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opioid analgesic approach: regional analgesia
techniques, wound infiltration with local anesthetics, acetaminophen, NSAIDs and dexamethasone (if no contraindications).
If opioids will be used, choose shorter-acting options such as remifentanil, fentanyl and
sufentanil intraoperatively. Titrate longer-acting opioids (such as morphine and hydromorphone) for a more controlled post-operative
effect.
Use prophylactic antiemetics such as
ondansetron (4mg) and dexamethasone (4mg,
if no contraindication). Finally, perform tracheal extubation awake.
3. Post-op precautions
Once the patient is out of the OR and recovering PACU, maintain him in a 25° to 30° head-up
position, so long as there are no contraindications to doing so. Employ CPAP in patients
who were using it pre-operatively or in patients
for whom SaO2 is 85% on 2 to 3L/min. Observe
closely for apneic episodes.
For pain control, again use non-opioids when9 6
O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | D E C E M B E R 2012
