Post-op care Flashcards
What should be done for a patient to emerge from anesthesia?
- reverse muscle relaxant
- stop anesthetic gas inhalation
- DON’T reverse analgesia
- extubate
(patient is awake when they open their eyes and obey commands)
What could be causes of delayed emergence?
- residual anesthetics
- residual muscle relaxant
- opioid overdose
- hypoglycemia
- CVA (bleeding or ischemia)
- hypothermia
When should post-operative planning begin?
When a patient is scheduled for surgery
Enhanced recovery after surgery (ERAS)
- best outcomes
- reduce unnecessary use of resources
What is the best muscle relaxant reversal drug?
Sugammadex
Neostigmine/physiostigmine
Which drug reverses the effects of opioids?
Naloxone
How do the hospital staff decide the level of post anesthesia care (PACU) needed?
- the type of surgery
- type of anesthetic
- intraoperative course of events
- patient pre-existing and evolving comorbidities
What are the typical recovery settings?
- Inpatient recovery
- Ambulatory/day surgery recovery
- Short stay (23-hour admission)
- recovery from non-operating room anesthesia/remote areas procedures (CT, MRI, invasive radiology)
What should be monitored in PACU?
- blood pressure
- pulse oximeter
- ECG
- temperature
What is the most common respiratory complication that could occur in a recovery room?
- respiratory depression-hypoventilation
- airway obstruction
What is a very common opioid or laproscopic surgery induced postoperative complication?
Postoperative nausea & vomiting (PONV)
treated with Zufran
How do u deal with an airway obstruction post-op?
head tilt-chin lift maneuver
What are the risk factors for PONV?
- FEMALE
- history of PONV
- opioid
- type of surgery (laparoscopic, squent)
- type of anesthesia (general anesthesia)
What is an intra-operative injury that could occur incidentally during a sinus surgery?
Corneal abrasion
- drying
- eye contact during face mask ventilation or surgical instrument
- intubation prone or lateral positioning
CAUSE tearing, decreased visual acuity, pain, and photophobia
- heal spontaneously within 72 hours
What could cause blindness intraoperatively?
- long procedures in prone position (like spinal surgery)
- patients with vascular disease
What could cause hearing impairment post-op?
spinal anesthesia
heals spontaneously
What are the intraoperative oral injuries that could occur?
- trauma of oral soft tissues, lips, tongue of vocal cords
due to - laryngoscope blades
- surgical instruments
- rigid oral airways
- dental damage
- sore throat and hoarsenessWhat are the nerve injuries that could be caused by improper positioning during surgery?
Spinal cord injury
- positioning for intubation
- hematoma accumulation after placement of neuraxial anesthetics
Peripheral nerve injuries
- COMPRESSION injury: during general or regional anesthesia
- STRETCH injury: from hyperextension of an extremity
If a patient becomes agitated post-op, that could lead to?
- contusion or fracture
- corneal abrasions
- sprains from struggling
- can jeopardize - suture lines
- orthopedic fixations
- vascular grafts
- drains - risk of injury to staff struggling to protect a combative patient
Why does a patient become agitated post-op?
some patients are unable to appropriately process sensory input
- most exhibit slight disorientation, somnolence, and sluggish mental reactions that rapidly clear
- others experience wide emotional swings
What are the causes of post-op agitation?
- in children: parental separation
- reduced mental capacity
- inability to speak due to oral fixations or tracheal intubation
- language barrier or new post-op hearing impairment
- recall of intraoperative events
- whithdrawal effects
- pain
- urinary urgency or gastric distention
When should a patient be discharged from PACU?
when a patient has an aldrete score of 9 or 10
- activity
- breathing
- circulation
- consciousness
- oxygen saturation
