POST ANESTHESIA RECOVERY
QUESTIONS AND ANSWERS
What should you monitor for with Amiodarone therapy ✅✅ANSW-hypotension & bradycardia
Drug related causes of Bradydysrhythmias (4) ✅✅ANSW--beta blockade
-anticholinesterases
-opiods
-dexmedatomidine
Procedure/Patient related causes of Bradydysrhythmias (4) ✅✅ANSW--bowel distention
-Inc ICP
-Inc IOP
-Spinal Anesthesia
Delirium definition ✅✅ANSW-Extreme disturbances of arousal, attention, orientation,
perception, intellectual, function and affect. Usually accompanied by fear and agitation.
delirium increases _____, _____, & _____ ✅✅ANSW--hospital stay
-pharmacy costs
-mrotality
___% of adults > ____years old will experience some delirium after surgery ✅✅ANSW--10%
-50 years old
>_____% incidence in ____surgery and _____. ✅✅ANSW--30%
-hip surgery
-bilateral TKA
(because its older/more at risk)
,Risk factors for Delirium (5) ✅✅ANSW--advanced age
-preoperative cognitive impairment
-decreased functional status
-ETOH abuse
-Previous hx of delirium
4 types of Delirium ✅✅ANSW--withdrawal psychosis
-toxic psychosis
-circulatory and respiratory origin
-functional psychosis
With delirium, you need to identify ______ ✅✅ANSW-what is causing it; rule-out
Possible causes of delirium (7) ✅✅ANSW--hypoxemia
-hypercapnia
-pain
-sepsis
-electrolyte disturbances
-seizures
-hypoventilation
Intraop predictors of delirium (3) ✅✅ANSW--surgical blood loss
-Hct <30%
-number of blood transfusions
Iatrogenic factors of delirium (2) ✅✅ANSW--hydration
-medications (versed, propofol)
Management of Delirium ✅✅ANSW--may require restraints to avoid injury or tube dislodgment
, -may need to re-sedate
-Pharmacologic therapy in high tolerance pt's (ex:ETOH)
-Minimize drug therapy in elderly
Peak age for Emergence excitement ✅✅ANSW-2-14 years old
____% of children experience agitation and delirium in PACU ✅✅ANSW-30
Common causes of delayed awakening ✅✅ANSW-**Residual Drug effects**
**Hypoglycemia**
**Electrolyte imbalance**
**Inc ICP**
-hypothermia
-hypoxemia
-air embolism
-hysteria
Treatment for Delayed Awakening ✅✅ANSW--Naloxone
-Flumazenil
-make sure NDMR are reversed to fullest
-assess for hypothermia
-assess hypoglycemia/hyperglycemia
Dose for Naloxone ✅✅ANSW-20-40mcg IV in increments
Dose for Flumazenil ✅✅ANSW--0.2mg initial
-increase 0.1mg increments
-Max dose of 3mg
Most common cause of oliguria in PACU ✅✅ANSW-volume depletion
QUESTIONS AND ANSWERS
What should you monitor for with Amiodarone therapy ✅✅ANSW-hypotension & bradycardia
Drug related causes of Bradydysrhythmias (4) ✅✅ANSW--beta blockade
-anticholinesterases
-opiods
-dexmedatomidine
Procedure/Patient related causes of Bradydysrhythmias (4) ✅✅ANSW--bowel distention
-Inc ICP
-Inc IOP
-Spinal Anesthesia
Delirium definition ✅✅ANSW-Extreme disturbances of arousal, attention, orientation,
perception, intellectual, function and affect. Usually accompanied by fear and agitation.
delirium increases _____, _____, & _____ ✅✅ANSW--hospital stay
-pharmacy costs
-mrotality
___% of adults > ____years old will experience some delirium after surgery ✅✅ANSW--10%
-50 years old
>_____% incidence in ____surgery and _____. ✅✅ANSW--30%
-hip surgery
-bilateral TKA
(because its older/more at risk)
,Risk factors for Delirium (5) ✅✅ANSW--advanced age
-preoperative cognitive impairment
-decreased functional status
-ETOH abuse
-Previous hx of delirium
4 types of Delirium ✅✅ANSW--withdrawal psychosis
-toxic psychosis
-circulatory and respiratory origin
-functional psychosis
With delirium, you need to identify ______ ✅✅ANSW-what is causing it; rule-out
Possible causes of delirium (7) ✅✅ANSW--hypoxemia
-hypercapnia
-pain
-sepsis
-electrolyte disturbances
-seizures
-hypoventilation
Intraop predictors of delirium (3) ✅✅ANSW--surgical blood loss
-Hct <30%
-number of blood transfusions
Iatrogenic factors of delirium (2) ✅✅ANSW--hydration
-medications (versed, propofol)
Management of Delirium ✅✅ANSW--may require restraints to avoid injury or tube dislodgment
, -may need to re-sedate
-Pharmacologic therapy in high tolerance pt's (ex:ETOH)
-Minimize drug therapy in elderly
Peak age for Emergence excitement ✅✅ANSW-2-14 years old
____% of children experience agitation and delirium in PACU ✅✅ANSW-30
Common causes of delayed awakening ✅✅ANSW-**Residual Drug effects**
**Hypoglycemia**
**Electrolyte imbalance**
**Inc ICP**
-hypothermia
-hypoxemia
-air embolism
-hysteria
Treatment for Delayed Awakening ✅✅ANSW--Naloxone
-Flumazenil
-make sure NDMR are reversed to fullest
-assess for hypothermia
-assess hypoglycemia/hyperglycemia
Dose for Naloxone ✅✅ANSW-20-40mcg IV in increments
Dose for Flumazenil ✅✅ANSW--0.2mg initial
-increase 0.1mg increments
-Max dose of 3mg
Most common cause of oliguria in PACU ✅✅ANSW-volume depletion
