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Junior Anaesthesia > POST-ANAESTHETIC CARE AND COMPLICATIONS > Flashcards

POST-ANAESTHETIC CARE AND COMPLICATIONS Flashcards

1
Q

Post-Anaesthetic Care

A(n) (optional or mandatory?) period of _________ and __________ given to every post operative patient

It is done in the ____________ OR _________________

A

mandatory

observation and monitoring

Recovery room(RR)

Post-Anaesthetic Care Unit (PACU)

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2
Q

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)

A

quiet

safe

day

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3
Q

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

A

residual

change in vital signs

complications; complications

comfort

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4
Q

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 ____________

A

trained nurses

1 : 1

airway management; An anaesthetist

fully recovered

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5
Q

Equipments used in post-op care

List 9?🌚

A

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)

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6
Q

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 __________________)

A

PACU

Respiratory; Nausea and Vomiting

Aspiration; Hypo; shock; Haemorrhage

hyper; tachy; Delayed

improper positioning

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7
Q

POST-ANAESTHETIC COMPLICATIONS

LATE (mostly in ________ )
______________
______ infection- _______,________

A

Ward

Sore throat

Chest

pneumonia, atelectasis

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8
Q

RESPIRATORY INSUFFICIENCY
Possible causes -

Airway _________- from _____________ , ________ , laryngeal _______, _______ around neck etc.
Inadequate _______________
_________ depression of ventilation →_____ventilation
Aspiration of _________________ → Pneumonitis
Pulmonary _____________ → Hypoxia

A

obstruction ; tongue falling back

secretions ; spasm ; haematoma

NDMR reversal ; Opioids

hypoventilation ; Gastric contents

atelectasis

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9
Q

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 ______________

A

Restlessness; confused

ketamine emergence

Dyspnoea

CO2 retention

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10
Q

Signs of CO2 retention-

______pnoea, later ________pnoea
-______,______,_______ extremities
-___________ Pulse
-_____cardia, _____ BP

A

Tachy; Brady

Sweating, warm, moist

Bounding; tachy

↑

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11
Q

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- _______, + ____________

A

PNS; another dose of reversal agents

Naloxone

CETT; liberal suctioning,

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12
Q

Laryngospasm

Is a Reflex ___________________ ; occurs commonly in (children or adults?)

A

closure of the vocal cords

Children

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13
Q

Laryngospasm

Causes:
________________ in the airway
______
________
_______________ when patient is not fully consciouss

A

Blood or secretions

URTI ; Asthma

Extubation

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14
Q

Laryngospasm

Presents with ________ or absent ________________, _______

A

crowing

inspiratory sounds

trachael tug.

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15
Q

Management of laryngospasm

Call _____________
____% oxygen delivered holding anaesthetic facemask firmly
________ secretions
________ ventilate with ————— or a ____________ with the expiratory valve ______

___________

Child may need to be ____________

A

anaesthetist

100% ; Suction

Manually ; an ambubag

breathing circuit ; closed

Jaw thrust ; reintubated

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16
Q

POST-OP. NAUSEA AND VOMITING

Troublesome post-anaesthetic problem Results in ___________ from RR
Occasional unplanned ___________ in day cases

A

delayed discharge; hospital admission

17
Q

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.

A

laparoscopies ; middle ear ; gynae

Female; prior history

N2O, Opioids, Ketamine

pain, dehydration, early ambulation

Metoclopramide, promethazine

18
Q

Effects of PONV

______________
______________
______________ ______________

PONV treatment
adequate ______________
______________
______________
______________ possible electrolyte imbalance

A

dehydration
hypovolaemia
electrolyte derangement

adequate hydration
analgesia
bed rest
correct possible electrolyte imbalance

19
Q

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,

A

crystalloids ; elevate

Trendelenburg ; head down

colloid ;1-1.5

Blood transfusion ; vital signs

20
Q

POST-OP. HYPOTENSION

Is reduction in BP >______ % below _______

Common causes:
Intraop. —————
Ongoing __________
Inadequate ___________
_________ loss of fluid
Others: Pre-existing IHDx, dysrhythmias etc

A

20; patient’s baseline

surgical blood loss; haemorrhage

volume replacement; 3rd space

21
Q

POST-OP. HYPERTENSION AND TACHYCARDIA
BP elevation of >_____% above baseline

Tachycardia- ↑PR/HR >______ bpm, adult in otherwise normal pre-op pt.

A

> 20%

100 bpm

22
Q

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

A

Pain ; Hypothermia ; shivering

distension ; Essential

hyperthyroidism; phaeochromocytoma

23
Q

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 ________ → _______

A

etiology

Esmolol; Short

Apresoline; 20mins

overRx; hypotension or hyper

24
Q

DELAYED RECOVERY

____________________ after GA

_____ to awaken- failure to progress beyond _________________________ and minimal __________

A

Prolonged unconsciousness

Slow

return of protective airway reflexes

minimal awareness

25
Q

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

A

Residual intraoperative drug

Pre-op.

hypoxia, ischaemia, strokes

26
Q

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 ____________

A

30; involuntary contractions

a fall in the core temperature

the core body temperature does fall

more violent

27
Q

Shivering increases to a maximum when body temperature is ____oC – becomes (more or less?) marked below this temperature

A

34

Less

28
Q

Shivering occurs in elderly as well as young patients
It occurs whether the anaesthetic technique is inhalational (_____________), balanced or regional

A

halothane shakes

29
Q

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

A

Epidural and spinal

GA

shivering and vasoconstriction

air conditioned; large volumes of fluid

Open body

30
Q

(Elderly or Younger?) patients experience intraoperative fall in body temperature more frequently than (Elderly or Younger?) people – (metabolic rate ____eases with age)

A

Elderly

Younger

decr

31
Q

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.

A

↑; 400 – 500

↑; hypoxaemia; lactate; acidosis

angina; ↑; response of the respiratory centre to carbon dioxide

MI; distress; artifacts

32
Q

Treatment of shivering

Administer _______ ________
Transport patient covered with _______

______ the room - Operating Room or Recovery room (RR)
Use of ___________
Intravenous fluid _______

A

Oxygen supplement

blanket; Warm

heating blankets
warmers

33
Q

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 : ________, _________

A

humidification

warming; inspired gases

normo; 33

Pethidine

Tramadol

34
Q

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

A

21

reflective

35
Q

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

A

artificial nose; anaesthetic circuit

elderly ; the child; cachectic

21; Pethidine

extradurally

Junior Anaesthesia (17 decks)

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