Post-op Complications Flashcards
common causes of laryngospasm in children
Secretions and/or stimulation during Stage 2
steps/tips for intubation to reduce the likelihood of laryngospasm
- Do not rush, especially with no muscle relaxant
- Before repeated laryngoscopy with no MR,re-dose propofol or mask ventilate with high-percent sevo
steps/tips for extubation to reduce the likelihood of laryngospasm (5)
- Suction oropharynx before extubation
- Extubate end-inspiration or with positive pressure
- if Extubating awake, make sure they are AWAKE
- if Extubating deep, Keep them DEEP
- Immediately upon extubation, apply PEEP until air movement is confirmed.
Laryngospasm treatment
- 100% O2 with positive pressure
- lidocaine 0.5-1mg/kg
- Sux 0.5-1mg/kg with atropine 0.1mg
- intubate
complication of laryngospasm seen more in muscular adolescent males
post-obstructive negative pressure pulmonary edema
why is it not smart to wait for the laryngeal nerve to become hypoxic to break the laryngospasm
bc the babes will become bradycardic and die
what patients have an increased risk of bronchospasm
hx of reactive airway disease
when does bronchospasm most often occur
emergence, before extubation
bronchospasm treatment
B2 agonist (albuterol)
if severe epinephrine 10mcg/kg and reintubate
for every 10kg give how many mL of 1:10,000 epi for bronchospasm
1mL
list some things that can cause airway obstruction
- Sedation due to opioids, midazolam, general anesthesia
- Residual neuromuscular blockade
- Positioning
- Sleep apnea
- Laryngospasm
- Laryngeal edema
- Secretions
- Wound hematoma
- Vocal cord paralysis
Symptoms of airway obstruction (4)
- stridor
- desat
- paradoxical breathing
- inspiratory retractions
1 intervention for obstruction
chin lift, jaw thrust
interventions for obstruction (8)
- Stimulation
- Chin lift, jaw thrust*
- Oral or nasal airway
- Repositioning
- Suctioning
- CPAP, PEEP
- Antagonists
- Intubation
PONV potential causes
- opioids
- ileus
- gastric distention
- pain
- blood in stomach
- vagal stimulation
- motion
- increased ICP
Most effective PONV prophylaxis
hydration+ 5HT3 antagonist+ dexamethasone
Most effective PONV rescue
5HT3 antagonist, phenergan, non-opioid analgesics
Prevention of aspiration (5)
- Suction after induction and before extubation
- Minimal PIPs with LMAs and masks
- Extubate with airway reflexes intact
- Recovery position postoperatively
- Medical prophylaxis
If you suspect aspiration has occurred what testing should be done?
- baseline CXR and ABG
- CXR re-evaluation at 4hrs and if no change then probably didn’t aspirate
Interventions for mild aspiration
O2 and CPT
interventions for major aspiration
intubation, mechanical ventilation and probs ICU
Causes of pulm edema
fluid overload
post-obstructive negative pressure incident
pulm edema treatment
- O2
- diuretics
- admit until resolved
- reintubate if severe
in a healthy patient, how long does it take for pulm edema to resolve
few hours
Is hypotension common in peds?
nopeee
What are the two primary causes of hypotension in peds
hypovolemia
CHD
treatment for post-op hypotension in peds
- fluid bolus (crystalloid or colloid) if Hct stable
- PRBCs
- Factor VII
- return to OR?
most likely cause of HTN post-op
pain obvi
hypothermia definition
core temp < 36 C (96.8 F)
Risks associated with hypothermia
- Delayed drug metabolism and awakening
- Wound infection and delayed healing
- Sickling crisis
Warming methods
- FORCED WARM AIR
- HMEs
- Fluid warmers
- Wrapping (especially the head)
behavior seen with emergence delirium
disoriented, inconsolable, irrational
Which volatiles are more likely to cause emergence delirium
sevo and des (faster on/off)
age ED is typically seen with and for how long
<6 years
5-15min
pharmacologic strategies to reduce the likelihood of emergence delirium
- Regional
- Opioids
- Dexmedetomidine
- Propofol
- Ketamine
- Flumazenil
causes of laryngeal edema
- Traumatic or repeated laryngoscopy
- Poorly fitted ETT (cuffed or uncuffed)
- ETT cuff pressure
- Prolonged intubation
- Head and neck procedures
- Intraoperative positioning
- Upper respiratory infection
- Coughing
Stridor treatment
- humidified O2
- IV dexamethasone
- racemic epi
severe- reintubate
unresolved- admit for observation
process of laryngeal edema causing subglottic stenosis
this card sucks srry in advance
Pressure at the cricoid ring -> reduced blood flow -> edema ->ulcerated mucosa-> collagen ->fibrous scar
Scar contracts -> permanent subglottic stenosis and significant airway narrowing
treatment for subglottic stenosis
LTR
When should all post-op notes be complete according to CMS
before discharge
What should be evaluated post-op and documented for any case (6 general things)
- VS
- O2 requirements
- pain
- N/V
- sore throat
- intake
