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APPENDIX IV: PHARMACOLOGIC AGENTS

869

Table lV-30. Vasodilators

Indications: Heart failure, hypertension

Mechanism of action: Venodilators reduce preload, arteriodilators reduce

afterload, combined venodilators and arteriodilators reduce both preload

and afterload

General side effects: Headache, hypotension, compensatory sympathetic

reflex causing increased heart rate, vasoconstriction, and elevated plasma

renin (usually avoided with combination of medications that includes a

sympathetic inhibiting agent)

Venodilators: Refer to Table I V·24 Nitrates

Arteriodilators ( generic name Itrade name!): diazoxide (Hyperstar i.v.),

hydralazine (Apresoline), minoxidil (Loniten), milrinone (Primacor),

nifedipine (Procardia)

Combined venodilarors and arteriodilators: Sodium nitroprusside (Nipride)

Source: Dat3 (rom K Grimes, M Cohen. Cardiac Medications. In EA Hillegass, HS

Sadowsky (cds), Essentials of Cardiopulmonary Physical Therapy (2nd ed). Philadel·

phia: Saunders. 200 I ;537-585.

v

Effects of Anesthesia

Michele P. West

The recovery period after surgery is characterized as a time of physiologic alteration as a result of the operative procedure and the effects of anesthesia. I On transport from the operating room, a patient is

transferred to a postanesthesia care unit (PACU) (after general anesthesia) or to an ambulatOry surgery recovery room (after regional anesthesia), both of which are located near the operating room for

continuous nursing care. During this immediate postoperative phase,

the priorities of care are to assess recovery from anesthesia and the

status of the surgical sire, [Q determine the patient's physiologic status

and trends, and to identify actual or potential postsurgical problems.'

A patient who is able to be aroused, is oriented and comfortable, and

has stable viral signs for at least 1 hour, meers the criteria for discharge from the PACU.3 The criteria for discharge from the ambulatOry recovery room are similar to that of the PACU and include recovery from sedation or nerve block.3

The physical therapist should be aware of common postoperative

complications (and the protocols and procedures to address them) to

intervene as safely as possible, prioritize the physical therapy plan of

care, and modify treatment parameters.

871

872 AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

I.

The major systemic effects of general anesthesia are the

following;

A.

Neurologic effects. Anesthetic agents decrease corti-

cal and autonomic function.

B.

Cardiovascular effects. Anesthetic agems create the

potential for arrhythmia, decreased blood pressure, myocardial contractility, and peripheral vascular resistance.4

C.

Respiratory effects,,6

1.

Anesthesia has multiple effects on the lung,

including decreased or altered

a.

Arterial oxygenation

b.

Response to hypercarbia or hypoxia

c.

Vasomotor tone and airway reflex

d.

Respiratory pattern

e.

Minute ventilation

f.

Functional residual capacity

g.

Mucociliary function

h.

Surfactant

2.

The shape and motion of the chest are altered

secondary to decreased muscle tone, which causes

the following';

a.

Decreased anteroposterior diameter

b.

Increased lateral diameter

c.

Increased cephalad posirion of the dia-

phragm

3.

Other factors that affect respiratory function

and increase the risk of postoperative pulmonary

complications (e.g., atelectasis, pneumonia, lung collapse) include rhe following;

a.

Underlying pulmonary disease

b.

lncisional pain, especially if there is a thoracic or abdominal incision

APPENDIX V: EFFECfS OF ANESTHESIA

873

c.

Smoking history

d.

Obesity

e.

Increased age

f.

The need for large intravenous fluid administration intraoperatively

g.

Prolonged operative time

II.

During the postsurgical phase, the patienr is monitored

for the proper function and return of all of the major body systems. The most common postoperative complications include the following2.):

A.

Neurologic complications

1 .

Delayed arousal, agitation, or altered consciousness

2.

Cerebral edema, seizure, or stroke

3.

Periphetal muscle weakness or altered sensation

B.

Cardiovascular and hematologic complications

I .

Hypotension, shock, o r both

2.

Hypertension

3.

Dysrhythmia

4.

Myocardial infarction

5.

Hemorrhage

6.

Deep vein thrombosis

7.

Pulmonary embolism

C.

Respiratory complications

1.

Airway obstruction

2.

Hypoxemia

3.

Hypercapnia

4.

Aspiration of gastric contentS

5.

Hypoventilation

6.

Pulmonary edema

874 AClITE CARE HANDBOOK FOR PHYSICAL TI-lERAPISTS

D.

Renal complications

1.

Acute renal failure

2.

Urine retention

3.

Urinary infection

E.

Gastrointestinal complications

1.

Nausea and vomiting

2.

Hiccups

3.

Abdominal distention

4.

Paralytic ileus

F.

Integumentary complications

1.

Wound infection

2.

Wound dehiscence, evisceration, or both

3.

Hematoma

G.

Other complications

I.

Hypothermia

2.

Sepsis

3.

Hyperglycemia

4.

Fluid overload or deficit

5.

Electrolyte imbalance

6.

Acid-base disorders

The development of these conditions in the immediate (up to 12

hours postoperatively) or secondary (the remainder of the hospital

stay) postsurgical phase determines further medical-surgical managemenc and treatment parameters. A review of the anesthesia and surgical notes can provide information about the patienc's surgical procedure(s) and findings, hemodynamic and general surgical status,

unexpected anesthetic effects, operative time, position during surgery,

vital signs, electrocardiographic changes, and degree of blood loss.

APPENDlX V: EFFECfS Of ANESTHESIA 875

References

l. Litwack K. Immediate Postoperative Care: A Problem-Oriented

Approach. In JS Vender, BD Spiess (eds), Posr-Anesrhesia Care. Philadelphia: Saunders, 1992;1.

2. Litwack K. Posroperarive Patient. In SM Lewis, MM Heitkemper, SR

Dirksen (eds), Surgical Nursing: Assessment and Management of Clinical Problems. St. Louis: Mosby, 2000;390-399.

3. Feeley Tw, Macario A. The Postanesrhesia Care Unit. In RD Miller (ed),

Anesrhesia, Vol. 2 (5th ed). Philadelphia: Churchill Livingstone,

2000;2302-2322.

4. Wilson RS. Anesthesia for Thoracic Surgery. In AE Baue, AS Geha, GL

Hammond, er 31. (eds), Glenn's Thoracic and Cardiovascular Surgery

(96th cd). Stamford, Cf: Appleton & Lange, 1996;23.

5. Conrad SA, Jayr C, Peper EA. Thoracic Trauma, Surgery, and Perioperative Management. In DB George, RW Light, MA Manhay, RA Marthay (eds), Chest Medicine: Essentials of Pulmonary and Critical Care Medicine (3rd ed). Baltimore: Williams & Wilkins, 1995;629.

6. Benumof JL. Anesrhesia for Thoracic Surgery (2nd ed). Philadelphia:

Saunders, 1995;94.