← All decks
Anaesthesiology
Postanesthesia Recovery
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
12 sections · 182 slides
Overview
- Scope of this topic
- Why a watched recovery area exists
- Postoperative planning starts at scheduling
Standards, Value and Levels of Care
- Standards for postanesthesia care
- Components of quality in postanesthesia care
- Cost drivers in the postanesthesia care unit
- Communication as a safety tool
- Determinants of the level of postoperative care
- Recovery settings
- Separate recovery areas
- Recovery bay with stretcher and bedside monitoring
- Triage to the right level of care
- Patients suited to a lighter recovery
- Direct admission to intensive care
- Role of the medical director
Admission, Handover and Monitoring
- Minimum recordings on admission
- Continuous monitoring requirements
- Pulse oximeter probe on the finger
- Transfer of care to the nurse
- What the handover report must contain
- Structure of the admission report
- Reading the admission report table
- Components of a postanesthesia care unit admission report
- Components of a postanesthesia care unit admission report (continued)
Postoperative Pain Management
- Goals of postoperative analgesia
- Difficulty of measuring pain
- Incidence of severe pain after ambulatory surgery
- Severe pain by surgical specialty at three time points
- Reading the pain incidence panels
- Pain control in opioid use disorder
- Multimodal analgesia
- An aggressive plan for the difficult patient
- Routes of analgesic administration
- Neuraxial opioids
- Wound and peripheral nerve catheters
- Regional blocks after specific operations
- Anxiety versus pain during recovery
Discharge and Postoperative Evaluation
- Neurological and airway criteria for discharge
- Respiratory and circulatory criteria for discharge
- Discharge scoring systems
- Two most commonly used postanesthesia care unit discharge criteria systems
- Two most commonly used postanesthesia care unit discharge criteria systems (continued)
- Two most commonly used postanesthesia care unit discharge criteria systems (continued)
- Elements of the postanesthesia evaluation
Cardiovascular Complications
- Why cardiovascular problems surface in recovery
- Tachycardia as a sign of myocardial ischemia
- Early treatment of suspected ischemia
- Minimizing cardiac risk after surgery
- Assessment of the patient with heart failure
- Recovery unit as a cardiac step-down area
- Cardiac implantable electronic devices
Inadequate Postoperative Ventilation
- Risk factors for postoperative ventilatory events
- Defining inadequate ventilation after anesthesia
- Five causes of inadequate ventilation
- Residual drug effects on respiratory drive
- Patients most sensitive to respiratory depressants
- Reversal of drug-induced hypoventilation
- Consequences of increased airway resistance
- Sites of upper airway obstruction
- Simple maneuvers for airway obstruction
- Colour-coded oropharyngeal airways in graded sizes
- Laryngospasm
- Drug treatment of prolonged laryngospasm
- Time to hemoglobin desaturation after apnea begins
- Reading the desaturation curves
- Small airway resistance and radius
- Loss of radial traction on small airways
- Distinguishing high resistance from low compliance
- Bronchodilator treatment of small airway resistance
- Reduced pulmonary compliance
- Parenchymal and chest wall causes of low compliance
- Consequences of residual neuromuscular blockade
- Sugammadex and neuromuscular disease
- Bedside tests of ventilatory strength
- Dead space and its effect on carbon dioxide
- Carbon dioxide production during recovery
Inadequate Postoperative Oxygenation
- Assessing oxygen transfer
- Target arterial oxygen levels
- Loss of dependent lung volume
- Conservative measures that restore lung volume
- Determinants of pulmonary blood flow distribution
- Global reduction of alveolar oxygen
- Supplemental oxygen and the pulse oximeter
- Mixed venous oxygen tension
- Obstructive sleep apnea
- Apnea-hypopnea index and severity grading
- Severity grading of obstructive sleep apnea by apnea-hypopnea index
- Perioperative management of sleep apnea
- Nasal cannula in position for oxygen delivery
- Anemia and oxygen-carrying capacity
- Accepted hemoglobin levels for transfusion
- Incidence of postoperative hypoxemia
- Oxygen saturation over time by age group after general anesthesia
- Reading the saturation recovery curves
- Screening for hypoxemia
- Oxygen delivery devices
- Common oxygen delivery systems with correlating oxygen flow rates to delivered inspired oxygen ranges
Perioperative Aspiration
- Risk of aspiration after anesthesia
- Chemical pneumonitis from gastric acid
- Progression of severe acid aspiration
- Why reflexes stay impaired in recovery
- Positioning to prevent aspiration
- Immediate response to discovered aspiration
Renal and Metabolic Complications
- Assessment of the ability to void
- Urine analysis and tubular function
- Oliguria after surgery
- Fluid challenge and diuretic trial
- Interpreting high urine output
- Respiratory acidemia after anesthesia
- Causes of metabolic acidemia after surgery
- Lactic acidemia and tissue oxygen
- Reading the causes of acidemia table
- Causes of acidemia
- Causes of acidemia (continued)
- Respiratory alkalemia
- Glucose control after surgery
- Hyperglycemia after surgery
- Hypoglycemia after surgery
- Postoperative hyponatremia
- Symptoms and treatment of hyponatremia
- Postoperative hypokalemia
- Postoperative hyperkalemia
Trauma, Temperature and Mental Status
- Corneal abrasion
- Visual changes after anesthesia
- Hearing impairment after anesthesia
- Oral and dental injury
- Nerve injury from positioning
- Postdural puncture headache
- Soft tissue and joint injuries
- Postoperative hypothermia
- Circulatory effects of hypothermia
- Shivering after anesthesia
- Restoring normothermia
- Postoperative hyperthermia
- Defining prolonged unconsciousness
- Drug causes of prolonged sedation
- Naloxone to assess opioid sedation
- Non-drug causes of prolonged unconsciousness
- Incidence of postoperative stroke
- Consequences of a stormy emergence
- Emergence delirium in children
- Physical causes of agitation during emergence
- Respiratory causes of confusion
- Supportive management of altered mental status
- Postoperative cognitive decline in the elderly
- Reducing the incidence of delirium
- Importance of postoperative nausea and vomiting
- Medical risks of vomiting after surgery
- Patient and perioperative risk factors
- Anesthetic technique and nausea
- Prophylaxis against nausea and vomiting
- Droperidol and the black box warning
- Rescue therapy for nausea and vomiting
Summary and References
- Key points on planning and level of care
- Key points on pain, fluids and discharge
- Key points on cardiac and respiratory risk
- Key points on renal, glucose and temperature
- Key points on mental status and vomiting
- References
- References
- References
- References
- References
- References
- References
- References
- References
- References
- References
- References
- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition