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RECOVERY ROOM

A. Definition The recovery room is the area where patients recover from the immediate effects of anaesthesia and surgery and provides a setting for the detection and treatment of early post-operative complications. These areas vary considerably in the level of staffing and monitoring available from the "ideal" fully staffed, fully equipped modern recovery facility to the somewhat less than perfect dimly lit corridor just outside theatre. The commonest causes of recovery room mishaps all result from unidentified changes in a patient's airway, breathing or circulation and these can almost always be rectified if identified at an early stage.

B. Requirement of Recovery Room Recovery room should be arranged to keep it clean, quiet, and tools are useless removed. Instead, all the necessary tools must be in the RR. Air circulation should be smooth and the temperature in the room should be cool. When the air conditioner needs to be installed.

Requirement recovery room are as follows: 1. Quiet, clean and free of unnecessary equipment 2. Soft colors and enjoyable room 3. Indirect lighting 4. Plafond soundproof

5. Equipment that controls or eliminates the sounds (ex: protective rubber bed so as not to make a sound when hit) 6. Available standard equipment: respirator equipment; oxygen, laryngoscope, tracheostomy set, bronchial equipment, catheters, mechanical ventilators and suction equipment) 7. Equipment needs of circulation: blood pressure apparatus, equipment parenteral, plasma expanders, intravenous sets, defibrillator, catheter vein, and tourniquet 8. Surgical dressings, drugs and emergency medications 9. Set catheterization and drainage equipment 10. Patient bed that can be accessed easily, safely and can be moved easily 11. Room temperature ranged from 20-22.2oC with good ventilation.

C. Equipment in Recovery Room In 1993 the Association of Anaesthetists of Great Britain and Ireland published recommendations for the provision of equipment necessary for a modern day recovery area. These are shown in table. Association of Anaesthetists of Great Britain and Ireland Guidelines 1993 Position of recovery Size and temperature Situated as close as possible to the operating theatre to minimise the risks of transporting unstable patients An average of 1.5 recovery bays per operating theatre (9.3m2 per bay) Room temperature 21-22 oC, relative humidity 38 45% and fifteen changes of air per minute Gas scavenging system and six 13 ampere electricity outlets per bay Well lit with lighting approximating to the daylight spectrum Equipment in each bay Oxygen outlets, face masks and breathing systems Pulse oximetry

Availability of blood pressure monitoring and ECG Suction units with Yankaur ends A fully equipped anaesthetic machine with ventilator Drugs and intravenous fluids A paediatric equipment trolley containing facemasks, airways, endotracheal tubes and connectors in a range of paediatric sizes

These facilities may not all be available in many recovery areas throughout the world and some thought is necessary to determine the relative merits of each item on this long list. Certainly the two most important pre-requisites of any recovery area should be the provision of good lighting together with a suitably trained recovery nurse available to recover each unconscious patient on a one-to-one basis. The nurse must be available to stay with the patient constantly until awake and able to maintain their own airway. D. Purpose of Patient Care in the Recovery Room 1. Maintain of airway 2. Maintain of oxygenation 3. Maintain of circulation 4. General Condition Observation, vomiting and drainage 5. Balance liquid 6. Maintaining comfort and risk of injury

E. Criteria for Post-Surgery Recovery 1. Modified Aldrete Scoring Index Consciousness Fully awake Arousable on calling Not responding Condition Score 2 1 0

O2 Saturation

Maintains baseline saturation on room air Needs O2 to maintain >90% saturation O2saturation<90% with O2 supplement

2 1 0 2 1 0 2 1 0 2 1 0 2 1 0

Activity

Ability to move all extremities Ability to move two extremities Unable to control any extremity

Respiration

Able to breathe deeply and cough freely Dyspnea or limited breathing Apneic

Circulation

BP 20% of pre-anesthetic level BP 20 49% of pre-anesthetic level BP 50% of pre-anesthetic level

Pulse Rate

Pulse 20 beats of presedation rate Pulse 50 to 21 beats of presedation rate Pulse > 51 beats of presedation rate

Reqired for discharge from Recovery Room : 9-10 point

2. Bromage Score Full flexion of knees and feet Unable to raise extended legs :0 :1

Unable to raise extended legs and flex knee : 2 Unable to move knee and feet :3

Required for discharge from Recovery Room : 2 point

F. Monitoring Post-Surgery 1. Hypoxia Due to blockage of the airway. Therapy with O2 3-4 L / min, clear the airway, artificial respiration if necessary. 2. Heart rhythm and rapid pulse, hypertension Often caused by illness, onset of hypoxia or indeed essentially disease.

Therapy with O2, analgesic, Fowler position. 3. Hypotension Usually because of bleeding, less liquid, special anesthetic. Therapy with flat position, infusion of RL accelerate to normal tension. 4. Rowdy restless Usually the pain or after anesthesia with ketamine, the patient was conscious but still attached wedge tongue / airway. Therapy with O2, analgesic, prop removed, or sometimes need a pillow.

5. Gag Danger of pulmonary aspiration. Therapy of head and body tilt up to half his stomach, trendelenberg position, suction to clean vomit. 6. Shiver Due to cold, pain or allergies. Therapy with O2, blanket, if necessary, give analgesics. 7. Allergies to shock Because errors transfusion or drugs. Therapy to stop transfusion, replace Na Cl.

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