post

1. SPEAKER:-UMAR TARIQ
MODERATOR:-DR MADHAVI
SANTPUR

2.  Post operative period is the most crucial and
critical span of time after completion of
surgery
 In this period numerous complications occur
and if not treated on time can prove fatal
hence increasing the mortality rate

5.  The specialized care provided to the patient
after completion of surgery till the patient is
fully conscious
 This specialized care is provided in a
specialized area called PACU
 This specialized care is provided according to
the type of anaesthesia administered and
nature of surgery done

6. LOCATION
 The PACU should be situated as close as possible
to the operation theatre.
AREA AND CAPACITY
 The number of recovery beds should be 1.5-2
times the number of operating theatres
 Ideally the space allotted per bed should be at
least 15-20 sq meters
 There should be enough space to allow
unobstructed access for trolleys, equipments and
staff

7. MHYPOXIA
Gradual decrease in oxygen saturation in blood
 Mechanical obstruction may be caused by the
patients tongue, an incorrect held airway,
secretions, blood and vomit .
 The airway should be cleared under direct vision
using a laryngoscope, the patient turned on his or
her side and supplement O2 given.

8.  If the patient develops hypoxia , the
management is O2 by face mask ,after giving
jaw thrust and chin lift
Diffusion hypoxia is caused when N2O
diffuses out of the blood faster than oxygen
from air is taken up such that alveolar PO2 is
reduced. Supplementary postoperative
oxygen is essential

9.  Blood pressure may be low in the immediate
postoperative period because of hypovolemia
or because of the continuing pharmacological
effects of the anaesthetic techniques

10.  If the BP is low because of anaesthesia
technique used, the head end of the bed
may be tilted head down (although not
immediately after spinal or epidural
procedure as this might extend the block)
 Ephedrine diluted in 5 or 10 ml 0f NS and
given in small boluses(5-10mg) up to 30
mg IV (especially after spinal or epidural
anaesthesia).

11.  Severe hypotension must be treated. Oxygen
and IV fluids should be given to combat
hypovolaemia , Use vasopressors ( e,g diluted
ephedrine)
 If the cause of hypotension is thought to be
cardiac , a 12 lead ECG should be taken.

12.  An increased systolic BP is due to pain ,
extubation pressor response ,anxiety or fear
and also could be due to full bladder.
 Increased diastolic BP is seen in treated or
untreated hypertensive patients who may
develop rebound hypertension .

13. A slow pulse may be normal in young , fit adults or
may be caused by drugs , vagal stimulation ,
conduction block
Its treatment is necessary if the patients cardiac output
is being compromised by the slow pulse
Glycopyrrolate (0.2 -0.4 mg IV) or if there is
urgency in treatment atropine 0.6 mg IV should be
administered
If the patient is receiving beta –adenoceptor
blocking drugs it may be necessary to double the dose
of atropine

14.  The cause of fast pulse is often pain , anxiety,
hypercarbia , fever or inadequate
neuromuscular reversal
 If the tachycardia is compromising the
patients condition it should be treated by
fluid administration and in some cases blood
transfusion is needed

15.  Usually due to reversible causes like hypokalemia,
hypoxemia, alkalosis and stress after the operation.
 Could be the 1st sign of a post-OP MI
 Usually asymptomatic but could present with chest
pain, palpitations or dyspnea.
 Atrial flutterfibrillation:
-If the patient is stable, the heart rate could be
controlled with
β-blockers, digitalis or Ca channel blockers.
-If the patient is unstable (eg. In shock) cardioversion
is used.
-If hypokalemia is present, it should be corrected

16.  Body temperature below 35° C
 Causes : Trauma, exposure to cold enviornment and cold
fluids – IV / Irrigation
 Mild: 32 – 35C
 Mod: 28 – 32C
 Severe: 25 – 28C
 Hypothermia could lead to
◦ Coagulopathy
◦ Platelet dysfunction
◦ Increased O2 consumption due to shivering
 Treatment with warmers like forced air devices and warm
fluids.
 Meperidine (opioid analgesic) small doses can be used to
stop the shivering.

17.  Patients may be hypovolaemic when they
arrive in the recovery room due to inadequate
pre-operative resuscitation and/or intra
operative fluid replacement
 Blood loss should be replaced by blood only
after 15 -20 % of the blood volume has been
lost
 If significant hypovolemia is present ,a CVP
line and urinary catheter should be inserted
to monitor replacement of fluids

18.  Overzealous fluid replacement can result in
hypervolaemia. In fit patients, the kidneys
will deal with the overload, but in the
paediatric ,elderly & sick, pulmonary oedema
and cardiac failure may result.
 Diuretics e.g. Frusemide IV 5 – 10 mg will off
load acute pulmonary oedema

19.  Pain is an unpleasant sensory and emotional
experience associated with actual or potential
tissue damage .
o Assessment of pain
 The intensity of pain should be assessed , as for
as possible, by the patient as long as they are
able to communicate.

