Head-down position is useful for hypovolemic patients
Head-up position is useful for patients with underlying pulmonary dysfunction
Lateral position is useful for patients at high risk for vomiting or upper airway bleeding (e.g., after tonsillectomy)
Postoperative Pain Control
• Most commonly treated with oral or parenteral opioids.
• Preoperative oral administration of nonsteroidal antiinflammatory drugs (NSAIDs), acetaminophen, and gabapentin or pregabalin may significantly reduce postoperative opioid requirements
• Selective cyclooxygenase-2 inhibitors such as celecoxib reduce the risk of NSAID-related platelet dysfunction and gastrointestinal hemorrhage.
• Rescue single-shot, continuous nerve blocks, or continuous epidural analgesia are used when moderate to severe postoperative pain is present or oral analgesia is not possible.
• Before the recovering patient is fully responsive, pain is often manifested as postoperative restlessness.
• Differential diagnosis of postoperative agitation includes serious systemic disturbances (e.g., hypoxemia, respiratory or metabolic acidosis, hypotension), bladder distention, or a surgical complication (e.g., occult intraabdominal hemorrhage).
• Physostigmine, 1 to 2 mg intravenously (IV) (0.05 mg/kg in children), is most effective in treating delirium caused by atropine and scopolamine.
• Midazolam, 0.5 to 1 mg (0.05 mg/kg in children) is used in persistent agitation.
Nausea and Vomiting
• Risk factors for postoperative nausea and vomiting (PONV)
° Most common problem after general anesthesia, occurring in 30% to 40% of all patients
° The etiology of PONV is usually multifactorial, associated with anesthetic and analgesic agents, the type of surgical procedure, and intrinsic patient factors such as a history of motion sickness.
° Risk factors for postoperative nausea and vomiting
Patient factors: Young age; female gender, particularly if menstruating on the day of surgery or in first trimester of pregnancy; large body habitus; history of postoperative emesis; history of motion sickness; anesthetic techniques
General anesthesia: Opioids, volatile agents, neostigmine, surgical procedures, strabismus surgery, ear surgery, laparoscopy, orchiopexy, ovum retrieval, tonsillectomy, breast surgery
Postoperative factors: Postoperative pain, hypotension
• Prevention and treatment of PONV
° Propofol anesthesia decreases the incidence of PONV, and a preoperative history of smoking lessens the risk of PONV.
° Selective 5-hydroxytryptamine (serotonin) receptor 3 (5-HT3) antagonists such as ondansetron 4 mg (0.1 mg/kg in children), granisetron 0.01–0.04 mg/kg, and dolasetron 12.5 mg (0.035 mg/kg in children) are effective.
° Transdermal scopolamine is effective but associated with side effects such as sedation, dysphoria, blurred vision, dry mouth, urinary retention, and exacerbation of glaucoma, particularly in elderly patients.
° Dexamethasone, 4 to 10 mg (0.10 mg/kg in children) is an antiemetic and provides a varying degree of analgesia and a sense of patient well-being.
Related posts:
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Anesthesia for Patients with Cardiovascular Disease
Anesthesia for Genitourinary Surgery
Ambulatory, Non–Operating Room, and Office-Based Anesthesia
Spinal, Epidural, and Caudal Blocks
Cholinesterase Inhibitors and Other Pharmacologic Antagonists to Neuromuscular Blocking Agents
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