Appendix A DRUGS COMMONLY USED IN THE PACU

British/American Name

Adrenaline/epinephrine

Adenosine

Alfentanil

Aminophylline

Amiodarone

Amoxyeillin

Ampicillin

Aspirin

Atenolol

Atraeurium

Atropine

Benzylpenicillin

Bumetanide

Bupivaeaine

Buprenorphine

Calcium salts

Cefuroxime

Cephradine

Chlorpheniramine

Chlorpromazine

Cisatraeurium

Usage and dosage

Cardiac resuscitation: 1 mg (10 m!1:lOoo0) Anaphylaxis: 0.5-1 mg i.m.

3 mg, then 6mg then 12mg i.v.

50-100 meglkg then 15 meg/kg.

5 mg/kg over 20 min

5 mg/kg over 20-120 min. Max 1.2 g/24 h

250-500 mg tds

250mg-l g qds

Thrombotic prophylaxis: 75-300 mg od

Analgesia: 300-900 mg 4-6 hriy. Max. 4 g/day

Arrhythmias: 1 mg/min i.v. Max.JOmg or 150 meg/kg over 20 min 100-300 meg/kg

Cardiac arrest: 3 mg i. v.

with antieholinesterases 200 meg/kg

300-600 mg qds 50-100 mg/kg in 2-4 doses

1-2mgi.v.

2mg/kg in any4h period

300-600 meg 6-8hrly i.v.

3-6 meg/kg. Max. 9 meglkg

Calcium gluconate 10% 10m! (2.25mmol Cal

Calcium chloride 10% 10m! (6.8mmol Cal

750mg-1.5 g i.v. 6-8hrly

500mg-l g i.v. 6 hrly

50-100 mg/kg in 4 divided doses

Children: 0.1 mg/kg then 20 meg/kg

1O-20mgi.m.

10-20mg in 10m! saline over 1 min i.v.

25mgi.m.

0.15 mg/kg then 30 meg/kg

186 Post-operative Recovery and Pain Relief

British/American Name (continued)

Chlorpromazine (continued) Co-amoxyclav

Codeine

Cyclizine

Dantrolene

Diamorphine

Diazepam

Diclofenac

Digoxin

Dihydroeodeine

Disopyramide

Dobutamine

Domperidone

Dopamine

Dopexamine

Doxapram

Droperidol

Edrophonium

Enoxaparin

Enoximone

Ephedrine Ergometrine

Esmolol

Etomidate

Fentanyl

Fleeainide

Flucloxaeillin

Flumazenil

Frusemide/furosemide

Gallamine

Usage and dosage (continued)

500 mcg/kg 6-8 hrly Lm. 1 g tds Lv. slowly

25 mg/kg tds i. v.

30-60 mg Lm. 4 hrly. Max. 240 mg/day

3 mg/kg in divided doses

50mg i.m. or i.v. tds

I mg/kg. Rpt to max. of 10 mg/kg

2.5-5 mg by slow i.v. inj.

10-20 mg i.v. slowly

100-200mcg i.v.

75mgLm.,75-150mgp.r.

1-3 mg/kg in divided doses

250-500mcg i.v. over 1O-20min

50 mg i.m. 4-6 hrly

2 mg/kg over 5 min i. v. to max. of 120 mg

2.5-lOmcg/(kg min) by Lv. infusion

30-60 mg p.r. 4-8 hrly

2.5-5 mcg/(kg min) by Lv. infusion

0.5-6mcg/(kg min) by Lv. infusion

1-1.5 mg/kg Lv.

2.5-15mgi.v.

200-300 mcg/kg

500-700 meg/kg Lv.

20-40 mg (2000-4000u) Lm.

90 meg/(kg min) over 10-30 min then infusion at 5-20 mcg/(kg min) 3-6mgi.v., 15-30 mgi.m. 125-250 meg Lv.

50-200 mcg/(kg min) Lv.

300 meg/kg

50-200 meg then 50 meg as reqd

Children: 3-5 meg/kg then 1 meg as reqd

2 mg/kg over 10-30 mins then infusion of 1.5 mg/kg for Ih, reducing to 100-250 meg/kg for 24h. Max. 600mg/24h 250-1000 mg i. v. qds

Children under 2 y: quarter adult dose; children 2-10 y: half adult dose 200 meg Lv. Repeat to max. of I mg

20-50mg at 4mg/min Lv.

