Evaluation and Care of Postoperative Patient

1
Evaluation and Care of Postoperative Patient
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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
  criticaltemperature, 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

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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
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
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

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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

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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

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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

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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

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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

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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

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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

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Causes and Management of Postoperative
Complications

• Treatment (contd)
• Provide prophylactic anti-emetic in operating
  room
• Drugs
• Cyclinzine 2550 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

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Transferring the Patient to the Ward
Before sending the patient to the ward, make a
quick assessment of the patient

• 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 patients pulse rate and blood pressure
  stable?

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Transferring the Patient to the Ward

• Are the hands and feet well perfused and warm?
• Is there a good urine output?
• Is the patients 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

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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