special subjects
Postoperative Care
Airway
Most patients are extubated before leaving the operating room and soon become able to clear secretions from their airway. Patients should not leave the recovery room until they can clear and protect their airway (unless they are going to an intensive care unit [ICU]). After intubation, patients with normal lungs and trachea may have a mild cough for 24 hours after extubation; for smokers and patients with a history of bronchitis, postextubation coughing lasts longer. Most patients who have been intubated, especially smokers and patients with a lung disorder, benefit from an incentive inspirometer. Postoperative dyspnea may be caused by pain secondary to chest or abdominal incisions (nonhypoxic dyspnea) or by hypoxemia (hypoxic dyspnea—see also Oxygen Desaturation ). Hypoxemia secondary to pulmonary dysfunction is usually accompanied by dyspnea, tachypnea, or both; however, oversedation may cause hypoxemia but can blunt dyspnea, tachypnea, or both. Thus, sedated patients should be monitored with pulse oximetry or capnometry. Hypoxic dyspnea may result from atelectasis or, especially in patients with a history of heart failure or chronic kidney disease, fluid overload. Whether dyspnea is hypoxic or nonhypoxic must be determined by pulse oximetry and sometimes arterial blood gas; chest x-ray can help differentiate fluid overload from atelectasis. Hypoxic dyspnea is treated with oxygen. Nonhypoxic dyspnea may be treated with anxiolytics or analgesics. 