Module 13

Question 1

risks of post op N/V and RFs

Answer 1

risks: Pulm aspiration, wound complications, tissue approximation failure

Risk factors:
Female, young, prior hx, motion sickness, NON-SMOKER, volatiles anesthetics, opioids, longer procedure, lower ASA classification, anxiety, laparoscopy, abdominal procedure

Question 2

Tx of PONV

Answer 2

Anti-emetics: 5-HT3 (Zofran), anti-H1 (Phenergan), reglan, dexamethasone
Opioids: Avoid
Anesthetic: local/regional if possible
Multi-modal therapy

Question 3

what causes shoulder pain post op?

Answer 3

Chemical and pressure effects of pneumo
Self-limited: lasts 1-3 days
Treat same as incisional pain

Question 4

Strategies to limit post op pain

Answer 4

Intra-op would infiltration with local anesthetic
Lower insufflation pressure
Evacuation of pneumo after procedure
Multimodal analgesia
Heated/humidified insufflation is controversial

Question 5

When can you shower following lap?

Answer 5

Skin strips, adhesive bandages, liquid adhesive
Keep dry for 24-48 hrs
Ok for showers/bathing at 24-48h after procedure
Given D/C instructions: redness, swelling, increasing pain, discharge from wound

Question 6

When can you eat after appy? chole? Fundoplication? colon resection?

Answer 6

Appy: 0-1d
Chole: 0-1d
Fundoplication: 1-2d
Colon resection: 3-6d