TY  - CHAP
M1  - Book, Section
TI  - Postanesthesia Care
A1  - Butterworth IV, John F.
A1  - Mackey, David C.
A1  - Wasnick, John D.
PY  - 2022
T2  - Morgan & Mikhail’s Clinical Anesthesiology, 7e
AB  - KEY  CONCEPTS  Patients  emerging  from  anesthesia  should  not  leave  the  operating  room  until  they  have  a  patent  airway,  have  adequate  ventilation  and  oxygenation,  and  are  hemodynamically  stable.  Qualified  anesthesia  personnel  must  attend  the  transfer  to  the  postanesthesia  care  unit  (PACU).  Before  the  recovering  patient  is  fully  awake,  pain  may  be  manifested  as  postoperative  restlessness  or  agitation.  Significant  systemic  disturbances  (eg,  hypoxemia,  respiratory  or  metabolic  acidosis,  hypotension),  bladder  distention,  or  a  surgical  complication  (eg,  occult  intraabdominal  hemorrhage)  must  be  considered  in  the  differential  diagnosis  of  postoperative  restlessness  or  agitation.  Postoperative  nausea  and  vomiting  (PONV;  see  Chapter  17)  is  the  most  common  immediate  complication  following  general  anesthesia,  occurring  in  approximately  30%  or  more  of  all  patients.  Intense  shivering  causes  precipitous  rises  in  oxygen  consumption,  carbon  dioxide  (CO2)  production,  and  cardiac  output,  which  may  be  poorly  tolerated  by  patients  with  cardiac  and/or  pulmonary  impairment.  Respiratory  problems  are  the  most  frequently  encountered  serious  complications  in  the  PACU.  The  overwhelming  majority  are  related  to  airway  obstruction,  hypoventilation,  hypoxemia,  or  a  combination  of  these  problems.  Hypoventilation  in  the  PACU  is  most  commonly  due  to  the  residual  depressant  effects  of  anesthetic  and  analgesic  agents  on  respiratory  drive,  often  made  worse  by  preexisting  obstructive  sleep  apnea.  Hypoventilation  with  obtundation,  circulatory  depression,  and  severe  acidosis  (arterial  blood  pH  <7.15)  is  an  indication  for  immediate  and  decisive  ventilatory  and  hemodynamic  intervention,  including  airway  and  inotropic  support  as  needed.  Following  naloxone  administration,  patients  should  be  observed  closely  for  recurrence  of  opioid-induced  respiratory  depression  (“renarcotization”),  as  naloxone  has  a  shorter  duration  of  action  than  many  opioids.  Increased  intrapulmonary  shunting  from  a  decreased  functional  residual  capacity  relative  to  closing  capacity  is  the  most  common  cause  of  hypoxemia  following  general  anesthesia.  The  possibility  of  a  postoperative  pneumothorax  should  always  be  considered  following  central  line  placement,  supraclavicular  or  intercostal  blocks,  abdominal  or  chest  trauma  (including  rib  fractures),  neck  dissection,  thyroidectomy  (especially  if  thyroid  dissection  extends  into  the  thorax),  tracheostomy,  nephrectomy,  or  other  retroperitoneal  or  intraabdominal  procedures  (including  laparoscopy),  especially  if  the  diaphragm  may  have  been  penetrated  or  disrupted.  Hypovolemia  is  the  most  common  cause  of  hypotension  in  the  PACU  and  can  result  from  hemorrhage,  wound  drainage,  or  inadequate  fluid  replacement.  Noxious  stimulation  from  incisional  pain,  endotracheal  intubation,  bladder  distention,  or  preoperative  discontinuation  of  antihypertensive  medication  is  usually  responsible  for  postoperative  hypertension.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1190611648
ER  -