Surgical issues

Every type of surgery (excluding cardiac and neurosurgery) is referenced in this chapter with special attention to the recovery room needs of each specialty. The immediate postoperative care of the patients is simply and thoughtfully discussed so that their postoperative care will give them the best possible chance for a positive result after their surgery. Drains, catheters, and special procedures like bronchoscopy are also described.

The bleeding patient

Part one of this chapter tells you about the physiology of blood and oxygen supply, about anaemia and tissue hypoxia, and the physiology of coagulation. Drugs that interfere with clotting are discussed. Bleeding, coagulation, and platelet disorders are covered as well as disseminated intravascular coagulation. Part two is concerned with bleeding in the recovery room: how to cope with rapid blood loss, managing ongoing blood loss, and how to use clotting profiles to guide treatment. There is also a section covering blood transfusion, blood groups and typing. Massive blood transfusion is clearly described, there are guidelines about when to use fresh frozen plasma, when to use platelets, and when to use cryoprecipitate. The final section of the chapter is about problems with blood transfusions.

The respiratory system

This chapter discusses hypoxia and respiratory obstruction and the management of hypoventilation. Stridor and laryngospasm, laryngeal and vocal cord damage are described and ways of preventing these from occurring and treating them if they do occur are discussed. Aspiration and its complications and treatment are fully covered.

Mothers and babies

This chapter looks at pregnant mothers and the physiology of pregnancy. It describes how to look after these patients after operations they experience during their pregnancy as well as after Caesarean section. Instructions are given for the special care of newborn infants. Problems of postpartum haemorrhage, eclampsia, air and amniotic embolism, and aspiration pneumonia are discussed.

Pain

This chapter answers many questions, for example, ‘What is pain?’ and ‘Why pain is harmful?’. How we perceive pain and the physiology of pain are discussed. Plasticity and wind-up and the role of ketamine in preventing chronic pain are also included in this fascinating chapter.

Recovery room routines

In this chapter patients are followed from the operating theatre to the recovery room. Their care is discussed and routine procedures described. Nurse and anaesthetist handovers are outlined, and the transfer of the patient back to the ward is explained.

Metabolism

This chapter tells you how homeostasis in the body is achieved. Contributing factors such as stress, hormones, and the automatic nervous system are integrated into the discussion in a thoughtful way. The problem of cold postoperative patients is thoroughly referenced to modern investigation. Diabetes, how surgery destabilizes diabetics, and how to use insulin is explained. Malignant hyperthermia, thyroid storm, and acid–base disorders are all problems that can occur in the recovery room and guidelines for the management of these patients are outlined. Hydrogen ions affect haemoglobin and biochemical reactions and can cause acidosis and alkalosis—this chapter outlines how to interpret the blood gas results. How to distinguish between respiratory and metabolic causes of acid–base disorders is simply and clearly explained.

Crisis management

This chapter will give you the fundamental information to prepare your recovery room for any crisis. Crisis protocols and guidelines will help you to prepare for and conduct a full resuscitation. The management of anaphylaxis and seizures is described in detail.

Cardiovascular physiology

This is a difficult chapter but read it carefully and you will be rewarded with a clear understanding of how the heart works. ECGs are revisited and there are sections on caring for patients with pacemakers and stents.

Respiratory physiology

Breathing and normal respiration must be understood by recovery room staff. This chapter explains how patients breathe and what is happening when patterns of respiration alter. Terms that sound complicated, like functional residual capacity, are explained and the way in which breathing is driven from the brain and by chemoreceptors in the lungs is simply described.