Post-Anesthesia Care

The initial hours after surgery are a critical time in the care of the surgical patient. Familiarity with the clinical presentation of perioperative complications is important to achieving optimal outcomes. By taking an approach to complications based upon signs and symptoms seen in the early post-operative period among adult patients undergoing non-cardiac surgery, this book aids the practitioner in the clinical management of surgical patients during the often turbulent hours after surgery. After a brief introduction to PACU organization, this manual discusses the common and most serious symptoms encountered in the post-operative patient, giving guidance on diagnosis of the underlying disorder and the treatment options available. The book also includes chapters dedicated to subspecialty patients, including patients requiring post-operative mechanical ventilation, pediatric patients, patients with implantable cardiac devices, morbidly obese patients and the complex pain patient. This practical manual is essential reading for all practitioners working in the PACU environment.

    Takes a symptom-based approach to treatment, aiding quick formation of differential diagnosis for common and uncommon post-operative complications
    Focuses on the early post-operative period, enhancing recognition of the unique presentation of many complications at this critical time
    Takes a multidisciplinary approach, integrating the surgical, medical and nursing perspectives necessary for the complete care of the surgical patient

Table of Contents

Preface
Part I. Introduction:
1. Recovery: physiological challenges Niels D. Martin and James W. Heitz
2. Recovery: goals and standards Philippa Ratcliffe
Part II. Signs and Symptoms:
3. Hypertension James W. Heitz
4. Hypotension James W. Heitz
5. Dysrhythmia Eric Massey and Stephen O. Bader
6. Chest pain Jeremy L. Hensley and Stephen O. Bader
7. ECG changes Adam W. Green and Stephen O. Bader
8. Heart failure Glen D. Quigley and Elia S. Elia
9. Hypoxia Gadi Arzanipour and James W. Heitz
10. Wheezing and stridor Michelle McMaster and James W. Heitz
11. Tachypnea and hypopnea Erika Davis and Marc Fisicaro
12. Dyspnea Erika Davis and Marc Fisicaro
13. Dysphonia and airway trauma Megan J. Sharpe and Julie P. Ma
14. Fever, hyperpyrexia and hyperthermia Andrea M. Hages and James W. Heitz
15. Hypothermia Min J. Chun and Lisa Luyun
16. Hypoglycemia Brian Hipszer, James W. Heitz and Jeffrey I. Joseph
17. Hyperglycemia in the PACU Boris Mraovic and Jeffrey I. Joseph
18. Electrolyte disorders Michael Jon Williams
19. Nausea and vomiting James W. Heitz
20. Pruritus James W. Heitz
21. Weakness Donald Baumann
22. Movement disorders Nicole Renaldi
23. Limb paralysis James W. Heitz
24. Rigidity Ashley Caplan and James W. Heitz
25. Seizure James W. Heitz and Michelle Beam
26. Delirium James W. Heitz
27. Headache James W. Heitz
28. Delayed emergence Jon Zhou and James W. Heitz
29. Crying Michelle Beam and James W. Heitz
30. Rash David Beausang and Michelle Beam
31. Jaundice George Hsu and James W. Heitz
32. Visual disturbance James W. Heitz
33. Neuropathy Brian Lai and John T. Wenzel
34. Shivering James W. Heitz
35. Oliguria and postoperative urinary obstruction James W. Heitz
36. Polyuria James W. Heitz
37. Abnormal urine color James W. Heitz
38. Pain Benjamin Vaghari, Jaime Baratta and Kishor Gandhi
39. Shoulder pain Jordan E. Goldhammer
40. Anemia Elizabeth Wolo and James W. Heitz
41. Hemorrhage Jeremy L. Hensley and Stephen O. Bader
42. Intraoperative awareness Michelle Beam and James W. Heitz
Part III. Special Considerations:
43. Special considerations for mechanical ventilation Yousef Hamdeh, Zara Y. Mergan and James W. Heitz
44. Special considerations for the pediatric patient Peter Jonathan Gambino, Allan F. Simpao and Zvi Grunwald
45. Special consideration for the pregnant patient after non-obstetric surgery Suzanne Huffnagle and H. Jane Huffnagle
46. Special considerations for the cardiac patient with implanted devices Ryan P. Maxwell and Jordan E. Goldhammer
47. Special considerations for the morbidly obese patient Emily J. MacKay and Michele Mele
48. Special considerations for the renal failure patient Eric S. Schwenk
49. Special considerations for pain management Benjamin Vaghari, Jaime Baratta and Kishor Gandhi
50. PACU emergencies Robert F. Olszewski, Jr
Index.

James W. Heitz, Thomas Jefferson University Hospital
James W. Heitz is Associate Professor of Anesthesiology and Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, and Medical Director, Post Anesthesia Care Unit, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Contributors

Niels D. Martin, James W. Heitz, Philippa Ratcliffe, Eric Massey, Stephen O. Bader, Jeremy L. Hensley, Adam W. Green, Glen D. Quigley, Elia S. Elia, Gadi Arzanipour, Michelle McMaster, Erika Davis, Marc Fisicaro, Megan J. Sharpe, Julie P. Ma, Andrea M. Hages, Min J. Chun, Lisa Luyun, Brian Hipszer, Jeffrey I. Joseph, Boris Mraovic, Michael Jon Williams, Donald Baumann, Nicole Renaldi, Ashley Caplan, Michelle Beam, Jon Zhou, David Beausang, George Hsu, Brian Lai, John T. Wenzel, Benjamin Vaghari, Jaime Baratta, Kishor Gandhi, Jordan E. Goldhammer, Elizabeth Wolo, Yousef Hamdeh, Zara Y. Mergan, Peter Jonathan Gambino, Allan F. Simpao, Zvi Grunwald, Suzanne Huffnagle, H. Jane Huffnagle, Ryan P. Maxwell, Emily J. MacKay, Michele Mele, Eric S. Schwenk, Robert F. Olszewski, Jr