anaesthetics post-op Flashcards
how do you wake a patient up
change inspired gases to 100% oxygen then stop anaesthetic drug infusions
when some spontaneous reversal of muscle block has returned (check with peripheral nerve stimulator) reverse any muscle paralysis with neostigmine (approx 2.5mg in adults) and an anticholinergic to prevent muscarinic SE eg atropine (1.2mg)/glucopyrronium (0.5mg)
when spontaneously breathing inspect mouth and oropharynx under direct vision
- remove ET tube
- administer oxygen by facemask - as long as necessary to counteract hypoxia due to diffusion hypoxia, resp depression or ventilation/perfusion mismatch
if no problems transfer to recovery
indications to keep a patient sedated
- Really ill when came in – septic
- Needed for recovery
- Came from ITU
- Something went wrong
- Really long surgery – if upside down then face all swollen – keep them sedated for a while
what is sedation
sedation is a depression of awareness - pt response to external stimuli is limited. May be minimal, moderate or deep. Pt wont feel pain but is aware of what is going on around them
Minimal - only to relieve anxiety, little effect on patient awareness,
moderate - depresses consciousness, leaves the patient capable of responding to external stimuli (tactile or verbal).
deep - only responds to painful or repeated stimuli.
effect of GA
complete loss of consciousness
comparison between GA and sedation
the adverse effects that may be associated with general anesthesia are avoided with sedation.
patients maintain natural physiological reflexes; capable of breathing on their own. Some resp support might still be needed
recovery period quicker from sedation
GA allows anaesthetist to have complete control of the airway
observations made in recovery
look for hypoventilation - is there inadequate reversal, check with nerve stimulator
narcosis - reverse opiates with naloxone cautiously to minimise pain
check for airway obstruction
ensure adequate analgesia
monitor temp, HR, BP
recall criteria for discharge from recovery
when happy with CVS, resp status and pain relief
give clear instructions on postop fluid regimens, blood transfusions, oxygen therapy, pain relief and physiotherapy
anaesthetics handover
- What happened
- What you’ve given the pt
- Any concerns
- PMH
what if hypotensive post-op
- If hypotensive – check they have enough fluids, if not might need vasopressor drug on an infusion – cant have that on a ward so have to go somewhere else
what if massive haemorrhage in recovery
surgeons
clinical response to NEWS scores
interpretation of NEWS score
Hudson face mask
venturi
non-rebreather mask
confusion post-op
sx - agitation, disorientation, attempts to leave the hospital - esp at night
gently reassure pt in well lit surroundings
causes:
- hypoxia - pneumonia, atelectasis, LVF, PE
- drugs - opiates, sedatives
- urinary retention
- MI or stroke
- infection
- alcohol withdrawal
- liver/renal failure
Mx of confusion post-op
occaisionally sedation is necessary
lorazepam 1mg PO//IM
haloperiodol 0.5-2mg IM
reassure relatives that it is common and reversible
dyspnoea/hypoxia post op
any prev lung disease
sit pt up and give ox
monitor sats
look for evidence of:
- pneumonia, pulmonary collapse or aspiration
- LVF - MI, fluid overload
- PE
- pneumothorax due to CVP line, intercostal block, or mechanical ventilation
tests - FBC, ABG, CXR, ECG
hypotension post-op
if severe - tilt bed head-down and give ox
check BP and pulse, compare to pre-op
caused by hypovolaemia because of inadquate fluid input - replace
- monitior UO
- CVP line can monitor fluid resus
hypovolaemia also caused by haemorrhage - review wounds, drains and abdomen
return to theatre for haemostasis if unstable
beware cardiogenic and neurogenic causes - look for MI/PE
consider sepsis and anaphylaxis
hypertension post-op
from pain, urinary retention, idiopathic, inotropic drugs
oral cardiac medication inc antihypertensives should be continued through op
treat cause
if not absorping orally - 50mg labetalol IV over 1min
low UO post-op
aim for UO of >30ml/h or >0.5ml/kg/h
anuria from - blocked/malsited catheter, AKI
flush or replace the catheter
oliguria - little replacement of lost fluid - increase fluid input
review fluids
examine for signs of vol depletion
urinary retention common - palpable bladder
establish normovolaemia - CVP line, fluid challenge may help
catheterise bladder for accurate monitoring, check UE
if intrisic renal failure is suspected, stop nephrotoxic drugs and refer
post op N and V
any mechanical obstruction, ileus, emetic drugs (opiates, diogoxin, anaesthetics)
AXR, NGT and anti-emetic
