Consequently normothermia should be a goal
during emergence and recovery.
" Forced-air warming systems should be
used for treating hypothermia when available.
– Pharmacologic agents for reduction of shivering: it
is cautioned that hypothermia, a common
cause of shivering, should be treated by active
rewarming. Advantages of pharmacologic
agents as additive methods may be considered
for select patients when shivering is
known to be seriously harmful.
" In these patients, meperidine is recommended
as first-line drug for treatment of
shivering during emergence and recovery
for select patients. Other opioids may be
considered if meperidine is contraindicated
or not available.
– Antagonism of benzodiazepines: specific
antagonists should be available whenever
benzodiazepines are administered.
" Flumazenil should not be used routinely,
but may be administered to antagonize
respiratory depression and sedation in
select patients. After pharmacologic
antagonism, patients should be observed
long enough to ensure that cardiorespiratory
depression does not recur.
– Antagonization of opioids: specific antagonists
should be available whenever opioids are
administered.
" Opioid antagonists should not be used
routinely but may be administered to
antagonize respiratory depression in
selected patients. After pharmacologic
antagonism, patients should be observed
long enough to ensure that cardiorespiratory
depression does not recur. It is reminded
that acute antagonism of the effects of
opioids may result in pain, hypertension,
tachycardia or pulmonary oedema.
– Reversal of neuromuscular blockade: T4:T1 ratio
is the single and proven objective measure of
safe neuromuscular function up to now.
" It is recommended that assessment of
restoration of neuromuscular function
(e.g. by train-of-four monitor) should be
checked during emergence and recovery
on a case-by-case basis, and specific antagonists
are recommended to administer for
reversal of residual neuromuscular blockade
whenever indicated.
– Postoperative pain management: anaesthetists
are usually involved in the provision of pain
relief in the days following surgery. If so, they
have to ensure that:
– If patient-controlled anaesthesia systems
are to be used, all staff who are likely to