Week 1: PACU Discharge Criteria Before Discharging

Observed for respiratory depression for at least 20-30 minutes after last dose of parenteral narcotic Easy arousability Full orientation (person, place, time) Ability to maintain and protect airway Stable vital signs for at least 15-30 minutes Ability to call for help if necessary On obvious surgical complication s (i.e. active bleeding)

Post-Anesthetic Aldrete recovery score

Original Criteria
Color Pink Pale or dusky Cyanotic Respiration Can breathe deeply and cough Shallow but adequate exchange Apnea or obstruction

Modified Criteria
Oxygenation SpO2 > 92% on room air SpO2 > 90% on oxygen SpO2 < 90% on oxygen Breathes deeply and coughs freely Dyspneic, shallow or limited breathing Apnea BP +/- 20% of normal BP +/- 20-50% of normal BP > 50% of normal Fully awake Arousable on calling Not responsive

Points
2 1 0 2 1 0

Circulation BP +/- 20% of normal BP +/- 20-50% of normal BP > 50% of normal Consciousness Awake, alert and oriented Arousable but readily drifts back to sleep No response Activity Moves all extremities Moves two extremities No movement

2 1 0 2 1 0

Moves all extremities Moves two extremities No movement

2 1 0

Main goals are controlling postoperative pain, controlling nausea and vomiting, and reestablishing normothermia prior to discharge Majority of patients can meet discharge criteria within 60 minutes in the PACU, no demonstrable benefit from a mandatory minimum duration of PACU care Outpatients who meet the above discharge criteria may be fast-tracked to phase 2 recovery, similarly inpatients who meet the same criteria may be transferred directly from the OR to their ward