Post-Operative Period

‡ Emergence from the anesthesia may produce problems involving the airways, lungs, and cardiovascular system ‡ Airway obstruction occur because residual anesthetic effects continue partially to obtund consciousness and reflexes

Post-Operative Period
‡ Strong inspiratory efforts against closed glottis can lead to negative-pressure pulmonary edema. ‡ Pulmonary functional residual capacity is reduced post-operatively following all types of anesthesia and surgery, and hypoxemia may occur. ‡ Hypertension can be prodigious and must be treated.

Post-Operative Period
‡ Administration of opioids in the recovery room can be problematic among patients who still have a substantial residual anesthetic effect. ‡ Ketorolac frequently is effective ‡ COX 2 inhibitors for analgesia without respiratory depression

Post-Operative Period
‡ Nausea and vomiting caused by an action of the anesthetic on the chemoreceptor trigger zone and brain stem vomiting center. ‡ 5-HT3 serotonin receptor antagonist (ondansetron) is very effective in suppressing nausea and vomiting. ‡ Common treatment also includes droperidol, metaclopromide, dexamethasone, and avoidance of nitrous oxide.

Post-Operative Period
‡ Use of propofol as an induction agent and ketorolac as a substitute for opioids may decrease the incidence and severity of postoperative nausea and vomiting.

General Anesthesia
‡ Stages
± Stage of Analgesia ± Stage of Delirium ± Stage of Surgical Anesthesia ± Stage of Medullary Depression

Stage of Analgesia
‡ Sensation to pain is blunted ‡ Consciousness remains intact ‡ Skin and face may be flushed

Stage of Delirium
Inhibitory reflexes are depressed Patient is unable to follow commands Respirations become irregular Heart rate increase; cardiac dysrhythmias may appear ‡ Skin and face may be flushed ‡ Muscle tone is increased; patient may attempt to sit-up ‡ There may be vomiting, regurgitation, inhibition of reflex laryngeal closure ‡ ‡ ‡ ‡

Stage of Surgical Anesthesia
‡ Plane 1
± Some degree of muscle relaxation ± Breathing is similar to that of sleep ± Eyelid and conjunctival reflexes disappear ± Eyeballs begin to rove ± Pupils are normal in size

Stage of Surgical Anesthesia
‡ Plane 2
± Increase in muscular relaxation ± Respiration is more regular ± Eyeballs are fixed ± Pupils begin to constrict

Most surgical procedures are performed in this plane

Stage of Surgical Anesthesia
‡ Plane 3
± Muscular relaxation is great ± Abdominal relaxation is increased ± Eyes converge ± Pupils dilate ± Light reflex disappears

Stage of Surgical Anesthesia
‡ Plane 4
± Cessation of intercostals breathing ± Pupils dilate ± Fall in body temperature

Stage of Medullary Depression
‡ Medullary paralysis
± Respiratory arrest and vasomotor collapse

Purpose of Pre-anesthetic medication and conscious sedation
‡ Primary
± Decrease anxiety without producing excessive drowsiness ± Provide amnesia while maintaining cooperation ± Relieve pre-operative pain if present

Purpose of Pre-anesthetic medication and conscious sedation
‡ Secondary
± Reduce requirement for inhalational anesthetic ± Minimize undesirable effects of inhalational anesthetics ± Reduce volume and acidity of gastric contents ± Reduce stress response in the pre-operative period

Drugs used in pre-anesthetic medication and conscious sedation
‡ Chronic medications
± Drugs which are part of the patient s normal daily morning dose for pre-existing co morbidities

Drugs used in pre-anesthetic medication and conscious sedation
‡ Anticholinergic drugs
± Used for their vagolytic and membrane-drying properties ± Seldom used in adults in modern practice, except in situations requiring reduced secretions

Drugs used in pre-anesthetic medication and conscious sedation
‡ Drugs that reduce acidity and volume of gastric contents
± Induce H2 receptor antagonists, antacids and prokinetic agents

Drugs used in pre-anesthetic medication and conscious sedation
‡ Sedative-Hypnotics and Anti-Anxiety agents
± Benzodiazepines, butyrophenones, and barbiturates ± Useful when administered before surgery both for patient comfort and for facilitation of the anesthetic state.

Drugs used in pre-anesthetic medication and conscious sedation
‡ Opioids
± Used pre-operatively in small doses to act synergistically with sedatives in creating a tranquil patient ± Indicated in surgery of persons actually having pain or experiencing incipient withdrawal symptoms.


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