay should provide enough time for air in the intrathoracic, intraabdominal, or other cavities to be resorbed, and reduces the risk for barotrauma.

5. Laparoscopic abdominal procedures are less often associated with ileus than open procedures. The carbon dioxide introduced into the peritoneum during the procedure rapidly diffuses into the tissues, and patients can usually fly the next day if they do not have bloating.

6. Patients who have undergone a colonoscopy with polypectomy should wait at least 24 hours before flying because of the large amount of gas often present in the colon and the risk of bleeding or perforation at the polypectomy site.

7. Patients with colostomies are not at increased risk inflight, but increased fecal output resulting from intestinal distention may occur. A larger bag or frequent changes may be necessary.

Do not get body parts shaved to get the hairs removed before surgery

Hair removal is commonly performed before any surgery to provide the surgeon with a clean field and to prevent hair from falling into the surgical site. Many reports have however indicated an increased risk for surgical site infections in patients undergoing preoperative hair removal.

Scanning electron micrographs show that razors cause gross skin cuts while clippers cause less injury, and depilatory agents cause no injury to the skin surface. The rates of surgical site infections are higher when shaving is performed (6%) compared with clipping (1.7%) the hair or use of depilatory creams (0.6%).

The lowest rates of surgical site infections are reported when hair is removed just prior to the surgical incision.

Neurosurgeons question the need for hair shaving in brain surgery. Those who do not remove the hair follow the following

1.      Patients have their hair washed with shampoo and 4 %  chlorhexidine within 24 hours of their operation.

2.      In the operating room, the surgical site is scrubbed for 8 to 10 minutes with 4 % chlorhexidine diluted with water, and then cleansed with 10 % povidone-iodine solution.

3.      Prophylactic antibiotics are administered for three days.

The current view is that there is no difference in rate of surgical site infections among patients who have their hair removed prior to surgery and those who have not. If hair needs to be removed, it should be clipped rather than shaved, as patients who are shaved are more likely to develop surgical site infections.