0.5-1.5 mg/kg

SO-120mg i.v.

British/American Name (continued)

Gallamine (continued) Gentamicin

Glucagon

Glucose

Glycopyrronium

Haloperidol

Heparin

Hydralazine

Hydrocortisone

Hyoscine

Ibuprofen

Isoprenaline

Isosorbide

Ketamine

Ketorolac

Labetalol

Lignocaine/lidocaine

Lorazepam

Meptazinol

Metaraminol

Methadone

Methohexitone

Methoxamine

Metoclopramide

Metronidazole

Mexiletine

Midazolam

Milrinone

Mivacurium

Appendix A: Drugs Commonly Used in the PACU 187

Usage and dosage (continued)

J.5mg/kg 2-5 mg/kg daily in divided doses 8hrly

0.5-1 mg or unit s.c., i.m. or i.v.

For hypoglycaemia: up to 50 ml of 50% soln i. v.

10-15 mcg/kg with 50 mcg/kg of neostigmine

2-IOmg i.m. every4-8h

Deep-vein thrombosis or pulmonary embolus: 5-10 000 u i.v. then infusion ofl-2000u/h i.v. Children: 15-25 U/(kgh) i.v. or 250U/kg s.c. 12hriy

5-IOmg i.v. over 20 min

100-500mg s.c. or i.v. tds or qds

200-600 mcg s.c.li.m.

J.2-J.8g daily in 3-4 divided doses. Max. 2.4g/d

20 mg/kg in divided doses

0.5-10 mcg/min i.v.

2-lOmg/h i.v.

1-4.5mg/kgi.v. then 1O-45mcg/(kgmin) as infusion

IOmgi.v.li.m. then 1O-30mg4-6hriy

50 mg/min. Rpt as reqd. Max. 200 mg

Arrhythmias: 50-100 mg i.v. then infusion at 4 mg/kg for 30 min, then 2 mg/kg for 2 h, then 1 mglkg Local anaesthesia: 200 mg of plain soln.

500 mg of adrenaline-containing soin.

50mcg/kg i.v. diluted with NaCl

50-100 mg i. v. 2-4 hrly

15-100 mg in 500 mI. Dose adjusted to response 5-10 mg s.c. or i.m. 6-8 hriy

50-120mg

Children: I mg/kg

5-IOmg i.v. at I mg/min

10mg i.v. slowlytds; < 10 kg: 1 mgb.d.; 10-15 kg: I mgtds; 15-20 kg: 2 mg tds; 20-30 kg: 2.5 mg tds; 30-60 kg: 5 mg tds 500mg i.v. or Igp.r. tds

7.5 mg/kg i.v. or 125-250 mg p.r. tds

100-250 mg i. v. at 25 mg/min

Sedation: 2.5-7.5 mg i.v. (70mcg/kg)

50 mcg/kg i.v. then infusion at 0.5 mcg/(kg min)

70-250 mcg/kg, then 100 mcg/min every 15 min or 8-10mcg/(kgmin) as infusion

188 Post-operative Recovery and Pain Relief

British/American Name (continued) Usage and dosage (continued)

Morphine 10-15 mg/kg i.m. 4 hrly

Nalbuphine

Naloxone

Naproxen

Nefopam

Neostigmine

Nitroprusside

Noradrenaline/norepinephrine

Ondansetron

Oxytocin

Paneuronium

Papaveretum

Paracetamollacetominophen

Pentazocine

Perphenazine

Pethidine/meperidine

Phenazocine

Phenobarbitone/phenobarbital Phenoperidine

Phenoxybenzamine Phentolamine

Phenylephrine

Phenytoin

Potassium chloride

Prilocaine

Procainamide

Prochlorperazine

Promethazine

Propofol

Propranolol

Children: < 1 month: IS0mcglkg; 1-12 months: 200mcg/kg;

I-Syrs: 2.S-Smg;6-12yrs: S-lOmg

1O-20mg3-6hrly

Children: 300 mcg/kg

100-200 mcg every 2 min i.v./i.m.

Children: 10 meg/kg

SOO mg h.d. p.o./p.r.

60-90 mg tds p.o.

