Appendix A. Drugs Commonly Used in a Recovery Room

British name

Adrenaline Alcuronium (Alloferin) Aminocaproic acid

(Epsikapron) Aminophylline Ampicillin (Penbritin,

Amfipen) Aprotinin (Trasylol) Aspirin Atenolol (Tenormin) Atracurium (Tracrium) Atropine

Bupivacaine (Marcain) Buprenorphine (Temgesic) Bumetanide (Burinex)

Calcium chloridefgluconate Cefuroxime (Zinacef) Chlormethiazole

(Heminevrin) Chlorpheniramine (Piriton)

Chlorpromazine (Largactil)

Codeine phosphate

Dantrolene (Dantrium)

Deslanoside (Cedilanid) Dexamethasone (Decadron)

Dextrose 50% Diazepam (Valium, Diazemuls) Digoxin (Lanoxin) Dihydrocodeine (OF 118) Dobutamine (Dobutrex) Dopamine (Intropin)

American name

Epinephrine Not available Aminocaproic acid

(Amicar) Aminophylline (Theophylline) Ampicillin (Amcil,

Omnipen, Polycillin) Not available Aspirin Atenolol (Tenormin) Atracurium (Tracrium) Atropine

Bupivacaine (Marcaine) Not available Bumetanide (Bumex)

Calcium chloridefgluconate Cefuroxime (Zinacef) Not available

Chlorpheniramine (Chlortrimetron, Teldrin)

Chlorpromazine (Thorazine)

Codeine

Dantrolene (Dantrium)

Deslanoside (Cedilanid-D) Dexamethasone (Decadron,

Hexadrol) Dextrose 50% Diazepam (Valium) Digoxin (Lanoxin) Dihydrocodeine (Paracodin) Dobutamine (Dobutrex) Dopamine (Intropin)

Effects

Positive inotrope, vasopressor Muscle relaxant Anti-fibrinolysis

Bronchodilator Antibiotic

Trypsin inactivation Analgesic {I-blocker Muscle relaxant Anticholinergic

Local anaesthetic Analgesic Diuretic

Inotrope, replacement of Ca + + Antibiotic Sedative

Antihistamine

Sedative, antihistamine, IX-blocker

Analgesic

Inhibits malignant hyperpy­rexia

Inotrope Steroid

Raises blood sugar Sedative, anticonvulsant Inotrope Analgesic Inotrope Inotrope

182

British name

Doxapram (Dopram) Droperidol (Droleptan)

Dysopyramide (Rhythmodan, Norpace)

Edrophonium (Tensilon) Ephedrine Ergometrine

Flecainide (Tambocor) Flumazenil (Anexate) Frusemide (Lasix)

Gallamine (Flaxedil) Gentamicin (Genticin,

Cidomycin) Glycopyrronium bromide

(Robinul)

Heparin (Pularin) Hydralazine (Apresoline) Hydrocortisone Hyoscine (scopolamine)

Insulin Isoprenaline

Ketamine (Ketalar)

Labetalol (Trandate) Lignocaine (Xylocaine)

Lorazepam (Ativan)

Meptazinol (Meptid) Metaraminol (Aramine) Methoxamine (Vasoxine) Methyl prednisolone

(Solumedrone) Metoclopramide (Maxalon,

Primperan) Metronidazole (Flagyl,

Zadstat) Midazolam (Hypnovel) Morphine

Nalbuphine (Nubain) Naloxone (Narcan) Neostigmine (Prostigmin) Nitroglycerin (Tridil) Nitroprusside (Nip ride)

Oxytocin (Syntocinon)

American name

Doxapram (Do pram) Droperidol (Inapsine)

Dysopyramide (Norpace)

Edrophonium (Tensilon) Ephedrine Ergometrine (Ergonovine)

Not available Not available Furosemide (Lasix)

Gallamine (Flaxedil) Gentamicin (Garamycin)

Glycopyrrolate (Robinul)

Heparin Hydralazine (Apresoline) Hydrocortisone (Solu-cortef) Scopolamine (hyoscine)

