Surgical Patient Flashcards
Cardiovascular effects during surgery
Decreased BP
Decreased contractility
Vasodilation
Positive pressure ventilation instead of the normal negative pressure ventilation causes a decreased venous return.
Tx for CV effects of surgery
IV fluids
Possibly vasopressors
MSK effects of surgery and problems associated*
Muscle relaxation d/t tracheal intubation, surgical relaxation
DECREASED LUMBAR LORDOTIC CURVE
EXTENDED SACRUM
Urinary retention secondary to drugs and sympathectomy from anesthetics.
Tracheal intubation during surgery may cause (5)
Hoarseness Dislocated arytenoid Vocal cord granuloma Shortness of breath from paralyzed cord Dislocated hyoid
Respiratory complication of surgery and
Atelectasis – total or partial collapse of lung. Can be entire lobe or microscopic alveolar collapse.
This is secondary to the hypoventilation that occurs due to shallow tidal volumes during surgery, any sedatives administered, or splinting from pain post-operatively. Airway collapse causes inflammation and is believed to contribute to post-op temperature increase.
Fluid concerns of surgeyr
IV fluid volume fills dilated blood vessels and augment cardiac filling.
However, when anesthesia wears off, this can cause a transient fluid overload, resulting in edema and CHF.
Always check the bladder for distention, especiailly if the patients are hypertensive or complain of abdominal pain.
You could also get swelling in tissues from surgical trauma known as “third space” but this resolves in 24-48 hours.
In laparoscopic surgery, you may have gas insufflated into the abdomen.
Effects of opioids
Sluggish bowel motility
Urinary sphincter spasm
Delerium
Cholinergic muscle relaxant reversal agents (atropine and glycopyrollate) can cause
contraction ileus and urinary retention
This is secondary to increased parasympathetic tone.
ANS tone after emerging from anesthesia
INCREASED SYMPATHETICS
This is the excitement stage!
Opioids reset the CO2 receptor and apneic threshold, so this hypercarbia leads to catecholamine release from the adrenals –> sympathetic tone.
The increase in pCO2 is also felt to contribute to post op low grade fever (just like atelectasis as mentioned earlier) and increased sympathetic tone.
Most common cause of hypertension post-op in the absence of pain
Urinary retention and distended bladder
Post-op back pain may be due to
Extended sacrum
Also: facet pain, SI pain, hip pain
Why do patients get shoulder pain after surgery?
Insufflated gas can cause diaphragmatic irriation. The nerve supply to the shoulder is the suprascapular n., upper subscapular n., and the axillary n. (C5-C6).
The diaphragm is C3-C5.
This is an example of referred pain.
Pre-op prevention of post-op pneumonia
Tx of C3-C5
Post op prevention of post-op pneumonia
Tx of C3-C5
Rib raising
In a comparison of post-op patients and thoracic lymphatic pump, a study by sleszynski in 1993 found…
Patients had earlier return to pre-op values for FEV1 and FVC (baseline).
Impact of OMT on IgA levels
OMT found to increase serum IgA levels suggesting OMT may have therapeutic, preventive, and protective effects on both healthy and hsopitalized patients especially those experiencing high levels of emotional or physiological stress and those at higher risk of acquiring respiratory tract infections
Most common form of ileus post-op
Adynamic/inhibition ileus
Key osteopathic principle in treating adynamic ileus
Modulating sympathetic tone
Abdominal pain is primarily transmitted through which nervous system branch?
Autonomic
Noxious stimuli: stretch, distention, inflammation, ischemia
Plexus that controls motility in GI tract
Auerbach’s
Plexus that controls GI secretions and blood flow
Meissner’s
6 OMT techniques used to improve hemodynamics
BLT to thoracics Indirect myofascial release of sternum Indirect release of respiratory diaphragm Occipital release Rib raising Sibson's fascia release
