PACU

Question 1

If nausea is a result of hypovolemia, what signs are you going to see?

Answer 1

HR decrease;

Question 2

What are some potential complications in the postanesthesia care unit
(PACU) that may be augmented by the presence of postoperative residual
neuromuscular blockade?

Answer 2

Some potential complications in the PACU that can be augmented by the
presence of postoperative residual neuromuscular blockade include airway
obstruction, inadequate ventilation, and hypoxia. In addition to residual
neuromuscular blockade, obesity, the administration of opioids, long duration
of surgery, and emergency and abdominal surgery are all risk factors for
patients becoming hypoxic in the immediate postoperative period. For this
reason, a dangerous time for perioperative anesthetic complications starts with
the extubation of the trachea, transport to the PACU, and the first 30 minutes in
the PACU

Question 3

Name some factors that influence the success of antagonism of NMBDs

Answer 3

Factors influencing the success of antagonism of NMBDs include (1) the
intensity of the neuromuscular blockade at the time that the pharmacologic
antagonist is administered, (2) the choice of antagonist drug, (3) the dose of
antagonist drug, (4) the rate of spontaneous recovery from the NMBD, and (5)
the concentration of the inhaled anesthetic. (

Question 4

What are some pharmacologic or physiologic factors that may interfere with
the antagonism of the neuromuscular blockade produced by NMBDs?

Answer 4

There are several pharmacologic and physiologic factors that may interfere
with the antagonism of the neuromuscular blockade produced by NMBDs.
Physiologic factors include abnormalities in the patient’s temperature, acidbase status, electrolytes, or metabolism pathways, such as in the case of renal
or liver disease. These may all interfere with the metabolism and clearance of
the NMBD. Pharmacologic factors include the concurrent administration of
aminoglycoside antibiotics, local anesthetics, volatile anesthetics, magnesium,
dantrolene, lithium, tamoxifen, and cardiac antiarrhythmic drugs. Another
cause of an apparent inability to antagonize the effects of NMBDs is not
allowing sufficient time to pass for an anticholinesterase to begin exerting its
effect. In the case of neostigmine, 15 to 30 minutes may need to pass before the
maximal effect of neostigmine is realized. Finally, the lack of a mechanically
evoked muscular response to a train-of-four stimulus is an indication that the
antagonism of the neuromuscular blockade is not possible.

Question 5

A 22-year-old college student with a history of complex regional pain
syndrome (CRPS) in the left foot and ankle after a football injury is
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anesthetized for laparoscopic cholecystectomy. He reports allergy to penicillin
and is treated for chronic pain with paroxetine (Paxil) and gabapentin
(Neurontin) and indomethacin prn. He received fentanyl as the primary
narcotic during his operation to facilitate early discharge. In the PACU he is
shivering and has BP 183/98 mm Hg with pulse 121. He receives 15 mg
meperidine; shivering persists. He reports minimal 3/10 pain. The best option
at this juncture would be

Answer 5

A. Repeat meperidine
B. Labetalol
C. Lorazepam (Ativan)
D. Dantrolene

Question 6

. A 55-year-old man with polycystic liver disease undergoes an 8-hour right
hepatectomy. The patient receives 5 units of packed red cells, 1000 mL
albumin, and 6 L normal saline. The patient is extubated and taken to a
postanesthesia care unit (PACU) where ABGs are: Pao 2 135, Paco 2 44, pH
7.17, base deficit −11, [HCO3
−
] 12, 97% saturation, [Cl
−
] 119, [Na
+
] 145,
and [K+
] 5.6. The most likely cause for this acidosis is

Answer 6

A. Lactic acid
B. Use of normal saline
C. Diabetic ketoacidosis
D. Polyethylene glycol from bowel prep