Insulin Isoproterenol (Isuprel)

Ketamine (Ketalar)

Labetalol Lidocaine (Xylocaine)

Lorazepam (Ativan)

Not available Metaraminol (Aramine) Methoxamine (Vasoxyl) Methyl prednisolone

(Solumedrone) Metoclopramide (Reglan)

Metronidazole (Flagyl)

Midazolam (Versed) Morphine

Nalbuphine (Nubain) Naloxone (Narcan) Neostigmine (Prostigmin) Nitroglycerin Nitroprusside (Nipride)

Oxytocin (Pitocin, Syntocinon)

Appendix A

Effects

Respiratory stimulant Sedative, anti-emetic,

11-blocker Anti-dysrhythmic

Anticholinesterase Vasopressor Uterine constrictor

Anti-arrhythmic Benzodiazepine antagonist Diuretic

Muscle relaxant Antibiotic

Anticholinergic

Anticoagulant Hypotensive agent Steroid Anticholinergic

Reduces blood sugar Inotrope

Induction agent

11- and fJ-blocker Local anaesthetic,

anti-dysrhythmic Sedative

Analgesic Vasopressor Vasopressor Steroid

Anti-emetic

Antibiotic

Sedative Analgesic

Analgesic Opiate antagonist Anticholinesterase Hypotensive agent Hypotensive agent

Uterine contraction

Appendix A

British name American name Effects

Pancuronium (Pavulon) Pancuronium (Pavulon) Muscle relaxant Papaveretum (Omnopon) No approved name (Pantopon) Analgesic Paracetamol (Panadol) Acetaminophen (Phenaphen, Analgesic

Tempra) Pentazocine (Fortral) Pentazocine (Talwin) Analgesic Perphenazine (Fentazin) Perphenazine (Trilafon) Anti-emetic, antihistamine Pethidine Meperidine (Demerol) Analgesic Phenindione (Dindevan) Phenindione (Hedulin) Anticoagulant Phenobarbitone (Luminal) Phenobarbital (Luminal) Anticonvulsant, sedative Phentolamine (Rogitine) Phentolamine (Rogitine) IX-blockade Physostigmine (Eserine) Physostigmine (Antilirium) Anticholinesterase Potassium chloride Potassium chloride Potassium replacement Potassium iodide Potassium iodide Iodine replacement Prilocaine (Citanest) Prilocaine (Citanest) Local anaesthetic Procyclidine (Kemadrin) Procyclidine (Kemadrin) Anti-Parkinsonism Propofol (Diprivan) Not available Induction agent Propranolol (Inderal) Propranolol (Inderal) f3-blockade Promazine (Sparine) Promazine (Sparine) Anti-emetic Protamine sulphate Protamine sulfate Reversal of heparin

Salbutamol (Ventolin) Albuterol (Proventil, Ventolin) Bronchodilator Sodium valproate (Epilim) Valproic acid (Depakene) Anticonvulsant Suxamethonium (Scoline, Succinylcholine chloride Muscle relaxant

Anectine) (Anectine, Que1icin)

Tranexamic acid (Cyklokapron) Not available Antifibrinolysis Hypotensive agent Muscle relaxant

Trimetaphan (Arfonad) Trimetaphan (Arfonad) Tubocurarine (Tubarine) Tubocurarine (Curare)

Vecuronium (Norcuron) Verapamil (Cordilox) Vitamin K (Konakion,

Synka-Vit)

Intravenous fluids Compound sodium lactate

(Hartmann's solution) Dextran 40 (Rheomacrodex)

Dextran 70 (Macrodex)

Vecuronium (Norcuron) Verapamil (Isoptin, Calan) Phytonadione (Konakion, Aquamephyton)

Muscle relaxant Antidysrhythmic agent Vitamin K replacement

Lactated Ringer's solution

Dextran 40 (Gentran 40, LMD 10%, Rheomacrodex)

Dextran 70 (Macrodex) Dextrose 4%/sodium chloride 0.18% Dextrose 5%

Dextrose 4%/sodium chloride 0.18% Dextrose 5% Hetastarch 6% (Hespan)

