Post-op care

Question 1

What monitoring is done for patients post-op?

Answer 1

-Continuous 3-lead ECG
-Continuous pulse oximetry
-Regular BP (every 5-15mins)
-RR
-End-tidal CO2 if supraglottic airway remains in place
-Alertness
-Pain assessment
-Nausea assessment
-Wound review if needed

Question 2

What altered physiology is noticed in the immediate post-op phase?

Answer 2

NB anaesthetic drugs stay in the system for up to 24h
A - Drowsiness may cause reduced ability to protect own airway
B - Reduced ventilation due to drowsiness, residual NM blockade, early resp complications from intra-op ventilation, high spinal/epidural due to paralysis of accessory muscles
C - Vasodilation leading to hypotension (residual drugs)
C - Dehydration due to pre-op fasting, blood loss
D - Low GCS due to drugs
D - hypoglycaemia (fasting) / hyperglycaemia (surgical stress response)

Question 3

What are some common post-op complications?

Answer 3

-Hypotension
-SOB
-Low GCS
-Management of acute pain
-PONV
-Complications spinal / epidural

Question 4

What causes hypotensive complications post-op?

Answer 4

-Residual anaesthetic drugs
-Spinal / epidurals
-Hypovolaemia (dehydration, bleeding)
-Consider doing a VBG, treat with fluid boluses and early anaesthetic review

Question 5

What causes SOB post-op?

Answer 5

-Pain
-Residual neuromuscular blockade
-High spinal / epidural
-NB causes can be same as on the ward, LRTI, PE, pulmonary oedema

Question 6

What causes low GCS post-op?

Answer 6

-Drug overdose (opioids)
-high spinal / epidural
-Post-op delirium
-Intra-op / post-op intracerebral event
-Normal for patients to be drowsy for 24h, but should respond to voice, anything less is concerning

Question 7

How do you manage acute pain post-op?

Answer 7

RAT (recognise, assess, treat)
-R = define pain, list benefits of treating pain
-A = measure severity, classify type of pain, assess other factors
-T = drugs
-PCA = patient-controlled analgesia
–usually uses morphine/oxycodone, 1mg bolus doses with 5-min lock-out period, requires enhanced observations

Question 8

What complications of spinal /epidurals are there?

Answer 8

-Hypotension due to vasodilation
-Urinary retention
-Pruritis
-Respiratory depression (opioid toxicity, high block affecting resp muscles)
-Inadequate pain relief