Post-Operative Recovery and Pain Relief

Post-Operative Recovery and Pain Relief describes the major problems that may be encountered during recovery from anaesthesia and suggest how they may be avoided by careful monitoring, vigilant nursing and sound organization. The behaviour of patients during recovery is influenced by their pre-operative medical condition, by drugs they may receive both pre- and intra-operatively and by the nature of the surgery they have undergone. This updated and revised version of Eltringham's "Post Anaesthetic Recovery" contains sections devoted to each of these areas which reflect the current best practice. Post-Operative Recovery and Pain Relief will be of interest not only to nursing staff working in operating theatres and post-operative care units but also to those working in surgical units, house officers and junior anaesthetists.

1 The Role of the Recovery Room.- Designing a Post-anaesthesia Care Unit.- Equipment.- Equipment Required at Each Recovery Bay.- Cardiorespiratory Equipment.- Paediatric Equipment.- Miscellaneous Equipment.- Drugs and Intravenous Fluids.- Safety.- Pollution.- Blood-borne Infections.- Staffing.- Continuing Education and Training.- Policies and Protocols.- References and Bibliography.- 2 Normal Recovery.- Physiology of the Elimination of Drugs Used During Anaesthesia.- Volatile Agents.- Intravenous Induction Agents.- Suxamethonium.- Non-depolarising Muscle Relaxants.- Analgesics.- Progress of Normal Recovery.- Stage IV: Medullary Paralysis.- Stage III: The Stage of Surgical Anaesthesia.- Stage II: The Stage of Excitement.- Stage I: The Stage of Analgesia.- Care-plan Nursing.- Reception of the Patient.- Basic Nursing Position and Safety.- Routine Observations.- Assessment of Colour.- Peripheral and Central Cyanosis.- Assessment of Respiratory Function.- Assessment of Cardiovascular Function.- Tissue Perfusion.- Pulse Measurement.- Doppler Ultrasonic Recorder.- Blood Pressure Measurement.- Sphygmomanometer and Stethoscope.- Oscillotonometer.- Automatic Blood-pressure Recording.- Direct Arterial Pressure Measurement.- Assessment of Level of Consciousness.- Recognition of Blood Loss.- Maintenance of the Airway.- Insertion of Oropharyngeal Airway.- Insertion of Nasopharyngeal Airway.- Suction of the Upper Airway.- Care of the Intubated Patient.- Endotracheal Suction.- Extubation.- Care of the Patient with a Laryngeal Mask Airway (LMA).- The Ventilated Patient.- Oxygen Therapy.- Administration of Oxygen.- Maintenance of Fluid Balance.- Intravenous Fluid Therapy.- Intravenous Infusions.- Intravenous Infusion Drip Rates.- Intravenous Injections.- Blood Transfusion.- Drainage Systems.- Record Keeping and Charting.- Criteria for Discharge.- Discharge to a Ward.- Discharge to Intensive Care or High-dependency Unit.- Transfer of Patient to Ward Staff.- References and Bibliography.- 3 Pain Relief and Local Anaesthesia.- Gate-control Theory of Pain.- Methods of Pain Relief.- Analgesic Drugs.- Patient-controlled Analgesia.- Balanced Analgesia.- Local Anaesthetic Techniques.- Management of Toxic Reactions.- Local Anaesthetic Agents.- Specific Local Anaesthetic Blocks.- Spinal Blockade.- Epidural Blockade.- Caudal Blockade.- Local Infiltration.- Intercostal Nerve Blockade.- Intrapleural Blockade.- Inguinal Field Blockade.- Penile Nerve Block.- Brachial Plexus Blockade.- Intravenous Regional Anaesthesia (Bier’s Block).- Digital Nerve Blockade.- Femoral Nerve Blockade.- Patient Management in the PACU.- References and Bibliography.- 4 Complications.- Respiratory Complications.- Signs of Hypoxaemia.- Signs of Hypercarbia.- Upper Airway Obstruction.- Inadequate Ventilation (Hypoventilation).- Hypoxaemia.- Bronchospasm.- Aspiration of Gastric Contents.- Pneumothorax and Haemothorax.- Tension Pneumothorax.- Cardiovascular Complications.