Anesthesia Student Survival Guide.pdf - Index of

430 ● AnesthesiA student survivAl Guide
Table 27.1 Sample PACU sign-out.
Preop history − Medications, allergies, past medical history
Postoperative Respiratory Complications
The most frequent complication in the PACU is airway obstruction. Common
causes include:
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− underlying diagnosis
− Premedications
intra-operative history − Procedure
− Anesthesia type
− Medications & fluids given
− estimated blood loss, urine output
− intra-operative events/problems
− vital sign ranges
Patient status − Airway (preop exam, airway management, ett position)
− size, location of lines, catheters and invasive monitors
− level of consciousness
− Pain level
− intravascular volume status
− Overall impression
Postop instructions − Acceptable ranges (blood loss, vitals, urine output)
− Potential cardiovascular or respiratory problems
− labs or diagnostic studies (CXr, eCG) if necessary
− location and physician contact information
the tongue falling against the posterior pharynx (most common)
laryngospasm (see below)
glottic edema
secretions/vomit/blood in the airway
external pressure on the trachea (e.g. neck hematoma)
A clinical sign of partial obstruction is sonorous respiration. A sign of complete
obstruction is absent breath sounds and often paradoxical movement of the chest
with respiration.
Treatment modalities include supplemental oxygen, head lift, jaw thrust,
oral or nasal airway, or reintubation. If the patient displays signs of extrinsic
compression of trachea, such as an expanding hematoma with airway compromise,
reopening of the wound and drainage is therapeutic and can be lifesaving.
Laryngospasm (uncontrolled contraction of the laryngeal cords) may also
be seen in the PACU. Clinical indicators may include a high-pitched crowing
or silence if the glottis is totally closed. This may be more common after airway
trauma, repeated airway instrumentation or with copious secretions (including