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Table 37-13

Pain control (optimizes ventilation)
  • Patient-controlled analgesia
  • Low-dose ketamine (0.05 mg/kg/hr) as adjunct to epidural analgesia or added to morphine for patient controlled analgesia
  • Intercostal nerve blocks (2–3 mL of 0.5% bupivacaine)
  • Cryoanalgesia
  • Neuraxial opioids (epidural or intrathecal morphine diluted in saline; intrathecal dose about 1/10 the epidural dose; administer opioid before surgical incision as “preemptive analgesia”)
Atelectasis: Rapid shallow breathing in response to pain; treatment is any maneuver that increases functional residual capacity
Low cardiac output syndrome: Replace intravascular fluid volume; consider inotropes, vasodilators, or both
Cardiac dysrhythmias: Supraventricular tachycardias; consider prophylactic digitalis if the patient is normokalemic
Hemorrhage: Re-explore if blood loss >200 mL/hr
Tension pneumothorax
Peripheral nerve injury: Intercostal, brachial plexus, recurrent laryngeal