Recovery Room Care: BY Rajeev Kumar
Recovery Room Care: BY Rajeev Kumar
Recovery Room Care: BY Rajeev Kumar
CARE
BY
RAJEEV KUMAR
DESIGN
Location & size:
Should be close to the operating room with
Should have,
Large doors
Adequate lightning
Sufficient electrical and plumbing facilities
Efficient environmental control
Central nursing station and physician station
Storage and utility room
PACU STANDARDS
Standard for PACU were updated in 1994 by ASA house of
delegates
STANDARD 1
All patients who have received GA/RA/monitored
encouraged
Assure the availability of managing complication and
providing CPR
STANDARD 5
A physician is responsible for the discharge of the
inhallationl anesthesia
Emergence from IV agent
Primaraly depend upon redistribution.
As the dose increases , due to cummulative
dysfunction
Pateint high risk forvomiting airway bleeding
Poatoperative
wound hematoma in neck
compremissing airway should be drained
immediately
HYPOVENTILATION:
Defined as reduced alveolar ventilation resulting in
sympathetic tone.
Bradycardia- resudual effect of neostigmine
- beta blocker
- opioids
Tachycardia- pain, fever, hpovolumia, anemia.
-anticholinergic agent(atropine)
-vagolytic drugs(pancuronium,
meperidine)
Postoperative nausea and vomiting
(PONV)
This occurs in up to 80% of patients following
anaesthesia and surgery.
3. Anaesthetic technique:
Nitrous oxide
Ketamine
Neostigmine
4. Surgery:
Laproscopy
Ear surgery
Squint surgery
Ovum retrieval
Orchiopexy
5. Postoperative cause:
Pain
Movement
Hypotension
resistant cases.
Antihistamines Cyclizine. Adults 50mg
Simple analgesia,
◦ Paracetamol is a weak anti-inflammatory agent
◦ Modulates prostaglandin production in the central
nervous system
◦ Can be administered orally or rectally
◦ Best taken on a regular rather than 'as required' basis.
◦ Overdose results in hepatic necrosis
◦ Often combined with weak opiates (e.g.
dihydrocodeine = Co-dydramol)
Non-steroidal anti-inflammatory agents
◦ Inhibit the enzyme cyclo-oxygenase
◦ Reduces prostaglandin, prostacyclin and thromboxane
production
◦ Also have weak central analgesic effect
◦ Often used for their 'opiate sparing' effects
◦ Side effects include:
Gastric irritation and peptic ulceration
Precipitation of bronchospasm in asthmatics
Impairment of renal function
Platelet dysfunction and bleeding
Opiates
◦ Most commonly used drugs are diamorphine, morphine and
pethidine
◦ Diamorphine is a prodrug rapidly hydrolysed to morphine and
6-monoacetyl-morphine
◦ More lipid soluble than morphine with greater central effects
◦ Pethidine has only about 10% the analgesic potency of morphine
◦ All act on mu receptors in brain and spinal cord
◦ Mu 1 receptors are responsible for analgesia
◦ Mu 2 receptors are responsible for respiratory depression
◦ Side effects of opiates include:
Sedation
Nausea and vomiting
Vasodilatation and myocardial depression
Pruritus
Delayed gastric emptying
Constipation
Urinary retention
Routes of opiate administration
◦ Oral - available for codeine, dihydrocodeine and
oramorph
◦ Subcutaneous - useful for chronic pain relief
◦ Intramuscular - produces peaks and troughs in pain
relief
◦ Intravenous - reliable but can produce sedation and
respiratory depression
◦ Patient-controlled analgesia (PCA) - patient
determines own analgesic requirement
'Lock-out' period prevents accidental overdose
Safe as sedation occurs before respiratory depression
◦ Epidural or spinal
Lipid soluble opiates (e.g. fentanyl) are normally used
Produces good analgesia with reduced risk of side
effects
Regional analgesic techniques
◦ Peripheral nerve blocks Used mainly for pain relief after upper
or lower limb surgery. A single injection of local anaesthetic,
usually bupivacaine, results in 6–12h of pain relief.
◦ Epidural analgesia, Infusions of a local anaesthetic into the
epidural space, either alone or in combination with opioids,
act on the transiting nerve roots and the dorsal horn of the
spinal cord, respectively, to provide dramatic relief of
postoperative pain. For upper abdominal surgery an epidural
in the mid-thoracic region (T6/7) is used, while a hip
operation would need a lumbar epidural (L1/2).
◦ Intrathecal (spinal) analgesia, Spinal anaesthesia is of
insufficient duration to provide postoperative pain relief.
However, if a small dose of opioid, for example morphine 0.1–
0.25 mg, is injected along with the local anaesthetic, this may
provide up to 24 h of analgesia. Complications are the same
as those due to opioids given epidurally, and managed in the
same way.
Difficult pain problems
Patients in whom there is evidence of regular
intravenously
Opioid is usually used for analgesia in PCA
Intravenous PCA
Opioid Bolus dose Lockout time Infusion rate
(min)
Morphine 1-3 mg 10-20 0-1mg/hr
3. Pain
2=minimal
1=moderate
0=severe
4. Surgical bleeding
2=minimal
1=moderate
0=severe