IntroSx2- Postop Monitoring

  1. What postop values should you monitoring to prevent/ catch complications? (5)
    • fever/ hyperthermia/ hypothermia
    • tachy- or bradycardia
    • tachypnea or resp distress
    • hypertension/ hypotension
    • abnormal PCV/TP
  2. What are a few common postop problems? (4)
    • pain
    • blood loss
    • hypothermia
    • surgical site infection/ sepsis/ aspiration pneumonia
  3. What are the adverse effects of hypothermia? (3)
    • vasoconstriction
    • decrease enzymatic function
    • reduced cardiovascular responsiveness
  4. What are causes of postop hypothermia? (3)
    • excessive heat loss to cold tables, environment
    • lack of regulatory mechanisms d/t anesthesia
    • open cavities
  5. How do you treat hypothermia postop? (2)
    • passive warming (hot water blankets, bair huggers)
    • active warming (IV or IP fluids)
  6. When is active re-warming indicated in a hypothermic patient?
  7. What are the adverse effects of fever/ hyperthermia postop? (3)
    • increased cellular oxygen demand
    • vasodilation and tachycardia
    • endothelial damage and necrosis (>105F)
  8. Contrast hyperthermia vs pyrexia.
    • hyperthermia is increased body temp without resetting of the hypothalamus
    • pyrexia is a fever WITH resetting of hypothalamus as a response to inflammatory cytokines
  9. What are causes of postop hyperthermia? (3)
    • stress/ pain/ increased muscle activity
    • upper airway obstruction
    • environmental causes (heated cages, water blanket, etc)
  10. What re causes of postop fever/ pyrexia? (4)
    • infection (not in the immediate postop....infection takes a while to develop)
    • inflammation
    • neoplasia
    • drugs (opioids in cats!)
  11. How do you diagnose hyperthermia/ pyrexia? (5)
    • search for infection
    • search for severe inflammation or neoplasia
    • CBC- look for inflammation (pyrexia)
    • look for environmental causes (hyperthermia)
    • upper airway obstruction (hyperthermia)
  12. What is the treatment for hyperthermia? (2)
    • passive cooling (cold water bath, fans, alcohol)
    • active cooling (IV or IP fluids)
  13. How do you treat pyrexia? (1)
    anti-pyretics (NSAIDs)
  14. What are the adverse effects of tachycardia? (2)
    • reduced SV
    • increased myocardial workload and oxygen demand
  15. _________ is the most common type of tachycardia that occurs postop.
    Sinus tachycardia
  16. What are causes of tachycardia postop? (6)
    • pain and anxiety
    • hypoxemia and anemia
    • hypovolemia and hypotension
    • SIRS/sepsis
    • electrolyte disturbances
    • ventricular arrhythmias
  17. Describe the treatment of tachycardia postop. (5)
    • test dose of pain meds (to see if it's d/t pain)
    • check BP, ECG, PCV, blood gas
    • test dose of fluids (fluid challenge= 10-20mL/kg)
    • search for signs of sepsis
    • administer anxiolytic
  18. What are the adverse effects of bradycardia? (1)
    decreased CO and perfusion
  19. What are causes of bradycardia postop? (4)
    • conduction disturbances
    • excessive parasympathetic tone (common in GI dz)
    • elevated intracranial pressure
    • certain drugs (high dose opioids, alpha-2s)
  20. How do you treat postop bradycardia? (2)
    • do you even need to treat??? usually no if not symptomatic
    • atropine test dose= 0.02mg/kg
  21. What are causes of tachypnea postop? (3)
    • pain or anxiety
    • metabolic acidosis
    • pulmonary causes (aspiration pneumonia)
  22. How do you work up postop tachypnea? (3)
    • auscultation
    • pulse ox or blood gas
    • thoracic rads or US
  23. How is postop tachypnea treated? (2)
    • depends on underlying cause
    • oxygen supplementation
  24. Postop bradypnea is usually...
    drug-related (OPIOIDS, bensos, alpha-2s)
  25. How do you work up post-op bradypnea, and how is it treated?
    • arterial blood gas
    • treat by reducing drug dose, +/- mechanical ventilation, oxygen supplementation
  26. What are the most common causes of post-op hypertension? (2)
    • pain and anxiety
    • maybe cushing reflex d/t increased ICP
  27. What are common postop causes of hypotension? (4)
    • hypovolemia (blood or fluid loss)
    • vasodilation (secondary to sepsis)
    • reduction of venous return
    • cardiovascular dysfunction
  28. How do you work up postop hypotension? (3)
    • Increased PCV/ TP: hemoconcentration/ loss of free water
    • Decreased PCV/ TP: blood loss or hemodilution from fluid therapy
    • Increased PCV and decreased TP: splenic contraction, capillary leak secondary to sepsis, GI losses
  29. What are possible triggers of SIRS (system inflammatory response syndrome)? (4)
    inflammation, infection, trauma, reperfusion injury
  30. What are criteria to diagnose SIRS? (4)
    • fever
    • tachycardia
    • hyperventilation or decreased PaCO2
    • leukocytosis or leukopenia or left shift
  31. What are the physiologic effects of SIRS? (3)
    • migration and activation of neutrophils
    • cytokine production and ROS (reactive oxygen species--> oxidative damage)
    • vasodilation and capillary leak
  32. In a hypothermic, hypotensive patient, you should start with ____________ because...
    core rewarming (IV or IP fluids); if you start with peripheral rewarming, you're going to cause peripheral vasodilation and decrease BP even further--> start with core rewarming, then add peripheral rewarming once reach 95F
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IntroSx2- Postop Monitoring
vetmed IntroSx2