4 6 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 7
utes post-operatively. I want to avoid a larger bolus of narcotics, which might
not be necessary and most likely will trigger nausea and vomiting.
I rarely supplement pain relief with more than a few doses of Demerol.
There are always exceptions, of course, such as chronic pain patients whose
narcotic needs aren't being met. If patients say they're still in pain after
receiving Demerol 50 mg and their blood pressure and heart rate are within
normal limits, I'll occasionally use a low dose of Versed or Valium. This will
reduce anxiety, and satisfy a patient's request for additional pain relief.
4. Keep patients warm. Patients dislike waking up cold. In addition, shiv-
ering can increase cardiac oxygen demands significantly. I prefer to warm patients
near the end of a procedure, rather than actively warming them throughout the
case. For longer procedures, I'll actively warm the patient during induction (for
comfort) and during the last hour of the case. Surgeons frequently have concerns
about infection from blowing air or from the temperature of the room when warm-
ers are used continuously. When patients wake up shivering, I treat them with
Demerol. There is also evidence that preventing hypothermia can reduce risk of
SSIs.
Team player
I see myself as an important part of the OR team. Not so much as the manager
directing all facets of patient satisfaction, but more as the third base coach pro-
viding some important direction. I'm not boasting when I say the best and the
busiest plastic, reconstructive and orthopedic surgeons in Orange County, Calif.,
frequently request me to work their cases. There's one simple reason: Patient
feedback is overwhelmingly positive post-operatively. Recovery room nurses and
surgeons agree there are differences in patient emergence and recovery room
behaviors based on the quality of the anesthetic delivered.
OSM