Post anesthetic investigation and                      medications                By:- preeti chaudhary               Fina...
   Hand washing with soap and water or with alcoholic    cleansing agents should be performed before and    after patient...
 Optimal  postoperative care requires: clinical assessment and monitoring respiratory management cardiovascular manage...
 Anaesthetic  and surgical staff should record  the following items in the patient’s case  notes: § any anaesthetic, sur...
   A postoperative assessment should be carried out    when the patient returns from theatre.   Patients at risk of dete...
INTRA OPERATIVE HISTORY & POST    OPERATIVE INSTRUCTION        RESPIRATORY STATUS ASSESMENT Past medical history         ...
VOLUME STATUS ASSESMENT Hands - warm or cool,      ����������                                 MENTAL STATUS ASSESMENT  pi...
 Any  significant symptoms eg chest pain, breathlessness Pain and adequacy of pain control Following specialist surger...
 Patients requiring the frequent monitoring of  multiple variables should be considered for care  at level 2 or above. T...
   Patients in whom there is a suspicion of postoperative pulmonary    complications should have an arterial blood gas an...
*Any two of the following on two or more days: Pyrexia >38 C Positive sputum culture Positive clinical findings Abnorm...
Observe if :-            Seek further advice if:   Awake or easily            * Drowsy or unrousable    rousable         ...
   Postoperative blood pressure should always be reviewed with reference    to the preoperative and intraoperative assess...
   Accurate assessment of fluid and electrolyte status can be    difficult and the treatment of a particular patient must...
Composition of replacement                     fluids
FLUID       Na        K          GLUCOSE( Osm   pH            (mEq/l)   (mEq/l)    g/l)Whole       168-156   3.9-21.0     ...
Hetastarch   154   0     0     310   5.90.9%NaCl     154   0     0     308   6.0Lactated     130   4.0   0     273   6.5Ri...
   Hand washing with soap and water or with alcoholic    cleansing agents should be performed before and    after patient...
 Systemic   inflammatory response syndrome  (SIRS) is defined as the presence of 2 or more  of the following: § temperat...
 Oral intake should be commenced as soon as  possible after surgery. Nutritional replacement should be discussed  with a...
 Giventhe lack of a strong evidence base of effective practice for postoperative management this guideline has been devel...
CATEGORY          DRUG               DOSAGE              INDICATIONAntihistamine     Benadryl           10 -50 mg         ...
Oral surgery
Oral surgery
Upcoming SlideShare
Loading in …5
×

Oral surgery

447 views
388 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
447
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
15
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Oral surgery

  1. 1. Post anesthetic investigation and medications By:- preeti chaudhary Final year (8749063)
  2. 2.  Hand washing with soap and water or with alcoholic cleansing agents should be performed before and after patient contact. Early identification and appropriate treatment of sepsis improves outcome. Urine and blood cultures should be obtained whenever there is reason to suspect systemic sepsis. If the cause of sepsis is unknown, treat with broad spectrum antibiotics, guided by local protocols. Results from microbiological specimens should be reviewed regularly and antibiotics changed as necessary. A course of antimicrobial treatment should generally be limited to 5-7 days. Fungi and atypical organisms can contribute to sepsis syndrome, so take cultures and prescribe appropriately VITAL SIGN within 2
  3. 3.  Optimal postoperative care requires: clinical assessment and monitoring respiratory management cardiovascular management fluid, electrolyte and renal management control of sepsis nutrition Only accept responsibility appropriate to your training and experience. If in doubt ASK FOR HELP
  4. 4.  Anaesthetic and surgical staff should record the following items in the patient’s case notes: § any anaesthetic, surgical or intraoperative complications § any specific postoperative instruction concerning possible problems § any specific treatment or prophylaxis required (eg fluids, nutrition, antibiotics, analgesia, anti-emetics, thromboprophylaxis).
  5. 5.  A postoperative assessment should be carried out when the patient returns from theatre. Patients at risk of deterioration require frequent assessment. Patients with the following risk factors for deterioration should be reassessed within two hours of the first assessment postoperative : ASA grade ≥ 3 emergency or high risk surgery operation out of hours The doctor completing the initial postoperative assessment should consider the monitoring regimen and appropriate level of care required for the next 24 hours in collaboration with the nursing team.