183

Hetastarch 6% (Hespan) Human plasma protein fraction Human plasma protein fraction (Plasmanate,

Plasma-plex, plasmatein, Protenate) Polygeline colloid 3.5% (Haemaccel) Not available Sodium bicarbonate 4.2%, 8.4% Sodium bicarbonate 4.2%, 8.4% Sodium chloride 0.18, 0.9, 1.8% Sodium chloride 0.\8%, 0.9%, 1.8% Sodium chloride 0.18% or 0.45% in Dextrose 5%

Bladder irrigation fluids Glycine (aminoacetic acid) Sodium chloride 0.9%

Cylinders

Glycine (aminoacetic acid) Sodium chloride 0.9%

In addition to the above drugs, cylinders of oxygen, nitrous oxide, a 50: 50 mixture of nitrous oxide and oxygen (Entonox) and a helium-oxygen mixture (helium 80%, oxygen 20%) should be available.

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Subject Index

Accident and Emergency Department surgery 112

Accidents, reporting 11 Acidosis

after massive blood transfusion 103 correction of 152 metabolic, after vascular surgery 132 in renal disease 151

Activated partial thromboplastin time (APTI) 106

Admission, criteria for 17 Adrenaline 92 Adrenocortical insufficiency

in bowel surgery 114 Adult respiratory distress syndrome 104 AIDS (acquired immunodeficiency

syndrome) 10 Airway

upper, obstruction, causes 68-9 obstruction, management 69 partial obstruction, signs of 68 suction 38

Airway, insertion 36-7 Airway maintenance 35, 116

in the obese 158 in paediatric surgery 134-6 in rheumatoid arthritis 156 in thyroid surgery 121-2

Airway pressure 39 Al1ergic reactions to blood transfusions

102 Amniotic fluid embolism 117 Anaemia

iron deficiency 154 in renal disease 151

Anaesthesia at day surgery 163-6 hypotensive 133

Anaesthetic techniques 141-3 Anaesthetist's responsibility 16

Analgesia intramuscular 56 patient control1ed (PCA) 56-7

Analgesic drugs 55 Analgesic and relaxant technique 142 Anaphylactoid reactions 76 Ankylosing spondylitis 156-7 Antagonists, partial 56 Anti-emetics 55, 96 Anti-hypertensive agents 144 Anti-sialogogues 141 Anti-static, precautions 2, 12 Antibiotics 146 Anticoagulants 105-45 Anuria 112 Aortic surgery 131-2 Arterial blood pressure measurement 31 Arterial pressure monitors 173-5 Arteriovenous shunts 151 Arthritis, rheumatoid 156 Aspiration of gastric contents 76-8 Asthma 76, 147 Atelectasis 75-6

after nephrectomy 134 Atrial contractions, premature (PACs) 88 Atrial fibril1ation management 89-90 Atropine 84,92-7

Bays, patient 3 Bed sores, in geriatric patients 115, 157 Beds

features required 4 space needed 3

Benzodiazepine 141 Benzodiazepines, in day surgery 163 Beta blockers 144 Bier's block 63-4 Bladder, perforated, signs of 133 Bladder irrigation 132 Blood loss, recognition of 35

188

Blood pressure after prostatectomy 133 arterial 31 automatic recording 30 measurement 30-3 measurement in the obese 159 paediatric 136-7

Blood transfusion 45~ after thoracotomy 130 massive 103-4 mismatched 82 reactions 101-2 substitutes 81

