Understanding Anesthesiology - The Global Regional Anesthesia ...

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CHAPTER 4 Post-operative Phase In this chapter, you will develop an understanding of both the goals and challenges of the recovery phase of anesthesia with a special focus on postoperative pain management. 77
SECTION 1 Recovery In This Section 1. Goals of Recovery 2. Post-operative Nausea and Vomiting 3. Shivering 4. Pain Goals of Recovery At the end of the operative procedure, care and monitoring of the patient is handed over from the anesthesiologist to the nurse in the postoperative care setting as the patient enters the period of recovery. For most patients, this occurs in the Post-Anesthetic Care Unit (PACU). However, some patients, such as those requiring prolonged post-operative ventilation or close hemodynamic monitoring, may instead be admitted directly to the Intensive Care Unit. Prior to transporting the patient from the operating room, the anesthesiologist must ensure the presence of the following: • patent airway (provided either by an awake patient, oral airway or endotracheal tube) • adequate ventilation • stable hemodynamics • adequate pain control Any identified problems must be corrected before leaving the operating room to avoid transporting an unstable patient. On arrival in the PACU, the airway patency, breathing and circulation are immediately assessed. Supplemental oxygen is provided as indicated. Routine monitors are applied. The anesthesiologist then gives the attending nurse pertinent information about the patient’s past medical history and intra-operative course. The latter includes details of the nature of the procedure, anesthetic technique, fluid balance and any intraoperative complications. Finally, instructions regarding monitoring, management of fluids, pain and nausea as well as discharge plans are given. Monitoring in the PACU is an extension of that provided in the operating room. The patient is observed for potential complications, both surgical and anesthetic. When discharge criteria are met, the patient is transferred to their ultimate destination: the ward for inpatients or the same day surgery unit for outpatients. Criteria for discharge are stratified into “Phase 1” (which determines when the patient is able to be transferred from the PACU to the ward) and “Phase 2” (which addresses home-readiness and only applies to those patients having “same day 78
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1 ST EDITION Understanding Anesthes
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Preface ii
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GETTING THE MOST FROM YOUR IBOOK Th
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ACKNOWLEDGEMENTS Many individuals s
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THE ROLE OF THE ANESTHESIOLOGIST Dr
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CHAPTER 1 The ABC’s In this chapt
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There are many different laryngeal
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• Mouth opening: Three fingerbrea
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A patient who is deemed to be at ri
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Movie 1.1 Intubation technique The
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After intubation, correct placement
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The Difficult Airway Airway mismana
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volume, then the surgery should be
Page 27 and 28: Vascular Access Peripheral venous a
Page 29 and 30: Interactive 1.1 Body water distribu
Page 31 and 32: Complications of transfusion are nu
Page 33 and 34: CHAPTER 2 The Pre-operative Phase I
Page 35 and 36: are known to have cardiac disease o
Page 37 and 38: Premedication Pre-medication can in
Page 39 and 40: SECTION 2 Anesthetic Equipment and
Page 41 and 42: Monitoring The purpose of monitorin
Page 43 and 44: SECTION 3 Chapter 2 Review Review 2
Page 45 and 46: SECTION 1 Anesthetic Techniques In
Page 47 and 48: Table 9 Sedation VERBAL COGNITIVE A
Page 49 and 50: General Anesthesia General anesthes
Page 51 and 52: Epidural Anesthesia Epidural and sp
Page 53 and 54: Movie 3.1 Labour epidural insertion
Page 55 and 56: Figure 14 Sensory dermatomes tion i
Page 57 and 58: Figure 16 Anatomy relevant to spina
Page 59 and 60: cles (Figure 19).They then travel u
Page 61 and 62: SECTION 3 General Anesthesia In Thi
Page 63 and 64: amples of conditions which impair g
Page 65 and 66: and trauma surgery pose a higher ri
Page 67 and 68: Drugs for Maintenance of Anesthesia
Page 69 and 70: Contraindications to the inhaled ag
Page 71 and 72: Contraindications Opioids must not
Page 73 and 74: Table 15 Dose, onset, duration, eli
Page 75 and 76: tubation, leading to total airway o
Page 77: SECTION 4 Chapter 3 Review Review 3
Page 81 and 82: Post-operative Nausea and Vomiting
Page 83 and 84: SECTION 2 Post-operative Pain Manag
Page 85 and 86: lead to a decreased stress response
Page 87 and 88: CHAPTER 5 Special Patients In this
Page 89 and 90: Successful treatment of an MH crisi
Page 91 and 92: SECTION 2 Obstetrical Anesthesia In
Page 93 and 94: There is good evidence that a labou
Page 95 and 96: SECTION 3 Pediatric Anesthesia In T
Page 97 and 98: tain types of noxious stimuli. Exam
Page 99 and 100: SECTION 4 Anesthesia Outside the Op
Page 101 and 102: SECTION 5 Chapter 5 Review Review 5
Page 103 and 104: Opioid agonists and antagonists •
Page 105 and 106: FENTANYL Class Synthetic opioid ana
Page 107 and 108: REMIFENTANIL Class Synthetic opioid
Page 109 and 110: MORPHINE SULFATE Class Opioid analg
Page 111 and 112: NALOXONE Class Opioid antagonist. U
Page 113 and 114: ROCURONIUM Class Non-depolarizing m
Page 115 and 116: PANCURONIUM BROMIDE Class Nondepola
Page 117 and 118: SUCCINYLCHOLINE CHLORIDE Class Depo
Page 119 and 120: SECTION 3 Anticholinesterase and An
Page 121 and 122: GLYCOPYRROLATE Class Anticholinergi
Page 123 and 124: SECTION 4 Induction Agents Drugs 1.