50-70 mcglkg with or after atropine

0.3 mcg/(kgmin) titrated to effect

80 meg/rnl at 0.16-0.33 ml!min according to response

4-8mgt.d.s.

Su i.v. post-Caesarean section

S-20 u by slow i.v. infusion for postpartum haemorrhage

50-100 mcglkg, then 10-20 meg/kg as required

7.7-1sAmgi.m.4hrly

500 mg-lg 4-6 hrly. Max. 4g/day

Children: 10 mg/kg

30-60 mg 3-4 hrly

Children: 0.5-1 mg/kg

4 mg t.d.s. Max. 24 mg/day. Not recommended for children

1 mg/kg 3-4 hrly

5 mg p.o. 4-6 hrly

SO-200 mg q.d.s. i.m'/i.v. I mg/i.v. then 500mcg-1 mg every 40-60 min

Children: 100-lsOmcglkg

1 mg/kg in 200 rnl saline over 2 h

2.5 mg as reqd.

lOO-500mcgi.v.

N.B. Must he diluted as presented as lOmglrnl solution

IS mg/kg at a rate not exceeding SO mg/min

Children: IS mg/kg at a rate of 1-3 mg/(kgmin)

I.S g (20 mmol) over 2-3 h

400 mg is used alone. 600 mg is used with adrenaline/fely­pressin 100 mg at 50 mg/min. Max. 1 g

12.Smg i.m. or 2Smgp.r. 6hrly. Not recommended for children 2S-50 mg. Max 100 mg

2-2.S mglkg at 20-40 mg every 10 s

1 mg/min. Max. 10 mg

British/American Name (continued)

Protamine

Ranitidine

Rocuronium

Salbutamol

Spironolactone

Streptokinase

Suxamethonium

Temazepam

Thiopentone/thiopental

Tranexamic acid

Trimeprazine

Trimetaphan

Valproate

Vasopressin

Vecuronium

Verapamil

Appendix A: Drugs Commonly Used in the PACU 189

Usage and dosage (continued)

I mg neutralises 100 u heparin. Max. 50 mg

150mgp.o. or 50mgi.m./Lv. 6-8hrly

600 mcg/kg at induction, then ISO mcg/kg

500 mcg s.c.ILm. 250 mcg Lv.

100-200 mg daily

250000 u over 60 min, then 100000 u every hour

Myocardial infarction: I 500000 u over 60 min, then aspirin 150mgdaily 600mcg/kg

Children: 1-2mg/kg

20-40 mg p.o.

Children I mglkg

100-150mg Lv. up to 4mglkg

Children: 2-7mg/kg

0.5-1 g t.d.s.

2mglkgp.o.

3-4 mg/min according to response

400-BOOmg (up to 10mg/kg) Lv.

Children: 20-30 mglkg daily

20 u over IS min

60-100 mcglkg, then 20-30 mcglkg as reqd

Children: 10-20mcg/kg

5-10 mg i.v. over 2-3 min

Appendix B TRANSLATIONS OF STANDARD RECOVERY PHRASES

English Open your Breathe Have you Your Time to wake mouth deeply pain? operation up

went well

Arabic Iftah fammal< Nafass Fee alum? Amalia Issha shadeed nagahet

Dutch Openuw Diep Heeft u pijn? Alles is goed Wakker mond ademhalen worden

French Ouvrezla Respirez pro- Est-ce que Votre Reveillez-bouche fondement vousavez operation vous

mal? s'estbien passee

German Mundoffnen Tiefatmen Tutesweh? Die Opera- Aufwachen tion ist gelungen

Greek Aneekseto Anapnevse Echees pono? El enhirissi Ohrana stomasu vathia soupigay ksipnisis

kala Hindi/Urdu Apnamoonh Lambasans Apkokaheen Apka Abb jaagjao

kholiay lee-jaye daradhay? aperation theekho gayahay

Italian Aprite la Respirare Avete dolore? La vostra Eoradi bocca profonda- operazione e svegliarvi

mente andatabene Japanese Kuchi-o aite Shinkokyu-o Itami-ga Shujutsu-wa May-oaite

shittay arimasu-ka? seikodesu Portuguese Abralaboca Respire Esta com dor? Aoperacao Acorde!

