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POST ANESHTESIA CARE

THE POSTANESTHESIA CARE UNIT


CARE OF THE PATIENT
MANAGEMENT OF COMPLICATIONS
RECOMMENDATIONS
POSTANESTHESIA CARE
UNIT

Design
Equipment
Staffing
POSTANESTHESIA CARE
UNIT
Design
Located near the operating rooms
Proximity to radiographic, laboratory, and
other intensive care facilities on the same
floor
Each patient space should be well lighted
Multiple electrical outlets and at least one
outlet for oxygen, air, and suction
POSTANESTHESIA CARE
UNIT
Equipment

1.Pulse oximetry (SpO2)


2.Electrocardiogram (ECG)
3.Automated noninvasive blood pressure (NIBP)
monitors
4.Capnography
5.Temperature
6.Air warming device, heating lamps, and
warming/cooling blanket
POSTANESTHESIA CARE
UNIT
Emergency Equipment

1.Oxygen cannulas
2.Masks
3.Oral and nasal airways
4.Laryngoscopes , ndotracheal tubes, laryngeal mask
airways, and self-inflating bags for ventilation
5.Defibrillation device
6.Tracheostomy, chest tube, and vascular cutdown
trays
POSTANESTHESIA CARE
UNIT
Respiratory therapy equipment

1.Continuous positive airway pressure (CPAP)


2.Ventilators
3.Bronchoscope
POSTANESTHESIA CARE
UNIT
Staffing
Nurses specifically trained in the care of
patients emerging from anesthesia
PACU should be under the medical
direction of an anesthesiologist
One nurse to one patient is often needed.
A charge nurse should be assigned to
ensure optimal staffing at all times.
CARE OF THE PATIENT

EMERGENCE FROM GENERAL ANESTHESIA


TRANSPORT FROM THE OPERATING ROOM
ROUTINE RECOVERY
CARE OF THE PATIENT
EMERGENCE FROM GENERAL ANESTHESIA

Recovery from general or regional


anesthesia is a time of great physiological
stress for many patients.
Emergence from anesthesia should ideally
be a smooth and gradual awakening in a
controlled environment
CARE OF THE PATIENT
CARE OF THE PATIENT
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CARE OF THE PATIENT
TRANSPORT FROM THE OPERATING ROOM
This period is usually complicated by the lack of
adequate monitors, access to drugs, or
resuscitative equipment

Patients should not leave the operating room


unless they have a stable and patent airway,
have adequate ventilation and oxygenation,
and are hemodynamically stable
CARE OF THE PATIENT
TRANSPORT FROM THE OPERATING ROOM
All patients should be taken to the PACU on a
bed or trolley that can be placed in either:

Head down (Trendelenburg) hypovolemic


patients
Head-up position pulmonary dysfunction
lateral position prevent airway obstruction
and facilitates drainage of secretions.
CARE OF THE PATIENT
ROUTINE RECOVERY
a)Airway patency, vital signs, and oxygenation should be
checked immediately on arrival
b)Blood pressure, pulse rate, and respiratory rate
measurements are routinely made at least every 5 min
for 15 min or until stable, and every 15 min thereafter
c)Pulse oximetry should be monitored continuously
d)Neuromuscular function should be assessed clinically
e)At least one temperature measurement
f) Pain assessment
g)Presence or absence of nausea or vomiting
CARE OF THE PATIENT
Agitation
Pain is often manifested as postoperative
restlessness
Systemic disturbances
Hypoxemia
Acidosis
Hypotension
Bladder distention
Surgical complication (such as occult
intraabdominal hemorrhage)
CARE OF THE PATIENT
Nausea & Vomiting
Patient factors
1. Young/old age
2. Female gender, particularly if
menstruating on day of surgery of in
first trimester of pregnancy
3. History of prior postoperative emesis
4. History of motion sickness
CARE OF THE PATIENT
Nausea & Vomiting
Anesthetic techniques
1. General anesthesia
2. Drugs
a. Opioids
b. Volatile agents
c. Neostigmine
CARE OF THE PATIENT
Nausea & Vomiting

Postoperative factors
1. Postoperative pain
2. Hypotension
CARE OF THE PATIENT
Shivering & Hypothermia
Intraoperative hypothermia
Cold ambient temperature in the operating room
Prolonged exposure of a large wound
Use of large amounts of unwarmed intravenous
fluids
High flows of unhumidified gases
Effects of anesthetic agents
Immediate postpartum period
Discharge Criteria
Before discharge, patients should have been
observed for respiratory depression for at least
2030 min after the last dose of parenteral
narcotic. Other minimum discharge criteria for
patients recovering from general anesthesia
usually include the following:
(1) Easy arousal (from external stimulation)
(2) Full orientation
(3) The ability to maintain and protect the airway
(4) Stable vital signs for at least 1530 min
(5) The ability to call for help if necessary
(6) No obvious surgical complications (such as
active bleeding).
Discharge Criteria
Postanesthetic Aldrete Recovery Score

Oxygenation

SpO2 > 92% on room air
2
SpO2 > 90% on oxygen
1
SpO2 < 90% on oxygen
0
Respiration

Breathes deeply and coughs freely
2
Dyspneic, shallow or limited breathing
1
Apnea 0
Discharge Criteria
Postanesthetic Aldrete Recovery Score

Circulation
Blood pressure 20 mm Hg of normal 2
Blood pressure 2050 mm Hg of normal 1
Blood pressure more than 50 mm Hg of normal 0

Consciousness
Fully awake 2
Arousable on calling 1
Not responsive 0

Activity
Moves all extremities 2
Moves two extremities 1
No movement 0
Discharge Criteria
Postanesthesia Discharge Scoring System (PADS)
Vital signs
Within 20% of preoperative baseline 2
Within 2040% of preoperative baseline 1
> 40% of preoperative baseline 0

Activity level
Steady gait, no dizziness, at preoperative level 2
Requires assistance 1
Unable to ambulate 0
Discharge Criteria
Postanesthesia Discharge Scoring System (PADS)

Nausea and vomiting


Minimal, treated with oral medication 2
Moderate, treated with parenteral medication 1
Continues after repeated medication 0

Pain: minimal or none, acceptable to patient, controlled


with oral medication
Yes 2
No 1

Surgical bleeding
Minimal: no dressing change required 2
Moderate: up to two dressing changes 1
Severe: three or more dressing changes 0
RECOMMENDATIONS
1) Patients should not leave the operating room
unless they have a stable and patent airway,
have adequate ventilation and oxygenation,
and are hemodynamically stable.

2) Before discharge, patients should have been


observed for respiratory depression for at
least 2030 min after the last dose of
parenteral narcotic.