Intra- and post-operative care

Question 1

Sleep vs unconsiousness vs anaesthesia

Answer 1

Sleep - recurring lowered level of consciousness with decreased response to external stimuli (from which can be aroused)
Unconsciousness - State of unawareness from which one is unable to respond to sensory stimuli (somatic and autonomic reflexes may still occur)
Anaesthesia - Drug induced hypnosis. Loss of protective reflexes. Motor loss. Some degree on consciousness can be intact.

Question 2

Stages of depth of anaesthesia

Answer 2

1. Analgesia (induction to loss of consciousness)
2. Excitement (LOC to automatic breathing -breath holding, cough, swallowing, gag)
3. Surgical (light - medium - deep) (eyes fixed - intercostal paralysis - diaphragmatic respiration)
4. Overdose (Apnoea and death)

Question 3

How do we test depth of anaesthesia?

Answer 3

By response to surgical stimulus.

1. Somatic response (obvious to subtle)
2. Sympathetic response (HPT, tachy, sweat, lacrimation)

Both can be used for spontaneously breathing pt. However, in a paralysed pt only sympathetic response is monitored.

Question 4

Which parameters must be monitored intra-operatively?

Answer 4

CVS - pulse, sats, BP, ECG, blood loss (CVP, arterial line)
Resp - ventilation volumes ans pressures, capnography, oximetry
Renal - urine output (0.5-1 ml/kg/hr) [poor as ADH released during surgery]
Neuromuscular fx - PNS
Temperature, pressure points, glucose, Hb, eyes, thrombosis

Question 5

A patient cannot be transferred from theatre to recovery until?

Answer 5

1. Pt airway can be maintained
2. Ventilation is adequate
3. CVS function is stable

Question 6

What is the routine monitoring in the recovery room?

Answer 6

Pulse oximeter (routine oxygen unnecessary)
BP
Clinical assessment of LOC

Question 7

What are 10 common post-operative anaesthetic problems?

Answer 7

1. Airway obstruction
2. Hypoventilation (pain, paralysis, drug)
3. Hypoxaemia (give O2 - identify cause)
4. Hypotension (Hypovolaemia! / drugs)
5. Hypertension (Pain! / fluid overload /CVA / pre-existing)
6. Shivering (increase O2)
7. Somnolence
8. Delerium (hypoxia, pain, full bladder, drugs)
9. PONV
10. Pain

Question 8

Fitness for discharge from recovery based on what score?

Answer 8

Aldrete score. (>9)

Movement. Cough. BP. Consciousness. Colour.

Question 9

Fitness for discharge from hospital based on what score?

Answer 9

Post anaesthetic discharge scoring system (PADSS)

Mental state. Pain/nausea/vomiting. Bleeding. Vital signs. Intake and output.

Question 10

What are long term respiratory problem after anaesthetic due to?

Answer 10

Failure to cough/ clear secretions (Atelectasis, infection)

Hypostatic pneumonia (lying in same position)

Hypoventilation

Foreign body inhalation