fundo foibem Spanish Abra la boca Respire pro- Tienes dolor? Tu operacion Despiertese

fondamente a salido buen Swedish Oeppna Andasdjupt Har du Viirk? Din opera- Tid att vakna

munnen tion gick bra

191

INDEX

Accident and Emergency Department surgery. 114

Acidosis after massive blood transfusion. 105 correction of. 154-5 metabolic. after vascular surgery. 134 in renal disease. 153

Activated partial thromboplastin time (APTT). 108

Adrenocortical insufficiency in bowel surgery. 116

AIDS (acquired immunodeficiency syndrome). 5

Airway insertion. 25-7 laryngeal mask. 29 nasopharyngeal. 26-7 oropharyngeal. 25-6 upper

obstruction. 68-70. 123 causes. 68-9 management. 69-70

partial obstruction. signs of. 68 suction. 27-8

Airway maintenance. 24-5 in the obese. 24. 160 in paediatric surgery. 13 7-8 in rheumatoid arthritis. 158 in thyroid surgery. 123-4

Airway pressure. 29 Allergic reactions to blood transfusions. 103 Amniotic fluid embolism. 119 Anaemia

in elderly patients. 159 iron deficiency. 156 in renal disease. 153

Anaesthesia day surgery. 166-7.170-1 hypotensive. 123. 135 stages of recovery. 11-12

Anaesthetic techniques. 143-5 Anaesthetist's responsibility. 1 Analgesia

balanced. 49-53 intramuscular. 47-8

ophthalmic surgery. 126 patient controlled (peA). 49.50-51 see also Pain relief

Analgesic and relaxant technique. 144 Analgesics. 10.47-8

combination. 52-3 narcotic. 47-8

Anaphylactoid reactions. 76 Ankylosing spondylitis. 159 Antagonists. partial. 48 Antibiotics. 148 Anticoagulants. 107. 147 Anti-emetics. 125 Anti-hypertensive agents. 146 Anti-sialogogues. 143 Anuria. 114 Arterial blood pressure measurement. 20-23 Arterial pressure monitors. 179 Arteriovenous shunts. 153-4 Arthritis. rheumatoid. 158-9 Aspiration. of gastric contents. 77-8 Asthma, 76.149 Atelectasis. 76. 136 Atrial contractions. premature. 88 Atrial fibrillation. 89 Atropine. 84

Bays. patient. 1-2 equipment required at. 3

Bed sores. in geriatric patients. 159 Bellow drains. 38 Benzodiazepines. 143

in day surgery. 166 Beta blockers. 146 Bier's block. 55.63-4 Bladder

irrigation. 38. 135 perforated. signs of. 136

Blood-borne infections. 5-6 Blood loss. recognition of. 24. 114 Blood pressure

after prostatectomy. 135 arterial. 20-23 automatic recording. 19-20

193

194 Index

Blood pressure (continued) measurement. 18-23

in the obese. 161 paediatric. 139. 140

Blood transfusion. 35-7 after thoracotomy. 133 massive. 104-6 mismatched. 82 reactions. 103-4 substitutes. 109

Bowel surgery. 115-16 Brachial plexus block. 62-3. 144 Bradycardia. 83-4

after beta-blockers. 146 sinus. 83-4

Brain-stem auditory-evoked potentials. 177 Bronchitis. chronic. 148 Bronchoscopy. 130-31 Bronchospasm

in asthmatic patients. 149 causes and management. 76-7

Bupivacaine. 55 Buprenorphine. 48

Caesarian section. 118-19 Calcium gluconate. 109 Carbon dioxide. tension monitors. 175. 183 Cardiac arrest. 90-92 Cardiac failure. 81. 150 Cardiac massage. 94. 95 Cardiac output. diminished. 81-2 Cardiac tamponade. 82 Cardiorespiratory equipment. 3-4 Cardiovascular complications. 80-92

in the elderly. 159 Cardiovascular disease. 149-50 Cardiovascular function assessment. 16-23

blood pressure measurement. 18-23 Doppler ultrasonic recorder. 17-18 paediatric. 139-40 pulse measurement. 17 tissue perfusion. 16