Bowel surgery 113-4 Brachial plexus block 63, 142 Bradycardia 83-4

after beta-blockers 144 sinus 83

Bretylium 92 Bronchitis, chronic 146-7 Bronchoscopy 77, 128 Bronchospasm

in asthmatic patients 147 causes and management 76-7

Bupivacaine 59, 61 Buprenorphine 56

Caesarian section 116-7 Calcium chloride 92 Calcium gluconate 103, 143 Capnometer 177-9 Carbon dioxide

partial pressure 125 tension monitors 177-9

Cardiac arrest 90-3 Cardiac failure 81, 148 Cardiac massage 90 Cardiac output diminished 81-2 Cardiac tamponade 82 Cardiovascular collapse 58, 79 Cardiovascular complications 79-80 Cardiovascular depression, Bier's block 64 Cardiovascular disease 147-8 Cardiovascular function assessment 27-33

paediatric 136 Cardiovascular problems with the

elderly 157 Cardiovascular system menitoring 170 Cardioversion 90 Care plan nursing 23-4 Caudal blockade 61, 134 Celestin tube 112 Central venous pressure (CVP) 112

measurement 32 Chart for neurological observation 95 Charts and records 47-50

compiling in reception area 2 Chemical pneumonitis 78

Subject Index

Chest drains 128 Cheyne-Stokes respiration 71-2 Chronic bronchitis 146-7 Circumcision 134 Citrate intoxication 103 Cleaning of recovery unit and equipment 12 Clotting factors 104-5

congenital deficiency 105 Coagulation

disseminated intravascular (DIC) 133 failure 104-8

after vascular surgery 131-2 impairment in liver disease 150-1

Codeine phosphate, in head injury 111 Collapsed trachea (tracheomalacia) 122 Colostomy 47 Colour assessment, patient 26 Communication systems 5 Consciousness

assessment 34 delayed 93-4, 141

Convulsions 58, 60, 97-8 after Bier's block 64

Coronary artery disease 147 Corticosteroids 145 Coumarin-type drugs 105 Criteria for admission 17 Cushing's ischaemic reflex 124-5 Cyanosis, peripheral and central 26

Dantrolene 101 Day surgery 161-5

advice to patient 112 patient questionnaire 163 patient selection 161 post-anaesthetic complications 16~ procedures suitable for 161-3

Deaths in recovery unit 18 Deep vein thrombosis

in hip operations 115 in the obese 159

Defibrillation 91 Delirium 94, 120 Dental and faciomaxillary surgery 122-3 Dexamethasone, in reduction of cranial

pressure 125 Dextrose 101-4, 152 Dextrose/saline solutions 138 Diabetes mellitus 152 Diffusion hypoxaemia (Fink effect) 22, 75 Digital nerve blockade 64 Digitalisation 90 Digoxin 146 Discharge

from day unit 164-5 from recovery, criteria 51 to lTD 51 to ward 51

Subject Index

Disinfection of equipment 13 Disseminated intravascular coagulation 102,

105, 107, 133 Diuretics 145-6 Documentation for day surgery 163 Dopamine 109 Doppler ultrasonic device 30, 132, 173 Doxapram 55,71, 141 Drainage, chest 128-30 Drainage systems 46-7 Drug dosages

in liver and renal disease 150-1 for the malnourished 158

Drug elimination in the elderly 157 Drugs, analgesic 55 Dysphoria 56 Dysrhythmias 87-90

Ear, nose & throat surgery 118-121 ECG

(electrocardiograph) monitoring 31-2 monitors 171-3

Electroencephalogram (EEG) 171 Electrolyte imbalance in vascular

surgery 132 Emboli, micro- 104 Embolus, pulmonary 82 Emergency surgery 18,111-2 Endocrine disorders 152 Endorphin 53, 60 Endoscopy 112-3 Endotracheal suction 38 Endotracheal tube, paediatric sizes 135 Endrophonium test 72 Ephedrine 143 Epidural blockade 60-1 Epidural blood patch 59-60 Epidural narcotics 60-1 Equipment

defective 11 disinfection and sterilisation 13 disposable, reuse of 10 list of required 6-8

Excitement 94 Explosion risk 9, 11 Extubation 39

Faciomaxillary surgery 122-3 Femoral nerve blockade 64 Fentanyl, in day surgery 163 Fibrillation 89-92 Fibrin degradation products 106 Fibrinogen level 107 Fibrinolysis following prostatectomy 133 Fink effect, diffusion hypoxaemia 22, 75 Fire risk 9, 11

