PACU

Question 1

Immediate postop stridor in Recent extubated patient

Answer 1

Airway obstruction or edema

Question 2

Hypoxia and Decreases RR and TV

Answer 2

Think residual anesthetic effect

Question 3

Early hypoxia and wheezing

Answer 3

Bronchospasm

Question 4

1-5 days postop hypoxia think

Answer 4

Pneumonia or atelactasis or PE

Question 5

The most common cause of hypoxemia in recovery?

Answer 5

V/Q mismatch caused by loss of lung volume resulting from small airway collapse and atelactasis.

Question 6

RF for V/Q mismatch postop

Answer 6

Old
COPD
Obesity
Immobility

Encourage:
O2
Sitting
Coughing 
Deep breathing

Question 7

First line treatment for EPS?

Answer 7

Anticholinergic medication such as benztropine or diphenhydramine quickly and reliably treats extrapyramidal symptoms caused by antidopaminergic medication administration.

Options include benztropine, trihexyphenidyl, and atropine.

Question 8

EPS excpected symptoms?

Answer 8

Although often effective for treatment of postoperative nausea and vomiting (PONV), antidopaminergic drugs (e.g. droperidol, metoclopramide, prochlorperazine) can cause extrapyramidal symptoms (EPS) by altering the cholinergic-dopaminergic balance in the central nervous system, notably in the basal ganglia.

• Acute dystonias (abnormal movement or posturing due to involuntary/sustained muscle contractions),
• Akathisia (restlessness and need to be in constant motion)
• Tardive dyskinesia (involuntary repetitive or purposeless movements).

Question 9

EPS suspected in which patients?

Answer 9

When used in typical doses for PONV, the incidence of EPS associated with antidopaminergic agents is ≤1%, but may be higher in patients chronically on antidopaminergic agents, when large doses are used (e.g. 200 mg metoclopramide has 10% incidence of EPS), or when multiple antidopaminergics are administered simultaneously. As a side note, metoclopramide has weak antiemetic effect at 10 mg (< 20 mg) and recommended dosing for PONV is 25-50 mg IV. EPS occur in 0.3% with 10 mg and 0.6% with both 25 mg and 50 mg dosing.