Post-op Flashcards
Name anaesthetic techniques/ agents that cause post-op nausea and vomiting (6)
• At onset of hypotension following spinal or epidural
• inhalation techniques > non-opioid TIVA eg propofol (antiemetic)
• opioids
• etomidate!
• ketamine!
• ergometrine (cause uterine contractions to treat pph)
Treatment of laryngospasm? (5)
- Firm jaw thrust, positive mask pressure
Suction secretions and blood - Insert air way and ventilate 100% oxygen and CPAP. Can give gentle pressure with bag to relieve spasm.
Try pressure on Larson’s point while doing jaw thrust - If persist and can’t intubate, give propofol 0,5 mg/kg and lignocaine 1mg/kg (follow with laryngoscopy to inspect and clear airway)
- May be necessary to admin suxamethonium 0,3 mg/kg and reintubate
- If recur, spray hypopharynx with lignocaine
Name and describe the criteria for discharge from PACU (5) NB
Aldrete score
. Activity: can move voluntary or on command 0-2 (4 extremities)
• respiration: 0-2 ( able to breathe and cough freely)
• circulation: SBP 0 ( about 50 mmHg of pre-anaesthetic level) -2 ( about 20 mmHg of pre-anaesthetic level)
• consciousness: 0-2 (fully awake)
• oxygen saturation: 0(<90% even with oxygen) -2 (>92% on room air)
Need score of 9 out of to to be discharged
Which criteria are followed for discharge from general ward from intermediate recovery?
Same as aldrete but 2 additional criteria: pain, nausea and vomiting
Name 6 causes post-operative hypotension
• Anaesthetic agents (morphine)
• hypovolaemia (blood loss or fluid shifts ), (give fluid bolus)
• neuraxial blocks ( rx vasopressor)
• tension pneumothorax
• cardiogenic or septic shock
• myocardial ischaemia / arrythmias
Name 6 causes post-operative hypertension
•Pain
• full bladder
• chronic ht
• fluid overload
• hypoxaemia/hypercarbia
• myocardial ischaemia
• raised ICP
• endocrine diseases
Name 3 causes and treatment post-operative arrhythmia
•Tachycardia due to pain or sympathetic stimulation ( treat cause)
• bradycardia: atropine or glycopyrolate
. Afib / SvT: beta blocker, defib, adenosine (for SVT)
Name 5 causes post-operative airway obstruction
• Tongue falling back
• laryngospasm
• glottic oedema
• blood, secretions, vomit, throat packs in airway
• haematoma/swelling of neck
Name 2 causes post-operative hypoventilation
Common, usually mild
• residual effects anaesthetics (opioids, muscle relaxants)
• splinting (flattening) of diaphragm, tight dressings
Name 6 causes post-operative hypoxemia
• Hypoventilation
• increased oxygen consumption ( fever, shivering)
• atelactasis , lung collapse
• pulmonary oedema
• aspiration
• pneumothorax
Name causes post-operative laryngospasm
Spasm of supraglottic muscles often directly after extubation if patient not completely awake. Due to irritation airway by blood/ secretions
Treatment mild laryngospasm following extubation? (3)
Presents with stridor.
• Open airway
• Try to suction blood or secretions
• 100% oxygen with tight fitting mask under high pressure (close valve or ambubag or anaesthetic circuit to try force glottis open
Treatment severe or refractory laryngospasm following extubation? (4)
Present with airway block and desaturation
• propofol small dose 0,4 mg/kg
. Consider iv lignocaine
• if severe hypoxia give small dose suxamethonium 0,3 mg/kg iv and bag mask ventilate until sats improve
• re-inspect or suction airway
Name 3 causes post-op shivering and hypothermia
•intra - op hypothermia
• volatile anaesthesia
• increased oxygen consumption
Spinal (altered temperature regulation)
Treatment (4) post-op shivering and hypothermia
• Forced air warming blankets (bear hugger)
• oxygen (shivering increases oxygen consumption which can lead to hypoxia)
• pethidine if severe (very efficient, unknown moa )
• others: tramadol, ketamine, clonidine, odansetron, magnesium (undetermined level of efficacy)