Flooring 12, 13 Fluid balance 43-4

paediatric 137-8 prostatectomy 133 rheumatoid arthritis 156

Flumazenil 141 Frusemide 109

in reduction of cranial pressure 125

Gas cylinders, handling and stowage 11 Gastric contents, aspiration of 76 Gastro-oesophageal reflux 112 Gastroenterology 112-4 Gastrointestinal bleeding 113 Genito-urinary surgery 132-4 Geriatric patients 157

f89

Glasgow coma scale 111,124,126-7,171 Gloves, wearing of 11 Gynaecology 116-8

Haematological disease 154-5 Haematuria 112 Haemolytic reactions to blood

transfusions 102 Haemophilia 154 Haemorrhage

after hysterectomy 117 internal 35 paediatric 13 7 post partum 116 signs of after tonsillectomy 118

Haemothorax 78 after rib fracture 112 pleural effusion 79

Hallucinations 56 Hartmann's solution 138 Head injury 111 Headache, in spinal anaesthesia 59 Heart block 84-5 Heating and ventilation 6 Helium: oxygen mixture 119 Heparin 145 Hepatitis B Virus (HBV) 10, 18, 123

vaccination 11 Hiatus hernia 112 Hip operations 115 Human Immunodeficiency Virus (HIV) 18 Hydrocortisone 77 Hyoscine 141 Hypercarbia, signs of 67 Hyperkalaemia 104

in renal disease 151 Hypertension 82-3

cardiovascular disease 148 causes 83 neurosurgery 125 renal disease 151 vascular surgery 131

190

Hyperthermia causes and management 99-101 malignant 100, 137 neurosurgery 128

Hyperthyroidism 153 Hypervolaemia, signs of 35, 86 Hypocalcaemia 74 Hypoglycaemia 93, 152

paediatric surgery 138 Hypoglycaemic agents 145 Hypokalaemia 74,89

bowel surgery 114 Hypotension 79-82

beta blockers 144 bradycardia in epidural block 60 drugs causing 80 induced 143, 179 in spinal anaesthesia 59 vascular surgery 131

Hypotensive anaesthesia 133 Hypothermia 98-9

in the elderly 157 following bowel surgery 114 massive blood transfusion 103 thoracotomy 130 vascular surgery 131

Hypothyroidism 153 Hypoventilation 70-5 Hypovolaemia 80-1

following trauma 112 signs of 86, 112

Hypoxaemia 22,75-6 signs of 67

Hysterectomy 117-8

Ileostomy 47 Indl'ced hypotension 143 Induction agents, intravenous 141 Infection control 9-10 Inguinal field blockade 62 Inhalation agents, solubility 142 Insulin 104

and hypoglycaemic agents 145 therapy 152

Intensive Therapy Unit 3, 17, 18 Intercostal nerve blockade 61-2 Intermittent positive pressure ventilation

(IPPY) 112 Intestinal obstruction 113 Intra-ocular pressure (lOP) 124 Intracranial events, signs of 124 Intracranial pressure 124-5

monitoring 171 Intramuscular analgesia 56 Intrapleural catheterisation 62 Intravenous, regional anaesthesia 63-4 Intravenous fluid

induction agents 141

Subject Index

infusion & injection 45 in the obese 159 infusion drip rates 44 requirements, paediatric 138 therapy 44-5

Intubated patient, care of 38-9 Iron deficiency anaemia 154 Ischaemic gangrene after digital nerve

blockade 64 Isoflurane in day surgery 163 Isoprenaline 92

Jaw, wiring of 123

Ketamine anaesthesia 3, 143 dim lighting for 4

Laparoscopy 117 Laryngeal

nerves, damage to 121-2 oedema 68-70, 135-6

Laryngoscopy 119 Laryngospasm 68 Lighting 4 Lignocaine 59, 89, 92 Liver disease 150 Local anaesthesia 57-64

agents and techniques 57-9 at day surgery 165 complications, local and systemic 58, 65 local infiltration 61 patient management 65 toxic reactions 58