Cardiovascular system. monitoring. 133. 176 Cardioversion. 89 Care plan nursing. 12-13 Caudal blockade. 60-61 Celestin tube. 114 Central venous pressure (CVP). 21

measurement. 22 Cerebral function monitor. 176-7 Charts and records. 38-41

epidural analgesia. 58-9 neurological observation. 128-9 patient controlled analgesia. 50. 51

Chemical pneumonitis. 78 Chest drains. 38.79.131-2 Cheyne-Stokes respiration. 72 Chronic bronchitis. 148 Circulatory overload. signs of. 34

Circumcision. 137 Citrate intoxication. 105 Cleaning of recovery unit and equipment. 6 Clotting factors. 106

congenital deficiency. 106 Coagulation

disseminated intravascular (DIC). 107. 136 failure. 106-9

after vascular surgery. 134 impairment in liver disease. 107. 152-3

Codeine phosphate. in head injury. 113 Collapsed trachea (tracheomalacia). 69. 124 Colostomy. 38 Colour assessment. patient. 15 Complications. 67-111 Compressed spectral array. 177 Consciousness

assessment. 23-4 delayed. 93. 96

Convulsions. 55.99-100.130 Coronary artery disease. 149 Corticosteroids. 147 Coumarin-type drugs. 107. 147 Cricothyrotomy. 70 Cushing's ischaemic reflex. 127 Cyanosis. peripheral and central. 15. 67

Day surgery. 163-71 advice to patient. 166 anaesthetic management. 166-7.170-71 discharge from hospital. 167-8 documentation. 166 paediatric. 168-9 patient selection. 163-4 post-anaesthetic complications. 169-70 pre-admission clinic. 165 procedures suitable for. 164-5

Deep vein thrombosis in hip operations. 117 in the obese. 161

Defibrillation. 90-91 Delirium. 96-7 Dentallfaciomaxillary surgery. 124-5 Depolarising block. 73-4 Dexamethasone. in reduction of cranial

pressure. 127 Dextrose. 154 Dextrosel saline solutions. 141 Diabetes mellitus. 154-5 Diffusion hypoxaemia (Fink effect). 10; 75 Digitalisation. 89 Digital nerve blockade. 64 Digoxin. 148 Discharge

from recovery. criteria. 42-3 toITU.43 toward. 42

Disinfection of equipment. 6 Disseminated intravascular coagulation. 107.

136 Diuretics. 147-8.150 Documentation for day surgery. 166 Dopamine. 110 Doppler ultrasonic recorder. 17 Doxapram. 71 Drainage

chest. 38.79.131-2 systems. 37-8

Drug dosages in liver and renal disease. 152. 153 for malnourished patients. 160

Drug elimination. 9-10 in the elderly. 159 in renal disease. 153

Drugs. 5. 185-91 analgesic. 10.47-8

Dysrhythmias. 87-9

Ear. nose and throat surgery. 120-23 EeG (electrocardiograph)

atrial fibrillation. 89 monitoring. 21.177-9 premature atrial contractions. 88 premature ventricular contractions. 88 sinus bradycardia. 84 supraventricular tachycardia. 87 third-degree heart block. 85 ventricular fibrillation. 91 ventricular tachycardia. 87

Ecothiopate. 126 Edrophonium test. 73 Education and training. 7 Electroencephalogram. 176-7 Electrolyte imbalance in vascular surgery. 134 Emboli

micro. 105 pulmonary. 82

Emergency surgery. 113-14 Endocrine disorders. 154-5 Endoscopy. 114-15 Endotracheal suction. 28 Endotracheal tube. paediatric sizes. 138 Epidural blockade. 57-60 Epidural blood patch. 56 Epidural narcotics. 56-7 Equipment. 2-5

at each recovery bay. 3 cardiorespiratory. 3-4 disinfection and sterilisation. 6 disposable. 6 paediatric. 4

Evoked potentials. 177 Excitement. 96-7 Extubation. 28. 138-9

Faciomaxillary surgery. 124-5 Femoral nerve blockade. 64-5

Fentanyl. in day surgery. 166 Fibrillation. 89.91 Fibrin degradation products. 108 Fibrinogen level. 108

Index 195

Fibrinolysis following prostatectomy. 136 Fink effect. diffusion hypoxaemia. 10. 75 Flooring. 2 Fluid balance

maintenance. 33-4 paediatric. 141 prostatectomy. 135 rheumatoid arthritis. 158

Fractures. reduction. 117 Frusemide. 110

in reduction of intracranial pressure. 127

Gastric contents. aspiration of. 77-8 Gastroenterology. 114-16 Gastrointestinal bleeding. 115 Gastro-oesophageal reflux. 114 Genito-urinary surgery. 135-7 Geriatric patients. 159-60 Glasgow coma scale. 113. 176 Gloves. wearing of. 6 Glycosuria. 155 Gynaecology. 118-20.170

Haematological disease. 156-8 Haematuria. 114 Haemolytic reactions to blood transfusions.