Page 125 and 126: SODIUM THIOPENTAL Class Short-actin
Page 127 and 128: KETAMINE Class Phencyclidine deriva
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ETOMIDATE Class Short-acting hypnot
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DESFLURANE Class Volatile inhaled a
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ISOFLURANE Class Volatile inhaled a
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SECTION 6 Anxiolytics Drugs 1. Mida
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SECTION 7 Antiemetics Drugs 1. Onda
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DIMENHYDRINATE Class Antihistamine,
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SECTION 8 Vasoactive Agents Drugs 1
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EPHEDRINE SULFATE Class Sympathomim
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SECTION 9 Local Anesthetics Drugs 1
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LIDOCAINE Class Local anesthetic. U
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KETOROLAC TROMETHAMINE Class Non-st
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DANTROLENE Dantrolene is used in th
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Acetylcholine Acetylcholine (Ach) i
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Adjunct An adjunct is something add
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Airway assessment The purpose of th
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Aldrete score Phase 1 of recovery m
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Analgesia Pain relief Related Gloss
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Antecubital fossa The antecubital f
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Anticholinesterase Anticholinestera
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Antisialagogue An antisialogogue is
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Apneic threshold Apneic threshold i
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Asepsis Asepsis is another word for
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Atracurium Class Nondepolarizing sk
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Autonomic nervous system The autono
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Bacterial endocarditis The 2007 Ame
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Balanced anesthesia Balanced anesth
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Bier Block An intravenous regional
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Brachial plexus The brachial plexus
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Bupivacaine Class Local anesthetic.
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Capnograph The capnograph is a moni
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Cholinesterase Cholinesterase is a
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Cis-Atracurium Class Non-depolarizi
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CO2 (carbon dioxide) absorber The C
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Competitive inhibitor Competitive i
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Cormack Lehane Cormack Cormack Leha
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Cricoid cartilage The cricoid is a
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Dantrolene Dantrolene is used in th
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Difficult airway The American Socie
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Diphenhydramine Class Antihistamine
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Dura The dura is the outermost (and
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Ephedrine Sulfate Class Sympathomim
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Epidural anesthesia In epidural ane
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Epiglottis The epiglottis is a cart
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Esophageal intubation Esophageal in
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Euvolemia Euvolemia indicates that
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Fentanyl Class Synthetic opioid ana
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Flowmeter The anesthetic flowmeter
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Forced air warming system A forced
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Functional residual capacity Functi
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Glycopyrrolate Class Anticholinergi
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Hypothermia Hypothermia indicates a
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Induction Induction is the phase of
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Intralipid Intralipid is a fat emul
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Intravenous regional anesthetic An
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Isoflurane Class Volatile inhaled a
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Ketorolac Tromethamine Class Non-st
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Laryngoscope A laryngoscope is the
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Larynx The larynx is that part of t
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Lidocaine Class Local anesthetic. U
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Local anesthetic toxicity Local ane
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MAC MAC refers to the concentration
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Magill blade A Magill blade, used i
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Maintenance fluid requirements Main
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Mallampati classification The Malla
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Mechanical ventilation Mechanical v
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Metabolic acidosis Metabolic acidos
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Morphine Sulfate Class Opioid analg
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Muscarinic Muscarinic acetylcholine
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Myoglobinuria When pathological mus
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Nasotracheal intubation Nasotrachea
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Needle cricothyrotomy A needle cric
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Neonatal opioid depression The resp
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Neuromuscular junction The neuromus
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Nicotinic Nicotinic receptors are t
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Non-depolarizing muscle relaxants T
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Ondansetron Class Seratonin ( 5-HT
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Oxygen saturation The oxygen satura
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Oxytocin Oxytocin is used in obstet
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Parturient The parturient is the pr
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Patient controlled analgesia Patien
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Peripheral nerve stimulator A perip
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Phrenic nerve The phrenic nerve, ar
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Positive pressure ventilation Posit
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Post-operative nausea and vomiting
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Pre-operative assessment Every pati
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Pre-oxygenation The purpose of pre-
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Prone In the prone position, the pa
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Pseudocholinesterase deficiency Pse
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Pulse oximeter The oxygen saturatio
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Radiculopathies Radiculopathy descr
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Re-narcotization A narcotized patie
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Recurrent laryngeal nerve The recur
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Remifentanil Class Synthetic opioid
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Reticular activating system The ret
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Rocuronium Class Non-depolarizing m
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Second stage of labour The second s
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Serotonin syndrome Serotonin syndro
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Shock Shock occurs when perfusion o
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Sodium citrate Sodium citrate is a
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Spinal anesthesia Spinal anesthesia
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Subarachnoid space The subarachnoid
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Succinylcholine Class Depolarizing
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Superior laryngeal nerve The superi
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Sympathetic nervous system The symp
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Theophylline Theophylline is a medi
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Thrombocytopenia Low platelet count
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Tidal volume Tidal volume is the vo
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Transcutaneous electrical nerve sti
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Trendelenburg The trendelenburg pos
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Urticaria Hives. Urticaria is cause
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Vagolytic Drugs with a vagolytic ef
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Vallecula The vallecula is the spac
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Venous air embolism Venous air embo
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Videolaryngoscope The videolaryngos
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