Malignant hyperthermia 100-1 Malnourishment 158 Mannitol 109

in reduction of cranial pressure 125 Mendelson's syndrome 78 Mental handicap 123 Meptazinol 56 Metabolic acidosis 74, 132 Metabolic systems, monitoring 170 Methoxamine 143 Metriset 138 Micro-emboli 104 Middle ear surgery 121 Minute volume 39 Miotics 124 Monitoring

classification (ASA) 168 and monitors 167-79

Monoamine oxidase inhibitors (MAOIs) 144

Morphine 55

Subject Index

Muscle relaxants prolongation after antibiotics 114 residual paralysis 70-4 reversal 21

Muscular dystrophy 150 Musculoskeletal disease 156 Myasthenia gravis 149 Mydriasis 34 Mydriatics 124 Myocardial conduction, drugs affecting 85 Myocardial contractility depression 143 Myocardial infarction 81-2, 85 Myocardial ischaemia 131, 147

Nalbuphine 56 Naloxone 55,61,71,93, 141 Nasal packs 120 Nasopharyngeal airway, insertion 37 Nausea and vomiting 55, 95-6

in day surgery 163 Neostigmine 76, 113 Nephrectomy 134 Nerve stimulation, peripheral 72-3 Neurological

observation chart 95, 126 systems, monitoring 171

Neuromuscular blockade monitors 177 disease 149-50

Neurosurgery 124-8 Noise levels 5 Normal recovery 21-52

progress of 22 Nose operations 120--1 Nurse-doctor collaboration 16 Nurse-patient ratio 14-15 Nursing care plan 23-4

Obesity 158-9 Observations, routine 26 Obstetrics and gynaecology 116-8 Obstruction

intestinal 113 upper airway 68-70

Oesophagus, perforation of 113 Oliguria 108-9

vascular surgery 131 Ophthalmic surgery 123-4 Opiates 55-6

central depression due to 71 effect of 111 intramuscular 132 partial antagonists 56 reversal of 141 see also naloxone

Oropharyngeal airway, insertion 36-7 Orthopaedic surgery 114-6

Oscillotonometer 30, 173 Osteoporosis 156 Oximeter 67,70,176 Oxygen

administration and therapy 40--3 extubation 39 saturation monitors 176-7

Pacemaker 148 Pacing, transvenous and oesophageal 92 Paediatric surgery 134-8 Pain

factors influencing 54 signs of 55 theory of gate control 53-4

Pain relief laparoscopy 117 local anaesthesia 53-65 methods of 55-7 signs of inadequate 55 thoracotomy 131 vascular surgery 132

Papaveretum 55 Paraplegia 150 Partial antagonists 56 Patient controlled analgesia (peA) 56-7 Patient information required 24-5 Pelvis fracture 112 Penile nerve blockade 62-3

for circumcision 134 Pentazocine 56 Perfusion of tissue 27 Peritonitis, surgery for 113 Pethidine 55 Phaeochromocytoma 153 Phenothiazine 141 Physiology of elimination of anaesthetic

gases 21-2 Physostigmine 95 Placebos 54 Plaster casts 114 Platelet count 106 Pneumonitis, chemical (Mendelson's

syndrome) 78 Pneumothorax 78-9

191

block by supraclavicular route 63, 142 brachial plexus blockade 63 intercostal nerve blockade 62 nephrectomy 134 rib fracture 112

Policies, recovery 17 Pollution by anaesthetic agents 8 Porphyria 153-4 Position and safety of patient 25 Post end expiratory pressure (PEEP) 39 Post partum haemorrhage 116 Potassium level 152 Power outlet points 4

192

Pre-eclamptic toxaemia 116--7 Pre-operative drug therapy 144-6 Precautions, anti-static 12 Pregnancy 158

termination of 117 Premedication 141 Prilocaine 59 Propofol 141

in day surgery 163 Propranolol 76, 89 Prostatectomy 132-4 Protamine sulphate 145 Prothrombin time 106 Pulmonary

artery pressure monitors 174 capillary wedge pressure (PCWP) 33 embolus 82 tuberculosis, breathing circuits,

disposal 10 Pulse

measurement 28-30 oximeter 176 rate, paediatric 136

Pulse pressure measurement 81 Pupil size

cause of dilatation 34 dilated after ganglion-blocking agents 143 in ophthalmic surgery 124

