DR. AHMED S.

KOMI, MD
Dep. Of Anesth. & Intensive care
Farwaniya Hospital
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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
 Open ward design
 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
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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 general anesthesia should ideally
be a smooth and gradual awakening in a controlled
environment
CARE OF THE PATIENT
CARE OF THE PATIENT

 Residual anesthetic, sedative, and analgesic drug

effect
 Hypothermia
 Hypoxemia and hypercarbia
 Hypercalcemia, hypermagnesemia, and
hyponatremia
 Hypoglycemia and hyperglycemia
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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 age
2. Female gender, particularly if menstruating on day
of surgery of in first trimester of pregnancy
3. Large body habitus
4. History of prior postoperative emesis
5. 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
 Surgical procedures
1. Strabismus surgery
2. Ear surgery
3. Laparoscopy
4. Orchiopexy
5. Ovum retrieval
6. Tonsillectomy
 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
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 Discharge Criteria
Before discharge, patients should have been observed
for respiratory depression for at least 20–30 min after the
last dose of parenteral narcotic. Other minimum
discharge criteria for patients recovering from general
anesthesia usually include the following:
(1) Easy arousability
(2) Full orientation
(3) The ability to maintain and protect the airway
(4) Stable vital signs for at least 15–30 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 ± 20–50 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
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 Discharge Criteria
Postanesthesia Discharge Scoring System (PADS)
 Vital signs
 Within 20% of preoperative baseline 2
 Within 20–40% 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
 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 20–
30 min after the last dose of parenteral narcotic.
Our Aim is to Discharge
Happy Patient
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