Week 6 - PACU Flashcards
What are the standards for PACU?
-All patients who have received anesthesia
-Patient transported to PACU must be
accompanied
-Verbal report provided
-Patient should be evaluated continually
-A physician is responsible for the discharge
What are early postop physiologic changes?
PONV
Hypoxia
Hypothermia and Shivering
Cardiovascular Instability
What are common complications in PACU?
Nausea and Vomiting
Need for airway support
Hypotension – CV events
What is the most significant factor to correlate with hypoxemia when patients are admitted to the PACU?
Breathing room air during transport
-other significant factors include elevated BMI, sedation score, and respiratory rate
What are the most frequent causes of upper airway obstruction in PACU?
- Residual Neuromuscular Blockade
- Laryngospasm
- Edema or Hematoma
- OSA
What factors contribute to prolonged NDMR blockade?
Drugs: inhaled anesthetics, local anesthetics, cardiac antidysrhythmic, antibiotics, corticosteroids, calcium channel blockers, dantrolene
Hypermagnesemia, hypocalcemia, hypothermia, respiratory acidosis, hepatic/renal failure, myasthenia syndromes
What factors contribute to prolonged depolarizing blockade?
- Excessive dose of SUX
- Reduced plasma cholinesterase activity (decreased level, hormonal changes, pregnancy, contraceptives, glucocorticoids)
What is post-obstructive pulmonary edema (POPE) and its symptoms?
Negative-pressure pulmonary edema — results in arterial hypoxemia
Characterized by a transudative edema produced by either the exaggerated negative pressure generated by inspiration against acute airway obstruction (type I) or following relief of a chronic partial airway obstruction (type II)
Symptoms: arterial hypoxemia within 90 min after relief of obstruction, accompanied by tachypnea, tachycardia, rales, rhonchi, and evidence of bilateral pulmonary edema on chest x-ray
What patients are at low risk of MI in PACU?
<45 years old
No known cardiac disease
Only one risk factor
What patients are at high risk of MI in PACU?
DM
Smoker
Chest Pain
What are reversible causes of cardiac dysrhythmias in PACU?
- Hypoxemia
- Hypoventilation and associated hypercapnia
- Endogenous or exogenous catecholamines
- Electrolyte abnormalities
- Acidemia
- Fluid overload
- Anemia
- Substance withdrawal
What are predisposing risk factors of post-op deliruim?
- Reduced cognitive reserve: dementia, depression, advanced age (>70)
- Reduced physical reserve: atherosclerotic disease, renal impairment, pulmonary disease, advanced age, preoperative β-blockade
- Sensory impairment (vision, hearing)
- Alcohol abuse
- Malnutrition
- Dehydration
How do you treat post-op delirium?
- Withdrawal of any inciting stimulus
- Environmental modifications (frequent reorientation)
- Antipsychotic (haloperidol)
- Limit opioids
What are the different types of postop oliguria?
- Postop urinary retention
- Decreased intravascular volume (most common cause)
- Prerenal = hypovolemia, hepatorenal syndrome, low CO, renal vasuclr obstruction, intra-abdominal HTN
- Renal = ischemia, radiographic contrast dyes, rhabdomyolysis, tumor lysis, hemolysis
- Postrenal = surgical injury to ureters, obstruction of ureters
What is the pathophysiology of post-op shivering?
Associated with a decrease in pt’s body temperature
In normothermic pts – brain and spinal cord don’t recover simultaneously from general anesthesia
-the more rapid recovery of spinal cord function results in uninhibited spinal reflexes manifested as clonic activity
