Random facts
Why is the recovery period so important?
High morbidity and mortality rates during recovery
When does post-op delirium typically occur? And how long can it last?
Within the first 10 minutes, can last up to an hour
How would you describe prolonged emergence?
Patient minimally responsive 20 min since discontinuing inhalant, no paperback reflex and eyes still ventral-medial
What drugs can cause decreased anesthetic protein binding?
NON-anesthetic drugs?
NSAIDs, contrast dyes, antibiotics
... atropine or antibiotics (gentamycin)
What type of monitoring is needed during post-op care.
Describe post-op delirium
Hyper-arousal, agitation, hyperactivity, dysphoria
What is the most frequent cause of delayed emergence?
Anesthetic Sensitivity
What are some metabolic factors that could cause prolonged emergenc?
What type of healthy patients may need more advanced monitoring?
Brachycephalic patients, geriatric patients
What are some predisposing factors?
ABN glycemic control, age, ASA PS > 3, vision impairment, sepsis, metabolic disturbances, nausea/vomiting
What are the broadest causes of anesthetic sensitivity?
Inappropriate dosing and inappropriate monitoring
Neurologic factors affecting?
Hydrocephalus, Cerebral factors (hypoperfusion, hypoxia, hemorrhage, edema), Elevated ICPs, Head position, Cerebral thromboembolic event
T/F I should provided food and water to the patient immediately following extubation.
FALSE, wait until they are standing
What are perioperative factors that could lead to emergence delirium?
Drugs, pain, airway obstruction, distended bladder, electrolyte imbalances, hypoxia, hypercapia, sensory overload when waking
What is the rate of emergence dependent on (related to drugs)?
Drug: Timing, dose, half-life, route of administration, residual drug, multimodal synergism
Other things causing it...
What are teh t2o most common phenomena that can occur in the post-op recovery phase?
Prolonged emergence and post-op delirium
What breeds is post-op delirium most common in?What category of surgerise?
Greyhounds, Russian Wolfhounds, Afghans
(German shepards, huskies, malamutes, vizsla, Weimaraner)
20% occurrence in orthopedic cases
What patient factors can cause prolonged emergence?
Pt: Decreased CO [dec metabolism and perfusion], Hepatic metabolism (malnourished, young, old, cold), Hypothermia [depress CNS, increase inhalant solubility, dec metabolism], Renal failure/azotemia [alt. A/B status, dec protein binding, delayed metabolism, electrolyte changes]
Name the A-H’s of managing a patient that will not wake up from anesthesia
A + B = airway and breathing C = circulation
D = drugs E = electrolytes
F = failure to find cause (neurologic)
G = get them up H = hypothermia
SIMON likes HABC->D->E->G->F order