Post-Anesthesia Care Symptoms, Diagnosis and Management

Author: James Heitz, MD
Affiliation: Thomas Jefferson University, Philadelphia, PA
Publisher: Cambridge University Press
Publication Date: 2016
ISBN 10: 1107642213
ISBN 13: 9781107642218
eISBN: 9781108334037
Edition: 1st

Description:

A practical, symptom-based approach to identifying and managing the common and uncommon post-operative complications encountered in the surgical patient.

Table of Contents

Front Matter

  • ABOUT
  • DEDICATION
  • Contributors
  • Preface

Section I Introduction

    Chapter 1: Recovery: physiological challenges

    • Residual effects of anesthesia
    • Residual effects of intraoperative positioning
    • Physiological effects of surgical trespass
    • References

    Chapter 2: Recovery: goals and standards

    • ASPAN standards
    • American and European guidelines
    • Discharge criteria
    • Fast-tracking and the Modified Aldrete Score
    • References

Section II Signs and symptoms

    Chapter 3: Hypertension

    • Secondary causes of hypertension
    • Medications
    • Postoperative hypertension after the PACU
    • References

    Chapter 4: Hypotension

    • Preload
    • Cardiac output
    • Afterload
    • References

    Chapter 5: Dysrhythmia

    • Predisposing factors in the perioperative patient
    • Bradyarrhythmias
    • Tachycardias
    • Supraventricular tachycardias
    • Sinus tachycardia
    • Atrial tachycardia
    • Multifocal atrial tachycardia (MFAT)
    • AV nodal reentry tachycardia
    • Atrial fibrillation
    • Ventricular tachycardia
    • Ventricular fibrillation
    • Torsades de pointes
    • References

    Chapter 6: Chest pain

    • Myocardial ischemia and infarction
    • Pulmonary embolism
    • Pneumothorax
    • Chest pain following laparoscopic surgery
    • Chest wall pain
    • References

    Chapter 7: ECG changes

    • Tachycardia
    • Bradycardia and AV block
    • Ventricular premature contractions/atrial premature contractions
    • ST-segment and T-wave changes
    • QT interval
    • References

    Chapter 8: Heart failure

    • Classification
    • References

    Chapter 9: Hypoxia

    • Causes of postoperative hypoxemia
    • References

    Chapter 10: Wheezing and stridor

    • Review of laryngeal anatomy
    • Etiology of stridor after surgery
    • Assessment of stridor in the PACU
    • References

    Chapter 11: Tachypnea and hypopnea

    • Tachypnea
    • Hypopnea
    • References

    Chapter 12: Dyspnea

    • Cardiac
    • Pulmonary
    • Airway obstruction
    • Neuromuscular weakness
    • Disturbances of respiratory drive
    • References

    Chapter 13: Dysphonia and airway trauma

    • Nerve injuries
    • Dislocations
    • Nasopharyngeal injuries
    • Injuries of oral cavity/pharynx/larynx
    • Tracheal injuries
    • References

    Chapter 14: Fever, hyperpyrexia, and hyperthermia

    • Non-infectious
    • Infectious
    • References

    Chapter 15: Hypothermia

    • Clinical stages of hypothermia
    • Adverse effects of hypothermia
    • Management
    • References

    Chapter 16: Hypoglycemia

    • High-risk populations
    • Causes
    • Postoperative-specific etiologies of hypoglycemia
    • Prevention
    • Management
    • Summary
    • References

    Chapter 17: Hyperglycemia

    • Hyperglycemia in the hospital
    • Glycemic control and clinical outcome
    • Summary: glycemic control and clinical outcome
    • Treatment of hyperglycemia in the PACU
    • Blood glucose monitoring in the PACU
    • References

    Chapter 18: Electrolyte disorders

    • Sodium
    • Potassium
    • Calcium
    • Magnesium
    • Phosphate
    • References

    Chapter 19: Nausea and vomiting

    • Physiology
    • PONV management
    • References

    Chapter 20: Pruritus

    • Pharmacological pruritus
    • Pathophysiological pruritus
    • References

    Chapter 21: Weakness

    • Evaluation
    • Neuromuscular blocking drugs
    • Neuromuscular disease
    • References

    Chapter 22: Movement disorders

    • Extrapyramidal symptoms
    • Medication-induced EPS
    • Restless legs syndrome
    • Nystagmus
    • Shivering
    • References

    Chapter 23: Limb paralysis

    • Motor deficits caused by surgery
    • Regional anesthesia
    • Compression neuropathy
    • Quadriplegia
    • Paraplegia
    • Stroke
    • Conversion disorder
    • References

    Chapter 24: Rigidity

    • Malignant hyperthermia
    • Neuroleptic malignant syndrome
    • Serotonin syndrome
    • Opioid-induced rigidity
    • Antidopaminergic medication effects
    • Other medication effects
    • Hypocalcemia
    • Parkinsonism
    • Baclofen withdrawal
    • References

