- Ensure same monitoring as during anaesthesia.
- 40% O2 via a face mask for >15min to assist with any respiratory depression or ventilation/perfusion mismatch.1
- Monitor pulse and BP.
- Keep the patient warm.
- Look for hypoventilation (inadequate reversal check with nerve stimulator; narcosis reverse opiates with naloxone cautiously to minimize pain; check for airway obstruction, eg from bleeding tonsil). Ensure adequate analgesia.
- Return the patient to the ward when you are satisfied with his cardiovascular and respiratory status and pain relief.
- Give clear instructions on post-operative fluid regimens, blood transfusions, oxygen therapy, pain relief, and physiotherapy.
- Post-op vomiting is partly preventable by a 5-HT3 antagonist eg granisetron, or dexamethasone.
Metoclopramide is less good.
Epidural local anaesthetics GI paralysis compared with systemic or epidural opioids, with comparable pain relief.
Epidurals may also post-op risk of respiratory failure.
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