104 Haemophilia. 156-7 Haemorrhage

after hysterectomy. 120 paediatric. 139 post partum. 118 signs of after tonsillectomy. 121

Haemothorax. 78-9 after rib fracture. 164

Hallucinations. 145 Hartmann's solution. 141 Headache. in spinal anaesthesia. 56 Head injury. 113 Heart block. 84-5 Heart rate see Pulse Heparin. 107.147 Hepatitis B virus (HBV). 5

vaccination. 6 Hip operations. 117 Hudson mask. 31 Human immunodeficiency virus (HIV). 5 Hydrocortisone. 78.147 Hyoscine. 84 Hypercarbia. signs of. 67 Hyperkalaemia. 105

in renal disease, 153 Hypertension. 83

cardiovascular disease. 150

196 Index

Hypertension (continued) causes, 83 management, 83 neurosurgery, l30 renal disease, 153 vascular surgery, l33

Hyperthermia causes and management, 101 malignant, 102 neurosurgery, l30

Hyperthyroidism, 155 Hypervolaemia, signs of, 86 Hypocalcaemia, 74-5 Hypoglycaemia, 154

paediatric surgery, 141 Hypoglycaemic agents see Insulin Hypokalaemia, 74

bowel surgery, 116 Hypotension, 80, 82

beta blockers, 146 drugs causing, 80 induced, 145 in spinal anaesthesia, 56 vascular surgery, l33-4

Hypotensive anaesthesia, 123, l35 Hypothermia, 100-101

in the elderly, 159-60 following bowel surgery, 116 massive blood transfusion, 104 thoracotomy, l33 vascular surgery, l34

Hypothyroidism, 155 Hypoventilation, 70-75 Hypovolaemia, 80-81,86,144

following trauma, 114 signs of, 24,33-4

Hypoxaemia, 75-6 signs of, 67

Hysterectomy, 120

Ileostomy, 38 Induced hypotension, 145 Induction agents, intravenous, 9, 143-4 Infection

blood-borne, 5-6 control, 5-6

Inguinal field blockade, 62 Inhalation agents, solubility, 144 Insulin

and hypoglycaemic agents, 147 therapy, 154

Intensive Therapy Unit, discharge to, 43 Intercostal nerve blockade, 61 Intestinal obstruction, 115 Intracranial events, signs of, 127 Intracranial pressure, 127

monitoring, 177 Intramuscular analgesia, 47-8 Intra-ocular pressure (lOP), 126

Intrapleural blockade, 61-2 Intrapleural catheterisation, 61 Intravenous fluid,S, 154

induction agents, 9, 143-4 infusion and injection, 34,35

infusion drip rates, 34-5 in the obese, 161 requirements, paediatric, 141 therapy, 34

Intravenous regional anaesthesia, 55, 63-4 Intubated patient, care of, 28 Iron deficiency anaemia, 156 Ischaemic gangrene after digital nerve

blockade, 64 Isoflurane in day surgery, 166

Jaw, wiring of, 125 Jehovah's Witnesses, blood transfusion in, 37

Ketamine anaesthesia, 9,145 Kimal rapid infuser, 35,36

Laparoscopy, 119 Laryngeal

nerves, damage to, 124 oedema, 69,70, l38

Laryngeal mask airway, 29 Laryngoscopy, 69,121 Laryngospasm, 68 Life support, 94

paediatric, 95 Lighting, 2 Lignocaine, 55 Liver disease, 107, 152-3 Local anaesthesia, 53-5

agents and techniques, 53-4, 55 complications, local and systemic, 54 day surgery, 166-7, 169-70 local infIltration, 61 patient management, 65 toxic reactions, 54-5

