Evaluation and Care of Postoperative Patient

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