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Chapter: Clinical Anesthesiology: Anesthetic Management: Ambulatory, Non operating Room, & Office-Based Anesthesia

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Post Anesthesia Recovery and Discharge

Managing a patient’s emergence, postoperative pain, and PONV is critical to expediting discharge.

POST ANESTHESIA RECOVERY AND DISCHARGE

 

Managing a patient’s emergence, postoperative pain, and PONV is critical to expediting discharge. A plan to handle complications, such as postopera-tive pain and PONV, should be in place preopera-tively to standardize and streamline management as much as possible.

 

The entire anesthetic experience of the ambula-tory surgery patient should be focused on minimiz-ing complications, especially postoperative pain and PONV. Multimodal approaches to both complica-tions are advised;. Use of a combination of agents (eg, ondansetron, dexamethasone, and droperidol) has shown greater efficacy than monotherapy (eg, ondansetron alone) in patients at high risk of PONV. Likewise, analgesia regimens that minimize opioid use reduce PONV.

 

Pain management is centered on the combined use of regional techniques, opioids, and NSAIDSs (multimodal analgesia). Gabapentinoids (gabapen-tin, pregabalin) may have beneficial effects as part of a multimodal pain regimen. Likewise, oral, rectal, or intravenous acetaminophen or NSAIDs can be useful in the ambulatory setting. Cyclooxygenase-2 selective inhibitors have been used as part of mul-timodal pain management approaches, but their potential for prothrombotic effects has restricted their use.

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