    Chapter 25: Seizure

    • Management
    • Medication effects
    • References

    Chapter 26: Delirium

    • References

    Chapter 27: Headache

    • Postoperative secondary headache
    • Withdrawal headache
    • Anti-emetic medication-induced headache
    • Other medications
    • Anesthesia-related causes
    • Recognizing warning signs
    • Primary headaches after surgery
    • References

    Chapter 28: Delayed emergence

    • Medication effects
    • Respiratory failure
    • Metabolic disturbances
    • Neurological complications
    • Management
    • References

    Chapter 29: Crying

    • Anesthesia and crying
    • Unilateral tearing
    • References

    Chapter 30: Rash

    • Diffuse rashes
    • Focal rashes
    • References

    Chapter 31: Jaundice

    • Intra-hepatic hyperbilirubinemia
    • Post-hepatic hyperbilirubinemia
    • References

    Chapter 32: Visual disturbance

    • References

    Chapter 33: Neuropathy

    • Postoperative neuropathy
    • Surgically related postoperative neuropathy
    • Non-surgically related postoperative neuropathy
    • Management of postoperative neuropathy
    • References

    Chapter 34: Shivering

    • Management
    • References

    Chapter 35: Oliguria and postoperative urinary obstruction

    • Etiology
    • Prerenal oliguria
    • Intrarenal oliguria
    • Postrenal oliguria
    • Postoperative urinary retention
    • References

    Chapter 36: Polyuria

    • Iatrogenic overhydration
    • Hyperglycemia
    • Diuretics
    • Diabetes insipidus
    • Cerebral salt wasting syndrome (CSW)
    • Miscellaneous
    • Sevoflurane
    • References

    Chapter 37: Abnormal urine color

    • Yellow urine
    • Red urine
    • Orange urine
    • Brown urine
    • Black urine
    • Blue/green urine
    • Purple urine
    • White urine
    • Colorless urine
    • Standing urine
    • References

    Chapter 38: Pain

    • Pain assessment in the PACU
    • Opioids
    • Non-opioids
    • Oral analgesics
    • Regional analgesia in the PACU
    • Managing epidural catheters in the PACU
    • References

    Chapter 39: Shoulder pain

    • Intrinsic shoulder pain
    • Extrinsic shoulder pain
    • References

    Chapter 40: Anemia

    • Etiology of postoperative anemia
    • Nutritional supplementation
    • References

    Chapter 41: Hemorrhage

    • Presentation and diagnosis
    • Blood component transfusion
    • Hemostatic agents
    • References

    Chapter 42: Intraoperative awareness

    • References

Section III Special considerations

    Chapter 43: Special considerations for mechanical ventilation

    • Residual neuromuscular blockade
    • Negative pressure pulmonary edema
    • Hypothermia
    • Prolonged sedation
    • Upper airway edema and pulmonary edema
    • Sedation and mechanical ventilation in the PACU
    • Extubation in the PACU
    • Hypotension during mechanical ventilation
    • Bronchospasm
    • Auto-PEEP
    • Tension pneumothorax
    • References

    Chapter 44: Special considerations for the pediatric patient

    • Assessments
    • Pain in pediatric patients
    • Treatment of pain
    • Hydration status in the pediatric patient
    • Nausea and vomiting in the pediatric patient
    • Postoperative complications
    • Discharge
    • References

    Chapter 45: Special considerations for the pregnant patient after non-obstetric surgery

    • Physiological changes in pregnancy that impact PACU stay
    • Surgical procedures performed on pregnant patients
    • Specific postoperative considerations after regional anesthesia
    • Postoperative considerations for the fetus
    • References

    Chapter 46: Special considerations for the cardiac patient with implanted devices

    • Left ventricular assist device
    • Intra-aortic balloon pump
    • Pacemakers
    • References

    Chapter 47: Special considerations for the morbidly obese patient

    • Pulmonary complications
    • Cardiovascular complications
    • Endocrine complications
    • Thromboembolic disease
    • Difficult airway
    • Monitoring
    • Patient positioning
    • Oxygenation
    • Drug dosing
    • Postoperative analgesia
    • PACU discharge criteria
    • References

    Chapter 48: Special considerations for the renal failure patient

    • Acute kidney injury
    • Chronic renal failure
    • Renal excretion of drugs
    • References

    Chapter 49: Special considerations for pain management

    • The opioid-tolerant patient
    • Obstructive sleep apnea
    • Chronic kidney and end stage renal disease
    • Special considerations for the pediatric population
    • References

    Chapter 50: PACU emergencies

    • Respiratory arrest
    • Cardiac arrest/circulatory arrest
    • Cardiac ischemia
    • Cerebrovascular accident/stroke
    • Seizure
    • Hypoxia
    • Hypoglycemia
    • Malignant hyperthermia
    • Laryngospasm
    • Hypotension
    • References