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Evaluation and Care of Postoperative Patient. Postoperative Care. Responsibility of the anesthesia provider to provide care while patient recovers from effects of anesthesiaPostoperative period carries high risk of morbidity and mortality after any type of anesthesiaConstant monitoring of patient is critical?temperature, pulse, blood pressure, respiration rate and any signs of continuing blood lossAll postoperative patients should be cared for in a recovery ward or area well equipped with drugs, supplies and trained personnel.
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1. Evaluation and Care of Postoperative Patient
2. Evaluation and Care of Postoperative Patient Postoperative Care Responsibility of the anesthesia provider to provide care while patient recovers from effects of anesthesia
Postoperative period carries high risk of morbidity and mortality after any type of anesthesia
Constant monitoring of patient is critical—temperature, pulse, blood pressure, respiration rate and any signs of continuing blood loss
All postoperative patients should be cared for in a recovery ward or area well equipped with drugs, supplies and trained personnel
3. Evaluation and Care of Postoperative Patient Monitoring in Recovery Area Follow the ABCD of postoperative care:
Airway
Does the patient control her own breathing?
Check for any obstructions of the airway
Breathing
Note the rate and depth of respiration
Is there any sign of hypoxia?
4. Evaluation and Care of Postoperative Patient Monitoring in Recovery Area Circulation
Are the pulse and blood pressure stable?
Check for peripheral circulation
Is she bleeding? If yes, inform the surgeon
Does the patient need fluid replacement?
5. Evaluation and Care of Postoperative Patient Monitoring in Recovery Area Drugs
Is the patient in excessive pain? Consider additional drugs for pain management
Is nausea and/or vomiting severe? Consider anti-emetics
Consider providing sedation, if required
Is the patient restless, confused and agitated? Look for a cause
6. Evaluation and Care of Postoperative Patient Causes and Management of Postoperative Complications Hypoxia:
Airway obstruction – sedation, laryngospasm, blood or vomit
Reduced ventilatory drive – sedation, cerebral pathology
Peripheral factors – pain, distension
Central factors – lung and/or heart pathology
Treat the cause and then give oxygen to be safe
7. Evaluation and Care of Postoperative Patient Causes and Management of Postoperative Complications Tachycardia:
Pain, full bladder or anxiety
Hypovolemia
Hypoxia
Hypercapnia
Retching and vomiting
Treat the cause and then give oxygen to be safe
8. Evaluation and Care of Postoperative Patient Causes and Management of Postoperative Complications Hypertension:
Pain or full bladder
Hypercapnia
Essential hypertension
Fear/anxiety
Drugs (e.g., ketamine, ephedrine drip)
Retching and vomiting
Treat the cause and then give oxygen to be safe
9. Evaluation and Care of Postoperative Patient Causes and Management of Postoperative Complications Hypotension:
Hypovolemia – bleeding, loss into gut, inadequate replacement intra-operatively
Heavy sedation
After trauma – hemothorax or pneumothorax
Treat the cause and then give oxygen to be safe
10. Evaluation and Care of Postoperative Patient Causes and Management of Postoperative Complications Confusion and restlessness:
Hypoxia, hypercapnia, hypotension, hypothermia and hypoglycemia
New cerebral pathology (e.g., intra-operative stroke, ischemia)
Pain and full bladder – if the patient is also sedated
Ketamine
Treat the cause and then give oxygen to be safe
11. Evaluation and Care of Postoperative Patient Causes and Management of Postoperative Complications Sedation:
Large drug doses given at the end of operation, no pain
Hypoglycemia or even hyperglycemia
Cerebral pathology – intra-operative stroke, ischemia, cerebral edema
Others – hypoxia, hypercapnia, hypotension, hyperthermia
Treat the cause and then give oxygen to be safe
12. Evaluation and Care of Postoperative Patient Causes and Management of Postoperative Complications Postoperative nausea and vomiting:
Drugs – opiates
Women more prone to nausea and vomiting postoperatively
Gynecological and gut surgery
Pain, hypoxia and hypotension
Rough handling of patient
Treatment:
Handle the patient gently and stabilize blood pressure and oxygenation
13. Evaluation and Care of Postoperative Patient Causes and Management of Postoperative Complications Treatment (cont’d):
Provide prophylactic anti-emetic in operating room
Drugs:
Cyclinzine 25–50 mg IM
Or
Promethazine 25 mg IM, is a sedative, may cause hypotension
Or
Metoclopromide 10 mg IV, weak anti-emetic, but most widely used
14. Evaluation and Care of Postoperative Patient Transferring the Patient to the Ward Does the patient have a good color when breathing?
Is the patient able to cough and maintain a clear airway?
Is there any evidence for airway obstruction or laryngeal spasm?
Can the patient lift her head from the bed for at least 3 seconds?
Are the patient’s pulse rate and blood pressure stable?
15. Evaluation and Care of Postoperative Patient Transferring the Patient to the Ward Are the hands and feet well perfused and warm?
Is there a good urine output?
Is the patient’s pain controlled, and have necessary analgesics and fluids been prescribed?
In the ward:
Visit the patient in the ward to see if any further treatment is necessary during recovery from the effects of anesthesia
Keep a record (separate from the case notes) of the anesthetic technique you used and of any complications
16. Evaluation and Care of Postoperative Patient Other Complications and Problems Deep vein thrombosis
Pulmonary embolism
Hepatic dysfunction
Renal dysfunction
Headache (especially after spinal anesthesia)
Sore throat (endotracheal intubation)
Backache
Dental trauma