POST-ANAESTHETIC CARE AND COMPLICATIONS Flashcards
Post-Anaesthetic Care
A(n) (optional or mandatory?) period of _________ and __________ given to every post operative patient
It is done in the ____________ OR _________________
mandatory
observation and monitoring
Recovery room(RR)
Post-Anaesthetic Care Unit (PACU)
Post-Anesthetic care
There must be a dedicated _______ area for recovery of patients post-surgery
Patient remains there until it is ______ for discharge to ward or home (____ cases)
quiet
safe
day
Why is Post-Anaesthetic Care Important?
▪ ▪
Many patients will still have ________ effects of anaesthetic drugs
They have to be monitored for prompt diagnosis of __________________
This will prevent post-anaesthetic _____________
To manage any ____________
To provide ________ to the patients
residual
change in vital signs
complications; complications
comfort
Staff, Equipment and Monitoring
PACU/RR - staffed by ____________ .
✔
Recommended nurse : patient ratio is ___:____
Nurses should be specially trained especially in _____________________
______________ must be on hand to treat possible complications
A nurse must remain with the patient till ____________
trained nurses
1 : 1
airway management; An anaesthetist
fully recovered
Equipments used in post-op care
List 9?🌚
Beds/Trolleys
Oxygen and delivery devices
Suction apparatus
Self inflating resuscitation bag and mask Automated Sphygmomanometer
Pulse oximeter
Thermometer
ECG
Complete range of resuscitation equipment(including drugs)
POST-ANAESTHETIC COMPLICATIONS
EARLY (in PACU)
__________ insufficiency
Post-operative ______ and _______, & possible ___________
———tension and ______ - 2o _________
Post op _____tension and ____cardia
________ Recovery
Shivering
Physical Injury- a fall, peripheral N. injury (due to __________________)
PACU
Respiratory; Nausea and Vomiting
Aspiration; Hypo; shock; Haemorrhage
hyper; tachy; Delayed
improper positioning
POST-ANAESTHETIC COMPLICATIONS
LATE (mostly in ________ )
______________
______ infection- _______,________
Ward
Sore throat
Chest
pneumonia, atelectasis
RESPIRATORY INSUFFICIENCY
Possible causes -
Airway _________- from _____________ , ________ , laryngeal _______, _______ around neck etc.
Inadequate _______________
_________ depression of ventilation →_____ventilation
Aspiration of _________________ → Pneumonitis
Pulmonary _____________ → Hypoxia
obstruction ; tongue falling back
secretions ; spasm ; haematoma
NDMR reversal ; Opioids
hypoventilation ; Gastric contents
atelectasis
RESPIRATORY INSUFFICIENCY
Presentation - may manifest as
_________, _________- 2• to Hypoxia, exclude other causes like pain, full bladder,
__________ __________ delirium
________ & use of accessory mm. of respiration
Signs of ______________
Restlessness; confused
ketamine emergence
Dyspnoea
CO2 retention
Signs of CO2 retention-
______pnoea, later ________pnoea
-______,______,_______ extremities
-___________ Pulse
-_____cardia, _____ BP
Tachy; Brady
Sweating, warm, moist
Bounding; tachy
↑
Respiratory Insufficiency
Treatment, depends on the specific cause
AIRWAY OBSTRUCTION- relieve appropriately (release wire with cutter, remove tight neck dressing)
Inadequate NDMR reversal- confirm with _______ , and ____________________
Opioid resp. depression- antagonist e.g. ___________
Aspiration- _______, + ____________
PNS; another dose of reversal agents
Naloxone
CETT; liberal suctioning,
Laryngospasm
Is a Reflex ___________________ ; occurs commonly in (children or adults?)
closure of the vocal cords
Children
Laryngospasm
Causes:
________________ in the airway
______
________
_______________ when patient is not fully consciouss
Blood or secretions
URTI ; Asthma
Extubation
Laryngospasm
Presents with ________ or absent ________________, _______
crowing
inspiratory sounds
trachael tug.
Management of laryngospasm
Call _____________
____% oxygen delivered holding anaesthetic facemask firmly
________ secretions
________ ventilate with ————— or a ____________ with the expiratory valve ______
___________
Child may need to be ____________
anaesthetist
100% ; Suction
Manually ; an ambubag
breathing circuit ; closed
Jaw thrust ; reintubated
POST-OP. NAUSEA AND VOMITING
Troublesome post-anaesthetic problem Results in ___________ from RR
Occasional unplanned ___________ in day cases
delayed discharge; hospital admission
POST-OP. NAUSEA AND VOMITING
Contributing/Predisposing factors-
Type of surgery- ___________, _______ surgery, _________ procedures
(Male or Female?) patients with ________ of PONV
Anaesthetic Agents- esp. ________,_____,________,
Others - Severe _____, __________, __________
Prophylactic antiemetics better than Rx
Eg.- _________,___________ , cyclizine, ondasetron etc.
laparoscopies ; middle ear ; gynae
Female; prior history
N2O, Opioids, Ketamine
pain, dehydration, early ambulation
Metoclopramide, promethazine
Effects of PONV
______________
______________
______________ ______________
PONV treatment
adequate ______________
______________
______________
______________ possible electrolyte imbalance
dehydration
hypovolaemia
electrolyte derangement
adequate hydration
analgesia
bed rest
correct possible electrolyte imbalance
PONV Treatment
Vol. expansion with __________
If severe/shock- ________ the legs, place in __________ position (__________), use _________ (max. _____ L/24 hrs) to bring up BP fast,
__________ may be required
Review available data to find cause- procedure, intraop. events including EBL, PMHx, medications
Monitor- __________ esp. BP, UO, ECG (12- lead)
If vol. expansion is unsatisfactory,
crystalloids ; elevate
Trendelenburg ; head down
colloid ;1-1.5
Blood transfusion ; vital signs
POST-OP. HYPOTENSION
Is reduction in BP >______ % below _______
Common causes:
Intraop. —————
Ongoing __________
Inadequate ___________
_________ loss of fluid
Others: Pre-existing IHDx, dysrhythmias etc
20; patient’s baseline
surgical blood loss; haemorrhage
volume replacement; 3rd space
POST-OP. HYPERTENSION AND TACHYCARDIA
BP elevation of >_____% above baseline
Tachycardia- ↑PR/HR >______ bpm, adult in otherwise normal pre-op pt.
