Post-op care

Question 1

What should be done for a patient to emerge from anesthesia?

Answer 1

• reverse muscle relaxant
• stop anesthetic gas inhalation
• DON’T reverse analgesia
• extubate
  (patient is awake when they open their eyes and obey commands)

Question 2

What could be causes of delayed emergence?

Answer 2

• residual anesthetics
• residual muscle relaxant
• opioid overdose
• hypoglycemia
• CVA (bleeding or ischemia)
• hypothermia

Question 3

When should post-operative planning begin?

Answer 3

When a patient is scheduled for surgery

Enhanced recovery after surgery (ERAS)

• best outcomes
• reduce unnecessary use of resources

Question 4

What is the best muscle relaxant reversal drug?

Answer 4

Sugammadex

Neostigmine/physiostigmine

Question 5

Which drug reverses the effects of opioids?

Answer 5

Naloxone

Question 6

How do the hospital staff decide the level of post anesthesia care (PACU) needed?

Answer 6

• the type of surgery
• type of anesthetic
• intraoperative course of events
• patient pre-existing and evolving comorbidities

Question 7

What are the typical recovery settings?

Answer 7

• Inpatient recovery
• Ambulatory/day surgery recovery
• Short stay (23-hour admission)
• recovery from non-operating room anesthesia/remote areas procedures (CT, MRI, invasive radiology)

Question 8

What should be monitored in PACU?

Answer 8

• blood pressure
• pulse oximeter
• ECG
• temperature

Question 9

What is the most common respiratory complication that could occur in a recovery room?

Answer 9

• respiratory depression-hypoventilation

- airway obstruction

Question 10

What is a very common opioid or laproscopic surgery induced postoperative complication?

Answer 10

Postoperative nausea & vomiting (PONV)

treated with Zufran

Question 11

How do u deal with an airway obstruction post-op?

Answer 11

head tilt-chin lift maneuver

Question 12

What are the risk factors for PONV?

Answer 12

• FEMALE
• history of PONV
• opioid
• type of surgery (laparoscopic, squent)
• type of anesthesia (general anesthesia)

Question 13

What is an intra-operative injury that could occur incidentally during a sinus surgery?

Answer 13

Corneal abrasion

• drying
• eye contact during face mask ventilation or surgical instrument
• intubation prone or lateral positioning

CAUSE tearing, decreased visual acuity, pain, and photophobia
- heal spontaneously within 72 hours

Question 14

What could cause blindness intraoperatively?

Answer 14

• long procedures in prone position (like spinal surgery)

- patients with vascular disease

Question 15

What could cause hearing impairment post-op?

Answer 15

spinal anesthesia

heals spontaneously

Question 16

What are the intraoperative oral injuries that could occur?

Answer 16

- trauma of oral soft tissues, lips, tongue of vocal cords 
    due to - laryngoscope blades 
                - surgical instruments 
                - rigid oral airways 
- dental damage 
- sore throat and hoarseness

Question 17

What are the nerve injuries that could be caused by improper positioning during surgery?

Answer 17

Spinal cord injury

• positioning for intubation
• hematoma accumulation after placement of neuraxial anesthetics

Peripheral nerve injuries

• COMPRESSION injury: during general or regional anesthesia
• STRETCH injury: from hyperextension of an extremity

Question 18

If a patient becomes agitated post-op, that could lead to?

Answer 18

• contusion or fracture
• corneal abrasions
• sprains from struggling
• can jeopardize - suture lines
  - orthopedic fixations
  - vascular grafts
  - drains
• risk of injury to staff struggling to protect a combative patient

Question 19

Why does a patient become agitated post-op?

Answer 19

some patients are unable to appropriately process sensory input

• most exhibit slight disorientation, somnolence, and sluggish mental reactions that rapidly clear
• others experience wide emotional swings

Question 20

What are the causes of post-op agitation?

Answer 20

• in children: parental separation
• reduced mental capacity
• inability to speak due to oral fixations or tracheal intubation
• language barrier or new post-op hearing impairment
• recall of intraoperative events
• whithdrawal effects
• pain
• urinary urgency or gastric distention

Question 21

When should a patient be discharged from PACU?

Answer 21

when a patient has an aldrete score of 9 or 10

1. activity
2. breathing
3. circulation
4. consciousness
5. oxygen saturation