Malignant hyperthermia, 102 Malnourishment, 160 Mannitol, 110

in reduction of cranial pressure, 127 Mapleson C circuit, 33 Mendelson's syndrome, 78 Mental handicap, 125 Meptazinol, 48 Metabolic acidosis, l34 Metabolic systems, monitoring, 176 Metriset, 141 Micro-emboli, 105 Middle ear surgery, 123 Minute volume, 29

Miotics, 126 Monitoring, 173-83

classification (ASA), 174 routine, 174-5

Monoamine oxidase inhibitors (MAOIs), 146 Morphine, 49 Muscle relaxants

non-depolarising, 10,74 prolongation after antibiotics, 74-5, 116, 148 residual paralysis, 72-3 reversal, 73-4,74-5

Muscular dystrophy, 152 Musculoskeletal disease, 158-9 Myasthenia gravis, 74, 151 Mydriatics, 126 Myocardial contractility depression, 145 Myocardial infarction, 82 Myocardial ischaemia, 149

Nalbuphine, 48 Naloxone, 71 Narcotic analgesics see Opiates Nasal packs, 122-3 N asogastric tube drainage, 37 Nasopharyngeal airway, insertion, 26-7 Nausea and vomiting, 97-8

day surgery, 170 Needle-stick injuries, 5 Neostigmine, 74, 115 Nephrectomy, 136 Nerve stimulation, peripheral, 73 Neurological

observation chart, 128-9 systems, monitoring, 176-7

Neuromuscular blockade monitors, 182-3 disease, 151-2

Neurosurgery, 126-30 Non-depolarising block, 74-5 Non-steroidal anti-inflammatory drugs

(NSAIDs), 49, 52-3, 166 Normal recovery, 9-44

progress, 10-12 Nose operations, 122-3 Nursing care plan, 12-13

Obesity, 160-61 Observations, routine, 14-15 Obstetrics and gynaecology, 118-20 Obstruction

intestinal, 115 upper airway, 68-70,123

Oesophagus, perforation of, 115 Oliguria, 109-11

vascular surgery, 134 Ophthalmic surgery, 125-6 Opiates, 47-8

central depression due to, 47

effect of, 47 intramuscular, 47-8 partial antagonists, 48 reversal of, 48 spinal, 56-7 see also Naloxone

Index 197

Oropharyngeal airway, insertion, 25-6 Orthopaedic surgery, 116-18 Oscillotonometer, 19 Osteoporosis, 158 Oximeter, 175,182 Oxygen

administration and therapy, 30-33 extubation, 28 increased utilisation, 75 saturation monitors, 175,181-2 tension, 175

Pacemaker, 150 Pacing, transvenous and oesophageal Paediatric equipment, 4 Paediatric surgery, 13 7-41

day case, 168-9 Pain

factors influencing, 46 gate-control theory, 45-6 hypotension, 82 signs of, 46

Pain relief, 45-65 laparoscopy, 119 local anaesthesia methods of, 47-56 thoracotomy, 133 vascular surgery, 134

Paracetamol, 52-3 Paraplegia, 152 Partial antagonists, 48 Patient controlled analgesia (PCA), 49,50-51 Patient information required, 12-13 Pelvis fracture, 114 Penile nerve blockade, 62

for circumcision, 137 Pentazocine, 48 Peritonitis, surgery for, 115 Phaeochromocytoma, 155-6 Plaster casts, 116 Platelet count, 108 Pneumothorax, 78-9

brachial plexus blockade, 63 intercostal nerve blockade, 61 nephrectomy, 136 rib fracture, 114 tension, 61, 79

Policies, recovery, 8 Pollution by anaesthetic agents, 5 Porphyria, 156 Position and safety of patient, 14 Positive end expiratory pressure (PEEP), 29 Post partum haemorrhage, 118

198 Index

Pre-eclamptic toxaemia, 118-19 Pregnancy, 160

termination of, 119 Premedication, 143 Pre-operative drug therapy, 146 Prilocaine, 55, 64 Propofol, 9,143-4

day surgery, 143, 166 Prostatectomy, 135 Prothrombin time, 108 Pulmonary

artery pressure monitors, 180-81 capillary wedge pressure (PCWP), 21-2 embolus, 82

