General Post Operative Care

General Post Operative Care

The anesthetist's role postoperatively can be divided into two periods; the first is actually a continued monitoring of the anesthetized patient in the recovery until complete cessation of the spinal anesthesia has occurred. The role of the anesthetist in the second phase of the postoperative period becomes surveillance with special attention to the possible development of post anesthetic complication which includes neurological complication.

• Hypotension: It may occur during transport from the operating room to the post anesthesia care unit owing to redistribution of blood volume with movement and in the recovery room. Concerns during this period start with the careful movement and transport of the patient. The management of hypotension include elevate the patients' legs, increase the rate at which intravenous fluids are being administered, vasopressors and call for help.
• Urinary retention: If the patient does not have an indwelling urinary catheter, then recovery room personnel should be alert for a distended bladder. The voiding mechanism is mediated through sacral autonomic fibers, which are the last to regain function after spinal anesthesia. Even after patients are able to move their extremities and respond to sensory stimuli, they may have some residual autonomic blockade, and thus may not only be unable to void but may also become hypotensive in the sitting or standing position. A painful distended bladder needs catheterization.
• Back ache: As a needle passes through skin, subcutaneous tissues, muscle, and ligaments it causes varying degrees of tissue trauma. A localized inflammatory response with or without reflex muscle spasm may be responsible for postoperative backache. Postoperative back soreness or ache is usually mild and self-limited, although it may last for a number of weeks. If treatment is sought, acetaminophen, nonsteroidal anti-inflammatory medication, and warm or cold compresses should suffice. Although backache is usually benign, it may be an important clinical sign of much more serious complications, such as epidural hematoma and abscess