Surgical Procedures 

      • Surgical Procedures 
        • Preoperative care
          • Parental presence
          • Preoperative sedation
        • Postoperative care
          • Continuous monitoring
          • Vital signs assessment
            • Potential causes of Postoperative vital sign alterations in children
Alteration  Potential Cause  Comments
Heart rate
Increase Decreased perfusion (shock) Heart rate may increase to maintain cardiac output.
Elevated temperature
Respiratory distress (early)
Medications (atropine, morphine, epinephrine)
Decrease Hypoxia Bradycardia is of more concern in young child than tachycardia.
Vagal stimulation
Increased intracranial pressure
Respiratory distress (late)
Medications (neostigmine [Prostigmin Bromide])
Respiratory Rate
Increase Respiratory distress Body responds to respiratory distress primarily by increasing rate.
Fluid volume excess
Elevated temperature
Decrease Anesthetics, opioids Decreased respiratory rate from opioids may be compensated for by increased depth of respiration.
Blood Pressure
Increase Excess intravascular volume This is serious in premature infants because it increases risk for intraventricular hemorrhage.
Increased intracranial pressure
Carbon dioxide retention
Medication (ketamine, epinephrine)
Decrease Vasodilating anesthetic agents (halothane, isoflurane, enflurane) Decreased blood pressure is late sign of shock because of elasticity and constriction of vessels to maintain cardiac output.
Opioids (e.g., morphine)
Increase Shock (late sign) Fever associated with infection usually occurs later than fever of noninfectious origin. Absence of fever does not rule out infection, especially in infants.

Malignant hyperthermia requires immediate treatment.

Environmental causes (warm room, excess coverings)
Malignant hyperthermia
Decrease Vasodilating anesthetic agents (halothane, isoflurane, enflurane) Neonates are especially susceptible to hypothermia, with serious or fatal consequences.
Muscle relaxants
Environmental causes (cool room)
Infusion of cool fluids or blood


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