Post-Anesthesia Care

Post-Anesthesia Care - Wake Up Call

• PACU (Post-Anesthesia Care Unit): Critical recovery area for patients immediately post-op.
  • Aims: Stabilize vital signs, manage pain & PONV (Postoperative Nausea and Vomiting), ensure airway patency, detect early complications.
• Patient Reception & Initial Assessment:
  • Handover: Structured (e.g., SBAR) from OR team.
  • Connect monitors: ECG, SpO₂, NIBP, Temp.
  • Rapid ABCDE assessment: Airway, Breathing, Circulation (inc. surgical site), Disability (LOC), Exposure.
  • Baseline vitals, pain score, Aldrete score.

⭐ The Aldrete score is pivotal for assessing post-anesthesia recovery; a score of ≥9 is commonly required before PACU discharge.

Post-Anesthesia Care - Complication Central

PACU: manage immediate adverse events. Early recognition & intervention are vital.

• Key PACU Issues & Actions:
  • Hypoxemia: SpO2 <90%. Causes: Airway obstruction, hypoventilation. Mgmt: ↑FiO2, airway support.
  • Hypotension: SBP <90 mmHg or >20% ↓ from baseline. Causes: Hypovolemia, vasodilation. Mgmt: Fluids, vasopressors.
  • Hypertension: SBP >180 mmHg or >20% ↑ from baseline. Causes: Pain, anxiety, hypoxia. Mgmt: Analgesia, antihypertensives.
  • PONV (Postoperative Nausea & Vomiting): Mgmt: Ondansetron 4mg IV, dexamethasone.
  • Pain: Mgmt: Multimodal analgesia (opioids, NSAIDs, regional techniques).
  • Shivering/Hypothermia: Core temp <36°C. Mgmt: Forced air warming, meperidine 12.5-25mg IV.
  • Delayed Emergence: Causes: Residual drugs, metabolic imbalance, neurologic event. Mgmt: Supportive, rule out causes, reversal agents (naloxone, flumazenil if indicated).

⭐ Hypoxemia (SpO2 <90%) is a critical early PACU complication, often due to airway obstruction or hypoventilation.

Post-Anesthesia Care - Monitor & Medicate

• Key Monitoring (PACU):
  • Vitals: HR, BP (MAP > 65 mmHg), RR, SpO2 (> 94%), Temp. Continuous ECG.
  • Airway: Patency, breathing pattern, auscultation.
  • Neurology: LOC (Aldrete score), pain (VAS/NRS).
  • Renal: Urine output > 0.5 mL/kg/hr.
  • Surgical: Site (bleeding, hematoma), drains.
  • PONV: Assess frequency & severity.
• Essential Medications:
  • Oxygen: Supplemental O2 to maintain SpO2.
  • Analgesia: Multimodal - Opioids (e.g., Fentanyl IV), NSAIDs, Paracetamol.
  • Antiemetics: Ondansetron 4-8 mg IV, Dexamethasone.
  • Fluids: IV crystalloids, guided by hemodynamics & losses.
  • Shivering:

    ⭐ Shivering increases oxygen consumption by up to 400-500%; active warming and drugs like pethidine are key.

    • Pethidine 12.5-25 mg IV, warm blankets, forced-air warmers.

Post-Anesthesia Care - Road to Recovery Ward

• Goal: Safe PACU discharge. Patient must be stable.
• Key Discharge Criteria:
  • Vitals: Stable (BP, HR, RR, Temp); SpO2 >92% (or baseline).
  • Pain: Controlled (VAS <4).
  • Nausea/Vomiting (N/V): Minimal/treated.
  • Consciousness: Awake, oriented (or baseline).
  • Surgical Site: No active bleeding/hematoma.
• Scoring Systems Aid Decision:
  • Modified Aldrete Score: ≥9 (activity, respiration, circulation, consciousness, O2 sat).
  • PADSS (ambulatory): ≥9 (vitals, activity, N/V, pain, bleeding).

⭐ Patients must demonstrate stable vital signs, adequate pain control, and minimal nausea/vomiting, often guided by a score like Modified Aldrete (≥9) or PADSS (≥9 for ambulatory), before PACU discharge.

High‑Yield Points - ⚡ Biggest Takeaways

• Aldrete score (≥9) guides PACU discharge; assesses activity, respiration, circulation, consciousness, O2 saturation.
• Commonest PACU issues: PONV, hypoxemia, hypotension, pain.
• Manage postoperative shivering with warming; meperidine for severe cases.
• Airway obstruction (e.g., tongue fall, laryngospasm) is critical; requires immediate intervention.
• Delayed emergence may indicate residual anesthesia, metabolic issues, or neurological injury.
• Prioritize pain control using multimodal analgesia.
• Monitor urine output (target >0.5 mL/kg/hr) for adequate perfusion_