Understanding Anesthesiology - The Global Regional Anesthesia ...

SECTION 1
Recovery
In This Section
1. Goals of Recovery
2. Post-operative Nausea and
Vomiting
3. Shivering
4. Pain
Goals of Recovery
At the end of the operative procedure, care and
monitoring of the patient is handed over from
the anesthesiologist to the nurse in the postoperative
care setting as the patient enters the period
of recovery. For most patients, this occurs in
the Post-Anesthetic Care Unit (PACU). However,
some patients, such as those requiring prolonged
post-operative ventilation or close hemodynamic
monitoring, may instead be admitted
directly to the Intensive Care Unit. Prior to transporting
the patient from the operating room, the
anesthesiologist must ensure the presence of the
following:
• patent airway (provided either by an awake
patient, oral airway or endotracheal tube)
• adequate ventilation
• stable hemodynamics
• adequate pain control
Any identified problems must be corrected before
leaving the operating room to avoid transporting
an unstable patient.
On arrival in the PACU, the airway patency,
breathing and circulation are immediately assessed.
Supplemental oxygen is provided as indicated.
Routine monitors are applied. The anesthesiologist
then gives the attending nurse pertinent
information about the patient’s past medical history
and intra-operative course. The latter includes
details of the nature of the procedure, anesthetic
technique, fluid balance and any intraoperative
complications. Finally, instructions regarding
monitoring, management of fluids, pain
and nausea as well as discharge plans are given.
Monitoring in the PACU is an extension of that
provided in the operating room. The patient is
observed for potential complications, both surgical
and anesthetic. When discharge criteria are
met, the patient is transferred to their ultimate
destination: the ward for inpatients or the same
day surgery unit for outpatients.
Criteria for discharge are stratified into “Phase 1”
(which determines when the patient is able to be
transferred from the PACU to the ward) and
“Phase 2” (which addresses home-readiness and
only applies to those patients having “same day
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