Prevention and Management of Perianesthesia Complications
Common perianesthesia complications
PONV is multifactorial; use multimodal prophylaxis (ondansetron, dexamethasone, droperidol, scopolamine) and treat with a different class than used prophylactically. Hypothermia causes shivering, coagulopathy, and delayed recovery; use forced-air warming and warmed fluids. Malignant hyperthermia presents with hypercarbia, tachycardia, muscle rigidity, and rising temperature; stop triggers, call for help, and give dantrolene.
Other emergencies
Anaphylaxis: urticaria, bronchospasm, hypotension; give IM epinephrine, oxygen, fluids, and adjuncts. Laryngospasm and negative-pressure pulmonary edema follow airway irritation. Aspiration causes hypoxemia, wheeze, and infiltrates; suction and support ventilation. Hemorrhage presents as tachycardia, narrowing pulse pressure, and falling hematocrit. Urinary retention and delirium are common in older adults.
Traps
Temperature elevation is a late sign of MH; hypercarbia comes first. Do not give antihistamines instead of epinephrine for anaphylaxis. PONV prophylaxis and treatment should not use the same drug class repeatedly. Distinguish emergence delirium from hypoxia and pain.
Worked example
A patient becomes tachycardic, hypertensive, and hypercarbic with masseter rigidity after sevoflurane and succinylcholine. Assume MH: discontinue triggers, hyperventilate with 100% oxygen, call for the MH cart, and administer dantrolene while cooling and monitoring.
Rule of thumb: for any unstable PACU patient, start with ABCs, call for help early, and treat reversible causes.