Author details

9. Monitoring, oxygen and positive airway pressure therapy for obese

Application of electricity to stimulate the skin can be used to manage different types of pain. The mechanism could possibly be explained by Gate control theory. There is a lack of strong evidence to suggest benefits of TENS in labor pain

corresponding to various body parts decreases pain perception by altering

Oxygen saturation and respiratory rate should be closely monitored in these group of patients receiving opioids or other potentially sedative medications [88]. For continuous assessment of the adequacy of ventilation in the postoperative setting, end-tidal CO2 measurement has become the standard of care [89, 90]. End-tidal CO2 detects hypoventilation earlier than any other physiological monitors. OSA patients at high risk should be continuously monitored with pulse oximetry until patient maintains oxygen saturation to their preoperative baseline levels [91, 92]. Studies have shown that pulse oximetry monitoring in postoperative patients is

Obese patients with suspected or confirmed OSA should be transferred with supplemental oxygen from operation room to the post-anesthesia care unit (PACU) after receiving general anesthesia. In the PACU, patient head end elevation by at least 30 degrees is recommended. Though there is not enough literature that shows the effect of supplemental oxygen in postoperative settings, the recommendation is that supplemental oxygen should

patients with sleep apnea

Table 3. Summarization of the nonpharmacological options.

Peripheral therapies (physical skin stimulation)

Hot-cold treatment Can be used in acute musculoskeletal injury [86].

Exercise To relieve pain by preventing spasms and contractures [13].

Distraction by music Decreases pain sensitivity and increase pain tolerance

physiology [13].

Reflexology Special techniques employed to apply pressure at reflex points on feet

Meditation, Yoga, Hypnosis, Herbal treatments, Aromatherapy, Relaxation—respiration techniques

Positioning Adequate position in the postoperative period by pillows and special beds. [13] Restriction of movement/resting Prolonged bed rest is not recommended—the bed rest for about two days may be beneficial after back surgeries by reducing edema.

Acupuncture and acupressure It could reduce cancer pain intensity [87]

Transcutaneous electrical nerve

122 Pain Management in Special Circumstances

Cognitive-behavioral therapies

stimulation (TENS)

very useful in detecting hypoxemic episodes [40, 93].

9.1. Monitoring

9.2. Oxygen therapy

Sayed Rahman<sup>1</sup> , Ahmed Zaghw<sup>2</sup> \*, Osama Elazzouny<sup>2</sup> , Dhari Almenshid<sup>2</sup> , Mustafa Rezk2 , Mohammed Azizuddin Imran<sup>3</sup> and Malek Alali2

