1.16 Post-operative care in recovery room (classification and 6H)
The 6H:
- Hypothermia: use warm blankets to fix this.
- Hypo/hypercapnia: check breathing rate and provide oxygen if necessary.
- Hypo/hyperglycemia: provide glucose or insulin.
- Hydrogen ions: check breathing
- Hypoxemia: check breating and provide oxygen if necessary.
- Hypovolemia: infusions
The safe exit checklist:
We will just go from top to bottom on the body:
- Brain: Consciousness: do they respond to voice.
- Lungs: Breathing: deep breaths, coughing?
- Heart: Stable BP and pulse?
- Skin: skin colour not pale and SpO2 is >94% in normal atmospheric air?
- Legs: Activity: can they move their muscles?
Antidotes:
| If the problem is | Use the following antidote |
|---|---|
| opoids | Naloxone |
| Benzodiazapines | Flumazenil |
| Muscle Relaxants like Atracurium | Use neostigmine |
| Muscle Relaxants like Vecuronium | Use Sugammadex |
| General Confusion | Use Physiostigmine |
Clinical rules of thumb:
- The urine output should be >30ml/h
- NPO: nothing per os. The patient can eat and drink usually by evening but if there was an abdominal surgery, its better to not eat anything for 24 - 48 hours.
- Pain and PONV: start non-opoids early to avoid pain. and the #1 complaint from patients is nausea (Post-Operative Nausea and Vomiting PONV). Treat it aggressivly with anti-emetics such as odansetron.