Pulse measurement, 17 oximeter, 175, 182 rate, paediatric, 139, 140

Pupil size cause of constriction, 24 cause of dilatation, 24 in ophthalmic surgery, 126

Reception area, I Reception of patient, 13-14 Records and charting, 38-41 Recovery policies, 8 Recovery room, 1-8

chart, 40 design, 1-2 education and training, 7 equipment, 2-5 policies and protocols, 8 safety, 5-6 staffing, 6-8

Regional anaesthesia, 144 day surgery, 169-70 intravenous (Bier's block), 55

Renal disease, 153-4 Residual paralysis, 72-3 Respiration

after thoracotomy, 132 Cheyne-Stokes, 72 conditions affecting mechanics of, 75 depolarising block, 73-4 non-depolarising block, 74-5 residual paralysis, 72-3 see also Ventilation

Respiratory disease, 148-9 function, assessment of, 16 paralysis in epidural block, 60 system monitoring, 132,175

Respiratory complications, 67 depression, 54, 71-2 in geriatric patients, 159 in myasthenia gravis, lSI paediatric, 13 7-8

Restlessness, 67,96-7,123

Rheumatoid arthritis, 158 Rib fracture, 62, 114 Ropivacaine, 55, 56

Safety and precautions, 5-6 Salivation, excessive, 143 Septicaemia, 82

following bowel surgery, 116 Septic shock, 136 Shivering, 98-9 Sickle cell disease, 157 Skin care in elderly, 159 Sphygmomanometer, 18-19 Spinal blockade, 56-7 Spleen rupture, 114 Spondylitis, ankylosing, 159 Staffmg, 6-7 Sterilisation of equipment, 6 Steroid cover

inadequate, 82 in rheumatoid arthritis, 158

Sub-glottic oedema, post extubation, 138-9 Suction

endotracheal, 28 upper airway, 27-8

Supraventricular tachycardia (SVT), 86-7 Suxamethonium

in accident department, 114 in day surgery, 167 metabolism of, 9-10 in paraplegia, 152

Sympathetic blockade, 145

Tachycardia, 67.85-7 sinus, 85-6 supraventricular and ventricular, 86-7

Teeth.loose. 139 Temperature regulation. paediatric, 140 Tension pneumothorax. 61,79 Thoracic surgery. 130-31 Thoracotomy. 131-3 Thrombin clotting time (TCT), 108 Thrombocytopenia. 107-8 Thrombus formation in vascular surgery, 134 Thyroid

crisis. 124 disease. 155-6 surgery, 123-4

Tidal volume. 29 Timolol. 126 Tissue perfusion. 16 Tongue, and airway obstruction, 68 Tonsillectomy. 120-21 Tracheal collapse. 69. 124 Tracheal tug. 72 Tracheomalacia. 69. 124 Tracheostomy, 121-2 Traction, orthopaedic. 117

Training. 7 Transurethral resection. 135 Trauma surgery. 113-14 T-tube drainage. 37-8

Uraemia in renal disease. 153 Urine output

anuria and haematuria. 114 impaired in renal disease. 153 measurement. 23 retention in regional anaesthesia. 57. 144

Urine outpuUdrainage. 37 Uterus. perforated. signs of. 119

Vacuum drainage bottles. 38 Valsalva manoeuvre. 86 Vascular surgery. 133-4 Vasodilating drugs. 145 Venous filling. observing. 20 Ventilated patient

care and monitoring. 29 chart. 41

Ventilation inadequate. 70-75 in the obese. 160 in paediatric surgery. 137-8 see also Respiration

Index 199

Ventilation perfusion imbalance. 76 Ventricular contractions. premature (PVCs).

88-9 Ventricular fibrillation. 91 Ventricular tachycardia. 86-7 Venturi mask. 31. 32 Vertebrae. fractured. 1I8 Visual evoked potentials. 177 Vitamin K deficiency. 107 Vocal cords. abductor paralysis. 69 Volatile anaesthetics. elimination. 9 Vomiting. 77-8.97-8

ophthalmic surgery. 126 wired jaws. 125

Ward staff. transfer of patient to. 43 Wenckebach phenomenon. 84 Windows. 2 Wiring of jaw. 125

X-ray Mendelson's syndrome. 78 prostatectomy. 136 thoracotomy. 132

Zygomatic arch. fracture. 125