PACU

extension of the anesthesia process and we are responsible for our patient even if we are not there.

1. meets all PACU DC criteria 2. minimal sedation/local MAC 3. no narcotics within 20 min of OR DC 4. report given to ward nurse 5. documentation

post anesthesia recovery score: 1. muscle activity 2. respirations 3. circulation 4. consciousness 5. color

1. N/V 2. agitation and pain 3. hypothermia and shivering 4. Urine 5. glucose disorder

1. airway obstruction 2. aspiration 3. bronchospasm 4. Pulm edema 5. pe 6. diffusion hypoxemia

1. Narcotics- respiratory depression 2. Inadequate respiratory muscle function Obesity Scoliosis NMB 3. Neuromuscular disease • MG • Eaton lambert syndrome • Muscular dystrophy • Gillian-barre

Unique to extubation period Vigorous inspiratory effort against a closed glottis (laryngospasm) or small ETT Usually with young health muscular men after rapid emergence Prevention: bite block Symptoms:  Coarse breath sounds  Pink frothy sputum  Hypoxia and hypertension  CXR normal heart with alveolar infiltrates Treatment:  Respiratory supportive measures – humidified oxygen, CPAP, mechanical ventilation, PEEP  Diuretics

1. hypo old Mia 2. decreased SVR

o hyper dynamic phase common during first 30 min after emergence o Results from: incisional pain, ETT intubation, bladder dissension, pre-existing htn o Develop differential diagnosis for postop HTN and tachycardia Most likely: pain, -hypothermia with shivering, bladder distention, essential htn • Possible: hypoxemia, hypercarbia, fever, anemia, hypoglycemia, withdrawal, MI

1. Hypoxemia (do not give sedative until this is ruled out) 2. Hypercarbia 3. Anesthetic agent residuals • Inhaled agent, ketamine, lidocaine • Inability to process sensory input during initial awakening 4. Decreased brain perfusion 5. Metabolic disturbances

floppy appearance poor coordination ineffective intercostal muscle complaining of SOB unable to sustain head lift TOF in OR does not rule this out

patient appears uncomfortable unconcerned about ventilation despite hypoxia slowing breathing with apnic pause treat: oxygen by mask continuous stimulation narcan 40-400mcg

pain N/V sedated hypothermia saturation admin