课件：肥胖门诊麻醉.ppt

Postoperative Considerations Potential postoperative complications include airway obstruction, respiratory failure, need for reintubation, life threatening hypoxia as well as systemic hypertension, ischemia, and cardiac arrhythmia（潜在的术后并发 症包括气道梗阻、呼吸衰竭、再插管的需求、低氧血症、高血压、组织 缺血即心律失常）. Once in the PACU, patients should be maintained in a semi-upright (25- 30o head-up) position, if possible（如果可能，病人进入恢复室应立即给予 半头高位）. 术后注意事项 Postoperative CPAP/BiPAP Although supplemental oxygen is beneficial for most patients, it should be administered with caution as it may reduce hypoxic respiratory drive and increase the incidence and duration of apneic episodes（虽然补充氧气对大 部分病人有益，但也可能降低呼吸系统的低氧驱动功能和对呼吸暂停的 耐受）. Because obese patients might have unrecognized OSA,recurrent hypoxemia may be better treated with CPAP or bi-level positive airway pressure (BiPAP) along with oxygen rather than oxygen alone（如果反复出 现低氧血症，病人最好使用CPAP或BiPAP，而不是单独吸氧）. Post-PACU Discharge Care Prior to discharge from the PACU the oxygen saturation on room air should return to baseline （出恢复室前氧饱和度回到基本水平）and the Patient should not become hypoxic or develop airway obstruction when left undisturbed in the recovery area（未打扰情况下不应该有低氧血症或气道 梗阻）. It has been suggested that most significant postoperative complications in OSA patients usually occur within 2 hours after Surgery（大多数的OSA病人 并发症发生在术后2小时内）. Therefore, it may be worthwhile to observe these patients in the recovery room for at least 2 h（因此建议这类病人在恢复室至少停留2小时）. Post-PACU Discharge Care The ASA-OSA Practice Guidelines suggest that OSA patients be monitored for a median of 3 hours longer than their non-OSA counterparts before discharge from the facility （建议OSA病人较非OSA病人增加平均3小时的 监护时间）. In addition, the monitoring should continue for a median of 7 hours after the last episode of airway obstruction or hypoxemia while breathing room air in an unstimulated environment（另外，在出现气道梗阻或非刺激状态下呼吸空气出现低氧血症后应平均再持续监护7小时）. Summary