Postanesthesia Care/Respiratory Therapy

Question 1

What are the most common causes of delayed

awakening from anesthesia?

Answer 1

In order of incidence, the most common causes of delayed
awakening following surgery are: 1) prolonged action of
anesthetic drugs, 2) metabolic causes, and 3) neurologic injury.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1232-1233

Question 2

What is the most common cause of hypotension in

the postanesthesia care unit?

Answer 2

Hypovolemia is the most common cause of hypotension in the
postanesthesia care unit. Left ventricular dysfunction is rare in
healthy individuals unless other complications such as sepsis,
hypoxemia, or acidosis are present. Venoconstriction from
hypothermia may actually mask hypotension until the body
temperature returns to normal.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1270.

Question 3

What are the most common causes of premature

atrial and ventricular beats in the PACU?

Answer 3

Hypomagnesemia, hypokalemia, increased sympathetic tone,
and myocardial ischemia all are capable of producing
premature atrial and ventricular beats. Of these, myocardial
ischemia is the least common.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1271.

Question 4

What is the recommended dose of intravenous
succinylcholine to treat postanesthetic
laryngospasm?

Answer 4

Laryngospasm that is unresponsive to positive pressure
ventilation can be treated with 0.1 mg/kg succinylcholine IV.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1227.

Question 5

What are the FDA recommendations postoperatively

for a patient who has been administered droperidol?

Answer 5

According to the FDA advisory, droperidol should be used
cautiously in all patients, and possibly avoided altogether in
patients with pre-existing ECG abnormalities. They recommend
that the patient be monitored for 2-3 hours with a 12-lead ECG
following administration of the drug.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 192-193.

Question 6

What routes of administration would be least

appropriate for the treatment of postoperative pain?

Answer 6

Subcutaneous and intramuscular injections are painful and
exhibit erratic absorption compared to the other routes. In
contrast to the postoperative pain control regimens of the past,
intravenous pain medication is the preferred route with
sublingual and rectal as secondary options.
Miller RD, Pardo MC. Basics of Anesthesia. 6th ed.
Philadelphia: Elsevier Saunders; 2011: 655-656.