- Hypotension.- Hypertension.- Bradycardia.- Tachycardia.- Dysrhythmias.- Cardiac Arrest.- Initial Management.- Miscellaneous Complications.- Delayed Return of Consciousness.- Restlessness, Excitement and Delirium.- Nausea and Vomiting.- Shivering.- Convulsions.- Hypothermia.- Hyperthermia.- Malignant Hyperthermia.- Blood Transfusion Reactions.- Problems Associated with Massive Blood Transfusion.- Failure of Coagulation.- Oliguria.- References and Bibliography.- 5 Recovery in Different Branches of Surgery.- Emergency Surgery.- Surgery for Trauma.- Surgery in the Accident Department.- Gastroenterology.- Endoscopy.- Upper Gastrointestinal Tract Bleeding.- Surgery for Intestinal Obstruction or Peritonitis.- Bowel Surgery.- Orthopaedic Surgery.- Plaster Casts.- Traction.- Reduction of Fractures.- Hip Operations.- Fractured Vertebrae.- Obstetrics and Gynaecology.- Caesarian Section.- Evacuation of Retained Products of Conception; Suction Termination of Pregnancy.- Laparoscopy.- Hysterectomy.- Ear, Nose and Throat Surgery.- Tonsillectomy.- Laryngoscopy.- Tracheostomy.- Operations on the Nose.- Middle-ear Surgery.- Thyroid Surgery.- Airway Problems.- Thyroid Crisis or Storm.- Dental and Faciomaxillary Surgery.- Post-operative Bleeding.- Wiring of the Jaw.- Fracture of the Zygomatic Arch.- Mentally Handicapped Patients.- Ophthalmic Surgery.- Position.- Intra-ocular Pressure (IOP).- Pupil Size.- Analgesia.- Drug Interactions.- Neurosurgery.- Thoracic Surgery.- Bronchoscopy.- Thoracotomy.- Pain Relief.- Vascular Surgery.- Pain Relief.- Genito-urinary Surgery.- Prostatectomy.- Nephrectomy.- Circumcision.- Paediatric Surgery.- Maintenance of Airway and Adequacy of Ventilation.- Maintenance of Adequate Cardiovascular Function.- Temperature Regulation.- Fluid Balance.- References and Bibliography.- 6 Pre-existing Factors Affecting Recovery.- Premedication.- Anaesthetic Technique.- Intravenous Induction Agents.- Long-acting Inhalational Agents.- Analgesic and Relaxant Technique.- Regional Anaesthesia.- Induced Hypotension.- Ketamine.- Pre-operative Drug Therapy.- Anti-hypertensive Agents.- Monoamine Oxidase Inhibitors (MAOIs).- Corticosteroids.- Insulin and Hypoglycaemic Agents.- Anticoagulants.- Diuretics.- Antibiotics.- Digoxin.- Respiratory Disease.- Chronic Bronchitis.- Asthma.- Cardiovascular Disease.- Coronary Artery Disease.- Hypertension.- Cardiac Failure.- Pacemaker.- Neuromuscular Disease.- Myasthenia Gravis.- Muscular Dystrophy.- Paraplegia.- Liver Disease.- Renal Disease.- Endocrine Disorders.- Diabetes Mellitus.- Thyroid Disease.- Hypothyroidism.- Hyperthyroidism.- Phaeochromocytoma.- Porphyria.- Haematological Disease.- Iron-deficiency Anaemia.- Haemophilia.- Sickle Cell Disease.- Deficiency of Clotting Factors.- Musculoskeletal Disease.- Rheumatoid Arthritis.- Osteoporosis.- Ankylosing Spondylitis.- Geriatric Patients.- Pregnancy.- Malnourishment.- Obesity.- References and Bibliography.- 7 Recovery and Day Surgery.- Patient Selection.- Social Circumstances.- Medical Factors.- Procedure Selection.- Examples of Suitable Procedures.- Pre-admission Clinic.- Documentation.- Anaesthetic Management.- Recovery from Anaesthesia.- Discharge from the Hospital.- Paediatrics.- Management.- Post-anaesthetic Complications.- Pain.- Regional or Local Anaesthesia.- General Anaesthesia.- References and Bibliography.- 8 Monitoring.- ASA Classification.- Routine Monitoring.- Respiratory System.- Cardiovascular System.- Metabolic Systems.- Neurological System.- Specific Monitors.- Electrocardiograph (ECG).- Arterial Pressure.- Invasive Methods.- Non-invasive Methods.- Pulmonary Artery Pressure.- Oxygen Saturation.- Neuromuscular Blockade.- Carbon Dioxide Tension.- References and Bibliography.- Appendix A Drugs Commonly Used in the PACU.- Appendix B Translations of Standard Recovery Phrases.