Post-Anesthesia Patient Care

Agenda

Post-Op Nausea and Vomiting, Shivering, Hypothermia, Hypotension, Hypoxia

• Common Occurrences in the PACU
• Differential Diagnosis Informs Treatment
• Populations Most Susceptible to Serious Outcomes From These Problems

Residual Paralysis

• Residual Paralysis Is One of the Most Common Reasons for Bad Outcomes in the PACU
• Associated Factors
• Assessment and Treatment Options

Pediatric Patients

• Even Healthy Pediatric Patients Are at Risk for Serious Outcomes in the PACU and Age Plays a Role
• Airway Events - Risks, Assessment and Treatment Plans
• Cardiac Events in Healthy Kids - Monitoring, Signs, Treatment
• Susceptibility to Medication Side-Effects
• Special Needs Children and Anesthesia

Elderly Patients

• Accumulation of Diseases With Aging Increases Risk of Bad Outcomes
• Vital Signs Are Vital - Monitoring That Makes Sense
• Side-Effects in the Elderly and Outcomes
• Clearance of Medications Affected by Aging
• Pain Management in the Elderly
• Cardiac Events in the PACU
• Preventing Pneumonia

Obstructive Sleep Apnea

• Obstructive Sleep Apnea (OSA) in All Populations
• How OSA Impacts Sedation, Pain Management, Residual Anesthesia, Surgical Side Effects, Aspiration
• OSA Patients and CPAP or Bilevel Support

Opiate Pharmacology/Pharmacokinetics

• Onset, Clinically Useful Half-Life, Clearance Half-Life and What That Means in the PACU Setting
• Interactions Between Opiates and Other Medications Patients Are Taking
• Challenges With Chronic Pain Patients and Opiate Abuse Patients

Cardiovascular Events in the PACU

• Monitoring Patients at Risk and Preventing Cardiac Events
• When to Order 12-Lead ECGs and What Labs Are Useful
• Using Appropriate Interventions
• Following up - Where Does the Patient Go, Who Does the Patient See in the Event of a Cardiovascular Event in the PACU?

Malignant Hyperthermia

• Incidence, Mortality
• Diagnosis
• Brief Overview of Treatment

High Risk Surgeries

• Which Surgeries Put Patients at Greater Risk of What Types of Bad Outcomes?

High Risk Patients

• Patient Specific Risks for Bad Outcomes and the Types of Bad Outcomes

Credits

Faculty

Joy L. Steadman, MD

The University of Tennessee Health Science Center

• Currently Vice-Chair of Anesthesiology at University of Tennessee Health Science Center in Memphis, TN and Director of Trauma Anesthesia Services at one of the busiest trauma centers in the U.S.
• Former director of Anesthesiology at one of the oldest/most established hospital systems in West Virginia
• Former Chief of Obstetric Anesthesia at Jackson-Memorial in Miami, FL where they did 10-12,000 high risk obstetric deliveries a year; also, pediatric anesthesiologist at University of Miami, performing anesthesia on newborns, pediatric traumas, complex pediatric neurosurgical cases, ENT and general surgical cases
• Won Mentor or Teacher of the Year at the largest anesthesia residency program in the U.S. seven times
• Invited to speak at Yale on educating residents after presenting to the Society of Education in Anesthesia at the National Meeting
• Appointed by the Governor of Tennessee to the Maternal Mortality Review Board. She sits on two national committees in the ASA and has presented at the ASA, SAMBA, SOAP, FSA and the TSA
• Member of ASA and TSA
• Recently published “Life-threatening perioperative anesthetic complications: major issues surrounding perioperative morbidity and mortality” in the Trauma Surgery and Acute Care journal – one of the British Medical Journal publications. Education includes Yale University undergrad and West Virginia University School of Medicine
• Can be contacted at 901-448-5988 or [email protected]