Reception area 2 Reception of patient 24 Records and charting 47-50 Recovery night work 18 Recovery policies 17 Recovery room role and design 1-6 Regional anaesthesia 142

day surgery 163, 165 intravenous (Bier's block) 63-4

Renal disease 151 Residual paralysis 72-3 Respiration

after thoracotomy 130 Cheyne-Stokes 71-2 conditions affecting mechanics of 74-5 depolarising block 73 non-depolarising block 73-4 normal 27 residual paralysis 72-3 see also ventilation

Respiratory disease 146--7 paralysis in epidural block 60 system monitoring 169-70

Respiratory complications 67-79 depression 55, 58, 61, 70-1 in geriatric patients 157 in myasthenia gravis 149 paediatric 135-6

Restlessness 94-5 Rheumatoid arthritis 156 Rib fracture 112

Subject Index

Safety and precautions 8-13 Salivation, excessive 141 Scavenging systems, atmospheric 8 Senior nurse, duties and qualifications 13, 14 Septic shock 133-4 Septicaemia 82

following bowel surgery 114 Shivering 96--7

after neurosurgery 128 Sickle cell disease 155 Skin care in elderly 115, 157 Sockets and switches 4, 12 Sphigmornanometer 30 Spinal blockade 59 Spleen rupture 112 Spondylitis, ankylosing 156 Staff 9-15

advice for 10, 11 danger from exhaled gases 8 protection of 9-11 recruitment 14 training 15

Staffing 13-16 24-hour 15-16 levels 14

Sterilisation of equipment 13 Steroid cover 82, 145

in rheumatoid arthritis 156 Sub-glottic oedema, post extubation 135-6 Suction, endotracheal 38-9 Supraventricular tachycardia (SVT) 86--7 Suxamethonium

in accident department 112 in day surgery 163 metabolism of 21 in paraplegia 150

Sympatheitc blockade 143

Tachycardia 85-7 sinus 85-6 supraventricular and ventricular 86--7

Teeth loose 136 Telephones 5 Temperature, ambient and chill factor 6 Temperature regulation, paediatric 137 Tension pneumothorax 79 Thoracic surgery 128-131 Thoracotomy 128-131 Thrombin clotting time (TCT) 107 Thrombocytopenia 106, 156 Thrombus formation in vascular

surgery 132

Subject Index

Thyroid crisis 122 disease 153-54 surgery 121-22

Tidal volume 39 Tonsillectomy 118-9 Tracheal collapse 69, 122 Tracheal tug 27, 72 Tracheomalacia 69, 122 Tracheostomy 119-20 Traction, orthopaedic 115-16 Training staff 15-16 Transurethral resection (TUR) 132 Trolleys, features required 4

Uraemia in renal disease 151 Urine output

anuria and haematuria 112 impaired in renal disease 151 retention in regional anaesthesia 142

Urine output/drainage 33, 131 Uterus, perforated, signs of 117

Valsalva manoeuvre 86 Vascular surgery 131-2 Vasodilating drugs 143 Venous filling, observing 31 Ventilated patient, care and

monitoring 39--40

Ventilation inadequate 70--5 in the obese 158-9 in paediatric surgery 134 see also respiration

Ventricular contractions, premature (PVCs) 88-9

Ventricular fibrillation 91-2 Ventricular tachycardia (VT) 86-7 Venturi mask 42 Vertebrae fractured 115-6 Vitamin K deficiency 105

193

Vocal cords, abductor paralysis 69, 121-2 Vomiting 76-7,95-6,111

ophthalmic surgery 123--4 recording 78 wired jaws 123

Ward staff, transfer of patient to 52 Windows 3 Wiring of jaw 123

X-ray, Mendelson's syndrome 78 X-ray

protection from 11 thoracotomy 130 trolley facility 4

Zygomatic arch, fracture 123