  6. 6. INTRA OPERATIVE HISTORY & POST OPERATIVE INSTRUCTION RESPIRATORY STATUS ASSESMENT Past medical history *Oxygen saturation Medications  Effort of breathing/use Allergies of accessory muscles Intraoperative  Respiratory rate complications  Trachea central or not? Postoperative  Symmetry of instructions respiration/expansion Recommended  Breath sounds treatment &  Percussion prophylaxis���� note�������� �� ���
  7. 7. VOLUME STATUS ASSESMENT Hands - warm or cool, ���������� MENTAL STATUS ASSESMENT pink or pale? Capillary return <2s or  Patient conscious and not? normally responsive ? Pulse rate, volume and (AVPU; Alert, Verbal, rhythm Painful, Unresponsive) Blood pressure Conjunctival pallor  If abnormal determine: Jugular venous pressure if confusion is present Urine colour and rate of (AMT) GCS, oxygen production saturation and blood Drainage from drains, wounds & NG tubes glucose������� ������
  8. 8.  Any significant symptoms eg chest pain, breathlessness Pain and adequacy of pain control Following specialist surgery it may be necessary to assess additional factors.
  9. 9.  Patients requiring the frequent monitoring of multiple variables should be considered for care at level 2 or above. Trends in the physiological data, rather than absolute numbers, should be reported to assist in the detection of deteriorating patients before a severe physiological compromise occurs. Postoperative monitoring should be continued on a daily basis. The monitoring regimen should be reviewed daily so as best to provide data for clinical decision making. Any change in a monitoring regimen should prompt reassessment of the level of care.
  10. 10.  Patients in whom there is a suspicion of postoperative pulmonary complications should have an arterial blood gas analysis, a sputum culture and ECG. Chest X-ray should be performed on suspicion of major collapse, effusions, pneumothorax or haemothorax. Other investigations should be used only if there are specific indications. Oxygen should be given to patients with hypoxaemia using a device that is best tolerated to achieve the necessary SpO2. In normally hydrated patients humidification is unnecessary. Failure to maintain an SpO2 >90% or PaO2 >8.0 kPa is an indication to consider assisted ventilation. Patients developing respiratory failure should be referred to a critical care specialist to be assessed for possible assisted ventilation. The referral should be timely as hypoxia or hypercapnia may lead rapidly to cardiorespiratory arrest.
  11. 11. *Any two of the following on two or more days: Pyrexia >38 C Positive sputum culture Positive clinical findings Abnormal chest X-ray –Atelectasis/infiltrates
  12. 12. Observe if :- Seek further advice if: Awake or easily * Drowsy or unrousable rousable  Distressed Comfortable  Hypertensive Normal preoperative BP preoperatively  Cold Warm  Capillary ref ll > 2 Well perfused (capillary seconds ref ll <2 seconds)  Heart rate >100 or <50 Heart rate 50-100 bpm bpm Passing urine (>0.5  Oliguric (<0.5 ml/kg/hr) ml/kg/hr)  Signs of bleeding (drains, No obvious bleeding wounds, haematoma)
  13. 13.  Postoperative blood pressure should always be reviewed with reference to the preoperative and intraoperative assessments. assessment is required for patients with: - heart rate < 50 and > 100 bpm -blood pressure <100 mm Hg systolic. Patients on regular antihypertensive medication should normally be maintained on this medication perioperatively. If the patient becomes hypotensive then it may be appropriate to discontinue some drugs. Beta blockers and IV nitrates may be used safely and effectively in postoperative hypertension. Beta blockers should be continued perioperatively in patients previously taking these drugs for coronary disease, congestive heart failure, hypertension or arrhythmias. Be aware of clinical factors which increase risk to the patient and how these interact with the risks imposed by the surgical procedure. Seek expert help early in the management of serious or potentially serious arrhythmias. Search for the underlying causes of any supraventricular arrhythmias, eg hypoxia, hypovolaemia, electrolyte abnormality, sepsis or drug toxicity. Where perioperative MI is diagnosed or suspected early specialist medical advice should be sought. Maintain normothermia in the postoperative period.
