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Post-Operative Period

Emergence from the anesthesia may produceproblems involving the airways , lungs , andcardiovascular system

Airway obstruction occur because residualanesthetic effects continue partially to obtundconsciousness and reflexes

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Post-Operative Period

Strong inspiratory efforts against closed glottiscan lead to negative-pressure pulmonary edema .

Pulmonary functional residual capacity is reducedpost-operatively following all types of anesthesiaand surgery, and hypoxemia may occur.

Hypertension can be prodigious and must betreated.

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Post-Operative Period

Administration of opioids in the recoveryroom can be problematic among patients whostill have a substantial residual anestheticeffect.

Ketorolac frequently is effective

COX 2 inhibitors for analgesia withoutrespiratory depression

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Post-Operative Period

Nausea and vomiting caused by an action of theanesthetic on the chemoreceptor trigger zoneand brain stem vomiting center.

5-HT3 serotonin receptor antagonist(ondansetron) is very effective in suppressingnausea and vomiting.

Common treatment also includes droperidol ,metaclopromide , dexamethasone , and avoidanceof nitrous oxide .

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Post-Operative Period

Use of propofol as an induction agent andketorolac as a substitute for opioids maydecrease the incidence and severity of post-operative nausea and vomiting.

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G eneral Anesthesia

Stages Stage of Analgesia

Stage of Delirium Stage of Surgical Anesthesia Stage of Medullary Depression

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Stage of Analgesia

Sensation to pain is blunted

Consciousness remains intact

Skin and face may be flushed

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Stage of Delirium

Inhibitory reflexes are depressedPatient is unable to follow commandsRespirations become irregularHeart rate increase; cardiac dysrhythmias mayappearSkin and face may be flushedMuscle tone is increased; patient may attempt tosit-upThere may be vomiting, regurgitation, inhibitionof reflex laryngeal closure

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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

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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 inthis plane

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Stage of Surgical Anesthesia

Plane 3 Muscular relaxation is great

Abdominal relaxation is increased Eyes converge Pupils dilate Light reflex disappears

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Stage of Surgical Anesthesia

Plane 4 Cessation of intercostals breathing

Pupils dilate Fall in body temperature

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Stage of Medullary Depression

Medullary paralysis Respiratory arrest and vasomotor collapse

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Purpose of Pre-anesthetic medicationand conscious sedation

Primary Decrease anxiety without producing excessive

drowsiness Provide amnesia while maintaining cooperation Relieve pre-operative pain if present

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Purpose of Pre-anesthetic medicationand conscious sedation

Secondary Reduce requirement for inhalational anesthetic

Minimize undesirable effects of inhalationalanesthetics Reduce volume and acidity of gastric contents Reduce stress response in the pre-operative

period

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Drugs used in pre-anestheticmedication and conscious sedationChronic medications

Drugs which are part of the patient s normal dailymorning dose for pre-existing co morbidities

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Drugs used in pre-anestheticmedication and conscious sedationAnticholinergic drugs

Used for their vagolytic and membrane-dryingproperties

Seldom used in adults in modern practice, exceptin situations requiring reduced secretions

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Drugs used in pre-anestheticmedication and conscious sedationDrugs that reduce acidity and volume of gastric contents

Induce H2 receptor antagonists, antacids andprokinetic agents

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Drugs used in pre-anestheticmedication and conscious sedationSedative-Hypnotics and Anti-Anxiety agents

Benzodiazepines, butyrophenones, andbarbiturates

Useful when administered before surgery both forpatient comfort and for facilitation of the

anesthetic state.

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Drugs used in pre-anestheticmedication and conscious sedationOpioids

Used pre-operatively in small doses to actsynergistically with sedatives in creating a tranquilpatient

Indicated in surgery of persons actually having

pain or experiencing incipient withdrawalsymptoms.

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end...

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