POST ANESTHESIA CARE / RESPIRATORY THERAPY

III. GENERAL PRINCIPLES OF ANESTHESIA

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Post Anesthesia Care / Respiratory Therapy

The acute onset of inspiratory stridor in a postoperative patient may be due to laryngospasm, laryngeal edema, foreign body aspiration, or vocal cord dysfunction.
The most prevalent anesthesia complication noted in the ambulatory surgery area is nausea and vomiting.

ACTIVITY	RESPIRATION	CIRCULATION	NEUROLOGIC	O₂SATURATION
0—Unable to lift head or move extremities upon command	0—Apneic; ventilator or assisted respiration	0—Abnormally high/low BP	0—not responding or only to pain	0—O₂ sat < 90%, even with supplement
1—Moves 2 extremities upon command and can lift head	1—labored or limited respirations; may have oral airway	1—BP within 20-50 mm Hg of preanesthetic level	1—Responds to verbal but drifts to sleep easily	1—Needs O₂inhalation to maintain > 90%
2—Moves all 4 extremities (Exception: spinal block and could move preop)	2—Takes deep breath and cough well; normal resp	2—Stable BP and pulse (Exception: can be d/c’d after medication)	2—awake and alert; oriented	2—Maintains O₂sat > 92% on room air

The most common cause of airway obstruction in the immediate post-operative phase is the loss of pharyngeal muscle tone in a sedated or obtunded patient.
- Snoring and activation of accessory muscles of ventilation are signs.
Laryngospasm may result from a glottis reflex closure or the larynx.
- Treated immediately with a jaw thrust along with CPAP (up to 40 cm H₂O).
- If unsuccessful, succinylcholine 0.1-1 mg/kg IV or 4 mg/kg IM.
The most common causes of hypoxemia in PACU:
- Atelectasis
- Pulmonary edema
- Pulmonary embolism
- Aspiration
- Bronchospasm
- Hypoventilation