20.  1. Verbal rating scale (VRS):
 The patient is asked to rate their pain on a
five point scale as “ none, mild, moderate,
severe, very severe
 2. Numerical rating scale (NRS) :
 This consists of a simple 0 to 10 scale
 Zero indicates to no pain, while 10 indicates
worst possible pain

22. ANALGESICS
 Opioids
Opioids may be administered by IM ,IV and by
epidural route
 Paracetamol
It is the most commonly used analgesic and
antipyretic drug. It is a weak analgesic .It is
only suitable for mild pain

23.  Nonsteroidal anti-inflammatory
drugs(NSAIDs)
NSAIDs should not be given in asthmatics or
to patients with a history of indigestion or
peptic ulcer, hypovolaemia , renal
dysfunction.

24. )Epidural analgesia
 It is effective in preventing dynamic pain
 It also reduces the endocrine –metabolic
stress response to surgery & thus reduce post
op complications
(b)peripheral nerve blocks & plexus blocks

26.  Incidence of post operative nausea and
vomiting PONV is 25 – 30 %.It may be
central,peripheral,vestibular in origin
Factors influencing PONV:
1.Patients factor:-
Post operative nausea and vomiting is more in
following patients. Patient factor:
 Women,
 young,
 positive history of PONV

27. 2.ANAESTHETIC FACTOR:-
Certain anaesthetic agents and techniques
increase the incidence of PONV:
 Opioids
 Inhalational agents specially N2O
 Neostigmine
 Hypoxia
3.SURGICAL FACTOR:-
 Gynaecological surgeries
 Ophthalmic
 ENT
 Neurosurgeries

28.  Use of regional technique when possible
 Use of propofol rather than sodium
thiopentone as an inducing agent
 Perioperative oxygen supplementation
o TREATMENT
 Inj metoclopromide
 Inj ondensetron
 Inj Dexamethasone

29.  Utmost care should be taken while
transportation of patient
 Bleeding should be observed by checking
soaked dressings/drain for amount, colour,
odour
 Encourage the patient for deep breathing &
coughing to prevent collapse of lung alveoli
 Remove secretions by suctioning

30.  Pain management should be done according to
instructions
 Change position of the patient frequently and do
mobilization to prevent venous stasis
 In case of intubated patients check ET tube for
blockage tube cuff should not be over or under
inflated
 I.V fluids, blood transfusion are administered &
reactions are managed in event of occurrence
 An unconscious/semi-concious patient should
not be left alone
 Oxygen therapy should be given as appropriate

31.  The recovery room should be equipped by
following equipments:-
 Equipment required for airway management
and oxygen therpy i.e oxygen outlets, face
masks, ET tubes, oxygen tubing, humidifier,
breathing system , difficult airway
devices,suction machine with suction catheter
 Defibillator, laryngscope with all blades,
resuscitation trolley

33.  Paediatric equipment trolley containing face
masks,airways ET tubes and connectors of various
sizes
 Monitoring equipments e.g, NIBP monitor, pulse
oximeter, capnography,ECG recording,

34.  Drugs for resuscitation (Emergency drug
tray), airway management, pain relief,
intravenous fluids,anti emetics
 In gynecological, laparoscopic,
gastrointestinal surgeries and female gender
are at the greater risk of having post
operative nausea and vomiting . These
patients require additional anti emetics

36.  NIBP
 SPO2
 ECG
 Urine output
 Temperature
 Respiratory monitoring

37.  Temperature should be monitored especially in long operations.
Hypothermia can lead to a number of problems e.g. delayed recovery,
impaired coagulation, shivering or even arrhythmias
 It can be treated by body surface warming,blankets and warm I.V
fluids
 Tramadol 1mg/kg body weight can be used to treat shivering

38.  Fluid management reduces adverse
outcomes and improves patients comfort
and satisfaction
 Certain procedures involving significant loss
of blood or fluids may require additional
fluid management

39.  Urine output is a good indicator of adequate perfusion and should be monitored in all
post op patients
 In addition to this loss of body fluids through vomitus, naso gastric tube drainage and
wound drainage should be recorded
 The intake of fluid and output should be carefully matched
 Excess blood in the wound drainage tube indicate bleeding inside the wound .In this
situation surgeon must be informed

40.  Many times blood is
transfused in the
immediate post operative
period . The recovery
room staff must match the
patients details with those
given on the blood bag to
prevent mismatched
transfusion
 They must monitor the
patient throughout the
blood transfusion to
recognize and treat the
blood transfusion reaction
at the earliest

41.  Any kinking or pulling out of catheters and drainage tubes
should be prevented and their patency and their proper
function should be maintained
 The side rails of the bed should be kept raised to prevent
patient from falling down
 If the patient vomits the head end of the bed should be lowered
the vomitus and secretions should be removed immediately by
suctioning to prevent aspiration
 Always wash hands before and after working with all patient
to prevent transmission of infection from one patient to
another
 If the patient is alert encourage him for deep breaths to
improve lung function and to prevent accumulation of
secretions

42.  The patients level of consciousness should be
assessed and documented. It is done by talking to
the patient and then looking for orientation and
the response of the patient to stimuli.
 The following criteria can be used for level of
consciousness

43.  Comatose: unconscious, unresponsive to stumuli
 Stupor: lethargic and unresponsive; unaware of
surroundings
 Drowsy: half asleep; sluggish; respond to touch and
sounds
 Alert: able to give appropriate response to stimuli