Post-operative review

Question 1

structure of post-op review

Answer 1

px details
operation
type of anaesthetic used
intraoperative complications
A-E
hypotension screen
SOB screen
GCS screen
fever screen
pain screen
PONV

Question 2

random but specific things to look for

Answer 2

drug chart - opioid overdose
CXR - basal atelctasis

Question 3

causes of post-op hypotension

Answer 3

residual anaesthetics
hypovolaemia (bleeding/dehydration)

Question 4

causes of post-op SOB

Answer 4

basal atelectasis (XR)
neuromuscular block
on-ward causes SOB (PE/pneumonia etc)

Question 5

causes of post-op GCS

Answer 5

drug overdose
spinal/epidural
post-op delirium
intracerebral event

Question 6

causes of post-op fever (5Ws)

Answer 6

1. Wind (pneumonia) - most common
2. Water (UTI)
3. Wound (superficial surgical site or deep/organ space infection)
4. Walking (deep venous thrombosis)
5. Wonder drug (drug fever)

Question 7

assess & manage post-op pain

Answer 7

assess: verbal/visual rating
mx: paracetamol to all px // oxycodone MR // WHO ladder // PCA // fentanyl patches

Question 8

notes on PCA

Answer 8

• Morphine/oxycodone
• Small bolus doses, 5 mins lock-up period (safety)
• Enhanced observations, background fluid to keep cannula running & supplementary O2

Question 9

PONV predisposing factors (px & surgery RFs)

Answer 9

• Female
• Young
• Travel sickness
• Non-smoker
• Dehydration
• Opioid //volatile gasses use
• Type of surgery

Question 10

PONV preventive measures

Answer 10

Rehyrdration IV

1-2 antiemetics intraoperatively

• Dexamethasone
• Ondansetron
• Cyclizine
• Droperidol
• Metocloparmide

Question 11

PONV mx

Answer 11

Apfel score

Question 12

specific spinal/epi complications

Answer 12

urinary retention
pruritis
respiratory depression