  14. 14.  Accurate assessment of fluid and electrolyte status can be difficult and the treatment of a particular patient must be individualised and reviewed frequently in the light of the response to treatment. Volume depletion should be avoided as this can lead to poor perfusion and problems such as anastomotic breakdown, cerebral damage, renal failure and multiple organ failure. Diuretics should not be used to treat oliguria and should be reserved for fluid overload. Hyponatraemia is more commonly due to excess water than sodium deficiency – assess volume status. Hypernatraemia most commonly indicates a total body deficiency of water and is an indication for prompt assessment and intervention, especially when levels exceed 155 mmol/L. Hypokalaemia can delay postoperative recovery - magnesium supplementation may also be required. Hyperkalaemia is a medical emergency – obtain senior help. Metabolic acidosis is usually due to poor tissue perfusion but can also be caused by excessive administration of saline.
  15. 15. Composition of replacement fluids
  16. 16. FLUID Na K GLUCOSE( Osm pH (mEq/l) (mEq/l) g/l)Whole 168-156 3.9-21.0 7.20-6.84blood inCPDPRBC, AS- 117 ?-49 552 6.61PRBC, CPD 169-111 ?-95 6.6PRBC,CPD 15.4 5.1-78.5 7.55-6.71A-1FFP 130-1605%ALBUMI 130-160 <2.5 0 330 7.4N2.5%ALBU 130-160 <2.0 0 330MINPLASMA 0 <2.0 7.4NATE10%DETRA 154 0 50 255 4.0N
  17. 17. Hetastarch 154 0 0 310 5.90.9%NaCl 154 0 0 308 6.0Lactated 130 4.0 0 273 6.5Ringer’ssolution5% dextrose 0 0 50 252 4.5D5LR 130 4.0 50 525 5.0D50.45% 77 0 50 406 4.0NORMOSOL 140 5.0 100 555 7.4Normosol - 40 13 50 363 5.6MNormosol-R 140 5.0 0 295 7.4Ph 7.4Normosol-R 140 5.0 0 295 6.6D5 140 5.0 0 547 5.2Normosol-R
  18. 18.  Hand washing with soap and water or with alcoholic cleansing agents should be performed before and after patient contact. Early identification and appropriate treatment of sepsis improves outcome. Urine and blood cultures should be obtained whenever there is reason to suspect systemic sepsis. If the cause of sepsis is unknown, treat with broad spectrum antibiotics, guided by local protocols. Results from microbiological specimens should be reviewed regularly and antibiotics changed as necessary. A course of antimicrobial treatment should generally be limited to 5-7 days. Fungi and atypical organisms can contribute to sepsis syndrome, so take cultures and prescribe appropriately
  19. 19.  Systemic inflammatory response syndrome (SIRS) is defined as the presence of 2 or more of the following: § temperature >38 C or <36 C § heart rate >90 bpm § respiratory rate >20 breaths/min or PaCO2 <4.3kPa § white cell count >12,000 cells/mm3 , <4,000 cells/mm3 or >10% immature forms. When SIRS is present an infective cause should be sought first.
  20. 20.  Oral intake should be commenced as soon as possible after surgery. Nutritional replacement should be discussed with a dietician and tailored to the patients requirements. Entenral nutrition is the preferred method of postoperative nutritional support and should be used if possible. Nutritional and metabolic status should be assessed regularly and the nutritional prescription modified as necessary.
  21. 21.  Giventhe lack of a strong evidence base of effective practice for postoperative management this guideline has been developed using a combination of evidenced based and consensus techniques. Initial systematic searches identified any relevant evidence. The critically appraised evidence, together with the clinical experience of the guideline development group, informed the formal consensus methods that were used to develop recommendations. These are presented in the form of “consensus statements”.
  22. 22. CATEGORY DRUG DOSAGE INDICATIONAntihistamine Benadryl 10 -50 mg Mild allergic chlorotrimetron 10 mg reactionbarbiturates nembutal 50 – 100mg toxic overdose seconal 100 mg (local anesthetic)steroids Solu-cortef 100 mg severe allergic decadron reactionvasopressors Methedrine 10-20 mg hypotension vasoxyl 10-20 mgbranchodilators Isuprel Nebulizer(0.2 mg) allergic or asthmatic Aminophylline 0.25-0.5 gm condition epinephrine o.2- Anaphylactic nitrogycerine 0.5ml(1:1000) shock or allergic 1/150-1/200 gr reactions Atropine sulfate linually Angina pectoris succinylcholine 0.4-0.6 mg 40-60 mg Bradycardia laryngospasm

×