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Edgard M. Simon, MD

Department of Anesthesiology

UP-Philippine General Hospital

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! Airway patency, vital signs, and oxygenationshould be checked immediately on arrival

! Blood pressure, pulse rate, and respiratory ratemeasurements are routinely made at leastevery 5 mins for 15 mins or until stable andevery 15 mins thereafter

! Pulse oximetry should be monitoredcontinuously in all patients recovering fromgeneral anesthesia, or at least until they regainconsciousness

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! Occurrence of hypoxemia does NOTnecessarily correlate with level ofconsciousness

! Neuromuscular function should be assessedclinically

! At least one temperature measurement shouldbe obtained

! Additional monitoring includes painassessment, nausea/vomiting, and fluid input/output

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! All patients recovering from general anesthesiashould receive 30-40% oxygen duringemergence because transient hypoxemia can

develop even in healthy patients (increased riskin patients with underlying pulmonarydysfunction or those undergoing upperabdominal/thoracic procedures and should be

constantly monitored with pulse oximetry)! Deep breathing and coughing should be

encouraged periodically

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! Heavily sedated or hemodynamically unstablepatients should receive supplemental oxygen

! Sensory and motor levels should beperiodically recorded

! Blood pressure should be closely monitored! Bladder catheterization may be necessary in

some patients

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! Visual Analog Scale! Adequate analgesia vs. excessive sedation!

Respiratory depression of opioids may notmanifest until 20-30 mins after IVadministration

! Risk of delayed respiratory depression withepidural morphine still present within 12-24hours after administration!

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! Pain is often manifested as postoperativerestlessness

! Serious systemic disturbances (such ashypoxemia, acidosis, or hypotension), bladderdistension, or surgical complication(hemorrhage) should also be considered

! May also be due to adverse drug effects

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! Postoperative nausea and vomiting (PONV)occurs in 20-30% of patients

! Etiology is usually multifactorial: anestheticagents, type of procedure, patient factors

! Also a common complaint at the onset ofhypotension following spinal/epiduralanesthesia

! May be treated with pharmacologic andnonpharmacologic agents

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! Patient factors" Young age" Female" Large body habitus" Previous PONV" Motion sickness

! Anesthetic techniques" General anesthesia" Drugs (opioids,

volatile agents, etc.)

! Surgical procedures" Strabismus surgery" Ear surgery" Laparoscopy" Orchiopexy" Ovum retrieval" Tonsillectomy

! Postoperative factors" Postoperative pain" Hypotension

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! Shivering may occur as a result ofintraoperative hypothermia or effects ofanesthetic agents

! Most important cause of hypothermia isredistribution of heat from the body core to theperipheral compartments

! Cold ambient temperature in the OR,prolonged exposure of a large wound, use oflarge amounts of unwarmed IV fluids or highflows of unhumidified gases can becontributory

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! Nearly all anesthetics, especially volatile agents,decrease normal vasoconstrictive response tohypothermia

!May also be due to regional anesthesia, sepsis,drug allergy, or transfusion reaction

! Intense shivering can cause rise in oxygenconsumption, carbon dioxide production, andcardiac output, which may be poorly tolerated by

patients with preexisting pulmonary or cardiacimpairment, leading to increased incidence ofmyocardial ischemia, arrythmias, increasedtransfusion requirements, and increased durationof muscle relaxant effects

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! May be treated with warming lights or heatingblankets

! May also be treated pharmacologically(meperidine, tramadol, sedation)