Post-Operative Recovery and Pain Relief

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.