Summary of study session V

In study session V you have learnt

• The post anesthesia care unit is designed and staffed to monitor and care for patients who are recovering from the immediate physiologic effects of anesthesia and surgery. Pulse oximetry (SpO2), electrocardiogram (ECG), and automated noninvasive blood pressure (NIBP) monitors for each space are desirable but not mandatory.
• Upon arrival in the unit, the anesthesia provider informs the PACU nurse of pertinent details on the patient's history, medical condition, anesthesia, and surgery. The anesthetist should transfer responsibility to PACU personnel until the patient's airway status, ventilation, and hemodynamics are appropriate.
• Routine recovery care includes; checking airway patency, vital signs, and oxygenation, neuromuscular function should be assessed clinically. Additional monitoring includes pain assessment, the presence or absence of nausea or vomiting, and fluid input and output including urine flow, drainage, and bleeding.
• All patients recovering from general anesthesia should receive 30–40% oxygen during emergence because transient hypoxemia can develop even in healthy patients.
• Blood pressure should be closely monitored following spinal and epidural anesthesia. Bladder catheterization may be necessary in patients who have had spinal anesthesia for longer than 4 h.
• Airway obstruction is a common and potentially devastating complication in the postoperative period. The most frequent cause of airway obstruction in the PACU is the loss of pharyngeal tone in a sedated or obtunded patient. The residual depressant effects of inhaled and intravenous anesthetics and the persistent effects of neuromuscular blocking drugs contribute to the loss of pharyngeal tone in the immediate postoperative period.
• Moderate to severe postoperative pain in the PACU can be managed with parenteral opioid. When opioids are used, titration of small intravenous doses is generally safest.
• Pain is often manifested as postoperative restlessness or agitation. Hypoxemia, hypotension, bladder distention, or a surgical complication such as occult intra abdominal hemorrhage should always be considered as well. Marked agitation may necessitate arm and leg restraints to avoid self-injury, particularly in children.
• Postoperative nausea and vomiting are a common problem following general anesthesia. Increased vagal tone manifested as sudden bradycardia commonly precedes or coincides with emesis. Ondansetron 4 mg (0.1 mg/kg in children), metoclopramide, 0.15 mg/kg intravenously, is somewhat less effective but is a good alternative to ondanestron.
• Shivering is common in the immediate postpartum period. The most important cause of hypothermia is a redistribution of heat from the body core to the peripheral compartments
• Hypothermia has been associated with an increased incidence of myocardial ischemia, arrhythmias, increased transfusion requirements, and increased duration of muscle relaxant effects. Small intravenous doses of meperidine, 10 –50 mg, can dramatically reduce or even stop shivering.
• Patients with a history of essential hypertension are at greatest risk for significant systemic hypertension in the recovery period. Additional factors include pain, hypoventilation and associated hypercapnia, emergence excitement, advanced age, a history of cigarette smoking, and preexisting renal disease.
• All patients must be evaluated by an anesthetist prior to discharge from the PACU unless strict discharge criteria are adopted. Criteria for discharging such as score of 10 or 9 "Aldrete score" are required to dischrge patient from PACU.
• Patients receiving regional anesthesia should also show signs of resolution of both sensory and motor blockade.