Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesia• It is extremely unlikely to be due to epidural analgesia but maypossibly be due to PCA morphine.• If, following examination, no serious cause can be found then ifat all possible management should be conservative.Reassurance, leaving room lights on and using cot sides may besufficient.• The use of sedative drugs is likely to add to confusional statesand should not therefore be used.Common causes of confusion:Blood GlucoseHypoglycaemia or hyperglycaemia may causeconfusion.Hypoxia Check with pulse oximetry. If oxygensaturation is less than 93% give O 2immediately and summon medical assistance.HypoventilationHypercapniaHypovolaemiaSodiumUraemiaBenzodiazepinesCheck respiratory rate, if 8 or less givenaloxone in 50 microgram increments andcheck arterial blood gases.Often a consequence of hypoventilation.Check ABGs to confirm diagnosis. Likeliestcause is excess opiates and naloxone may beused again as above.Check fluid balance, drains and other losses.Give fluid challenge. If BP fails to respond tofluid consider myocardial insufficiency (e.g.Ml) IF THERE IS AN EPIDURAL IN SITU DONOT STOP THE EPIDURAL UNLESS THEBLOCK IS ABOVE T4 LEVEL.Check electrolytes. High or low sodium maycause confusion.Check electrolytes.Diagnosed by giving intravenous flumazenil inAnaesthetists Handbook January 2010 137