> 20%
100 bpm
POST-OP. HYPERTENSION AND TACHYCARDIA
Frequent treatable causes include-
________ , ________thermia with _______, bladder ________, ________ hypertension (known hypertensive patient )
Others- hypoxaemia, hypercarbia (CO2 retention), anaemia hypoglycaemia, pre-anaesth. tachyarhythmic patient
Hyperdynamic states- ______thyroidism, ___________________ etc
Pain ; Hypothermia ; shivering
distension ; Essential
hyperthyroidism; phaeochromocytoma
POST-OP. HYPOTENSION, HYPERTENSION AND TACHYCARDIA
Rx is based on _________
While some resolve spontaneously as patient recovers from anaesthesia and surgery
Others may require Rx having excluded common causes
Antihypertensives- iv preps:
_______ – ______ acting – 0.3 mg/kg bolus then infusion
__________ – 5 mg aliquots titrate to BP, every ________
Others – Na Nitroprusside, Labetalol etc
All Rxs require continuous close monitoring while administering drug to prevent ________ → _______
etiology
Esmolol; Short
Apresoline; 20mins
overRx; hypotension or hyper
DELAYED RECOVERY
____________________ after GA
_____ to awaken- failure to progress beyond _________________________ and minimal __________
Prolonged unconsciousness
Slow
return of protective airway reflexes
minimal awareness
DELAYED RECOVERY
Common causes-
___________________ effects-e.g prolong deep anaesth
__________ condition- head injury, Coma
CNS Etiologies-______,_______,_________ (CVA) 2o to intraop. hypertensive/embolic crisis
Others - hyponatraemia, hyper/hypoglycaemia Management-
Determine the suspected/specific cause and treat accordingly
General principle of care of the unconscious- ‘ABC’ is observed
Residual intraoperative drug
Pre-op.
hypoxia, ischaemia, strokes
SHIVERING
A common problem affecting >_____ % of patients recovering from anaesthesia
consists of ____________________ of skeletal muscles initiated by lowering of skin temperature without __________________. However, if ___________________________ , the shivering may become ____________
30; involuntary contractions
a fall in the core temperature
the core body temperature does fall
more violent
Shivering increases to a maximum when body temperature is ____oC – becomes (more or less?) marked below this temperature
34
Less
Shivering occurs in elderly as well as young patients
It occurs whether the anaesthetic technique is inhalational (_____________), balanced or regional
halothane shakes
Common predisposition and causes of shivering include-
_______ and _________ blocks- causes a greater and more prolonged fall in temperature than ______ (_________ and ____________ are abolished below the level blocked)
Prolonged surgery in _________ operating rooms (OR)
Infusion of _____________ at room temperature
___________ cavities and prolonged surgeries
Epidural and spinal
GA
shivering and vasoconstriction
air conditioned; large volumes of fluid
Open body
(Elderly or Younger?) patients experience intraoperative fall in body temperature more frequently than (Elderly or Younger?) people – (metabolic rate ____eases with age)
Elderly
Younger
decr
Adverse effect of shivering include-
____ Oxygen consumption by ____-____%
____ Heart rate → ________, increase in blood ______ levels (metabolic _______ ) and myocardial hypoxia → ————
____ Carbon dioxide – hypercapnia may result if ___________________________ is impaired by drugs.
↑ risk of postoperative _____
Causes distress to the patient and Causes _______ in monitors.
↑; 400 – 500
↑; hypoxaemia; lactate; acidosis
angina; ↑; response of the respiratory centre to carbon dioxide
MI; distress; artifacts
Treatment of shivering
Administer _______ ________
Transport patient covered with _______
______ the room - Operating Room or Recovery room (RR)
Use of ___________
Intravenous fluid _______
Oxygen supplement
blanket; Warm
heating blankets
warmers
Treatment of shivering
Passive __________ (intubated patients)
Active _______ of ___________
Continued ventilatory support until ______thermia for patients with immediate post operative temperature < _____oC or elderly and debilitated patients who are hypothermic.
Use of drugs : ________, _________
humidification
warming; inspired gases
normo; 33
Pethidine
Tramadol
Prevention of shivering
Prevent hypothermia in operating room (OR)
Transport patients into operating room adequately covered.
Operating room should be kept as warm as possible (above ____oC) until surgical preparation is complete and patient draped.
Use of warmed prepping solution
Heating blankets
Thermal blanket with _______ surfaces.
IV fluid warmer
21
reflective
Prevention of shivering
Passive humidifiers ( __________ )/actively heated humidifier located in the _________
Intraoperative temperature monitoring for the _______,_________ and the ______ patient
Keep recovery room temperature above ____ oC
Use of warm LA solution
Addition of opioid e.g. ______ to LA solutn injected ____________
Keep patient warm during transfer from OR to RR
artificial nose; anaesthetic circuit
elderly ; the child; cachectic
21; Pethidine
extradurally
