Principles of post anaesthetic care 2018: General Case Study

A 67 year old man arrives in recovery following a Hartmann’s procedure (proctosigmoidectomy) for carcinoma of the sigmoid colon to be performed under a combined general anaesthetic and epidural. He has been extubated in theatre and is receiving 40% oxygen via a Hudson face mask. His vital signs are:

 SPO2 96%

 Respiratory Rate: 22

 BP 115/75, P113

 ECG: Atrial fibrillation

 Temperature: 37.8°c He has an IV infusion of Hartmann’s 1000mls in progress running 8 hourly.

An epidural catheter has been inserted at L3/4 via a 16g introducer needle and secured with a transparent occlusive dressing. His epidural infusion contains Bupivacaine 1mg/ml and Fentanyl 2mcg/ml which is in progress at 5mls/hr via an epidural infusion pump. A 16fg nasogastric tube was inserted on induction of anaesthesia and a free drainage bag attached. On arrival the nasogastric tube has drained 30mls. There is minimal blood loss observed from his wound site and he has 1 vacuum wound drain which has drained 150mls. His stoma site has been covered with a stoma bag and there is minimal drainage of blood. He has a urethral catheter which has drained 250 mls since it was inserted at the beginning of surgery. On arrival he is anxious and restless and has a pain score of 8/10. He has a history of ischaemic heart disease. The following postoperative drugs have been prescribed:

 Paracetamol 1g IV 4-6 hourly with a max dose of 4g in 24hrs

 Ondansetron 4mg IV 8 hourly