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G. histamine, bradykinins) at the site of injury. Nerve fibres are stimu­ lated to transmit the sensation of pain via the spinal cord to the brain. Anti-inflammatory agents can inhibit release of pain mediators, whilst local blocks prevent impulses reaching the brain. Opiate analgesics exert a central effect. Post-operative pain is inevitable for most patients. 7). Intensity of pain is influenced by cultural and family background, personality, past experi­ ence and motivation. Pre-operative literature can inform and allay anxiety while a calming, reassuring attitude from the medical and nursing staff will contribute to pain reduction.

Kumar and Clark's Handbook of Medical Management Infections acquired in hospital 22 Common sites include an operative site, in relation to a prosthesis, respira­ tory or GI tract translocation, urinary tract from catheters, infections from intravenous lines and cross-infection from any site (MRSA – see below). Specific infections Septicaemia In septicaemia, bacteria are not just present in the blood (bacteraemia), but are using it as a culture medium. Fever, tachycardia, hypotension, acute respiratory distress syndrome (ARDS) and multiple organ failure may ensue (see Chapter 3).

The patient is protected by knowledge of the risk factors that are associ­ ated with an increased risk of infection, namely (a) operations lasting more than 2 hours, (b) abdominal procedures, (c) endogenous or exogenous contamination and (d) more than three diagnoses for the patient. Aseptic surgical technique, preparation of the skin and bowel, and antibiotic prophylaxis reduce the risks substantially. 2 Examples of antibiotic prophylaxis* Operation Infection site Likely organisms Prophylactic antibiotics Colectomy Wound E.