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POSTOPERATIVE MANAGEMENT

Look out for the following in recovery:

  • Airway obstruction
  • Hypoxia
  • Haemorrhage: internal, external
  • Hypotension, hypertension
  • Postoperative pain
  • Shivering, hypothermia
  • Vomiting, aspiration
  • Falling to floor
  • Residual narcosis

PAIN MANAGEMENT TECHNIQUES

  • Pain is often the patient’s presenting symptom, provides useful clinical information
  • Responsibility to use this information to help alleviate the patient’s suffering
  • Manage pain wherever the patient is seen (emergency, operating room, ward), anticipate needs for pain management after surgery, discharge
  • Do not unnecessarily delay pain treatment; for example, do not transport the patient without analgesia simply so that the next practitioner can appreciate how much pain the patient is experiencing

POSTOPERATIVE PAIN MANAGEMENT

  • Effective analgesia is an essential part of postoperative management:
      - "Pain management is our job“
  • Prescribe regular analgesia; in practice, “On demand” often means “Not given”
  • Important injectable drugs for pain are opiate analgesics
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac (1 mg/kg) and ibuprofen can also be given orally and rectally, as can paracetamol (15 mg/kg)

PAIN MANAGEMENT FOR CHILDREN

  • Children suffer from pain as much as adults, but may show it in different ways
  • Opiate analgesics should be given cautiously if age is less than 1 year; not recommended for babies less than 3 months
  • When opiate analgesia is needed on ward, the most usual is to give intramuscular regimen:
      - Morphine:
      • Age 1 year to adult: 0.1–0.2 mg/kg
      • Age 3 months to 1 year: 0.05–0.1 mg/kg
  • Ketamine anaesthesia is widely used, also good for pain control

REVIEW of CORE LEARING OBJECTIVES

  • Pre-operative assessment
  • Pre-anaesthesia checklist
  • Techniques: Local, Spinal, Ketamine
  • Anaesthesia in emergency situations
      - Pregnancy
      - Paediatrics
  • Monitoring
  • Post-operative management
  • Pain management
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