Understanding Anesthesiology - The Global Regional Anesthesia ...

surgery”). A scoring system (Aldrete score) has been
developed that grades the patient’s colour, respiration,
circulation, consciousness and activity on a scale of 0-2.
For Phase 1 recovery, the patient must:
• be showing no signs of respiratory depression for at
least 20-30 minutes after last dose of parenteral
opioid.
• be easily aroused.
• be fully oriented to person, place and time.
• be able to maintain and protect the airway on his
own including evidence of a strong cough.
• have stable vital signs for at least 30 minutes.
It is also important that pain and post-operative nausea
and vomiting are controlled prior to PACU discharge
and that there are no ongoing surgical concerns such as
surgical site bleeding. Most healthy patients undergoing
routine surgery will meet the PACU discharge criteria
within 60 minutes.
post-operative hemorrhage and myocardial ischemia
are life-threatening but occur relatively infrequently.
With expertise in airway management and cardiovascular
resuscitation, the anesthesiologist is well-positioned
to detect and manage these critical events.
Hypertension is commonly seen in the PACU and has
many possible underlying causes. The patient may
have pre-existing essential hypertension which is
poorly controlled and may be exacerbated by the omission
of their usual medication on the day of surgery.
Other factors can lead to hypertension in the PACU
such as full bladder (which the patient may not recognize),
pain and importantly, hypoxemia and hypercarbia.
Fortunately, the most common PACU complications are
not usually life-threatening but are important to recognize
and manage nonetheless. A brief discussion follows
below.
Prior to being discharged home (from the same day surgery
unit), the patient must demonstrate the return of
cognitive function, ambulation and the ability to take
oral liquids.
Many types of complications can occur in the PACU.
Some of them, such as airway obstruction, aspiration,
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