post aneshtesia care

8/14/2019 Post Aneshtesia Care

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DR. AHMED S. KOMI, MD

Dep. Of Anesth. & Intensive care

Farwaniya Hospital


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POSTANESTHESIA CARE UNITDesign

Equipment

Staffing


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POSTANESTHESIA CARE UNITDesign

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


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POSTANESTHESIA CARE UNITEmergency Equipment

1. Oxygen cannulas2. 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


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POSTANESTHESIA CARE UNITRespiratory therapy equipment

1. Continuous positive airway pressure (CPAP)

2. Ventilators

3. Bronchoscope


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CARE OF THE PATIENT

EMERGENCE FROM GENERAL ANESTHESIA TRANSPORT FROM THE OPERATING ROOM

ROUTINE RECOVERY


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CARE OF THE PATIENTEMERGENCE FROM GENERAL ANESTHESIA

Recovery from general or regional anesthesia is a timeof great physiological stress for many patients.

Emergence from general anesthesia should ideally

be a smooth and gradual awakening in a controlled

environment


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CARE OF THE PATIENT


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CARE OF THE PATIENTResidual anesthetic, sedative, and analgesic drug

effectHypothermia

Hypoxemia and hypercarbia

Hypercalcemia, hypermagnesemia, andhyponatremia

Hypoglycemia and hyperglycemia


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CARE OF THE PATIENTTRANSPORT 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, haveadequate ventilation and oxygenation, and are

hemodynamically stable


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CARE OF THE PATIENTTRANSPORT 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 andfacilitates drainage of secretions.


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CARE OF THE PATIENTROUTINE 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 clinicallye) At least one temperature measurement

f) Pain assessment

g) Presence or absence of nausea or vomiting


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CARE OF THE PATIENTAgitation

Pain is often manifested as postoperative

restlessness

Systemic disturbances

Hypoxemia

Acidosis

Hypotension Bladder distention

Surgical complication (such as occult intraabdominal

hemorrhage)


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CARE OF THE PATIENTNausea & Vomiting

Patient factors

1. Young age2. Female gender, particularly if menstruating on day

of surgery of in first trimester of pregnancy

3. Large body habitus

4. History of prior postoperative emesis5. History of motion sickness


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Anesthetic techniques

1. General anesthesia2. Drugs

a. Opioids

b. Volatile agents

c.

Neostigmine


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Surgical procedures

1. Strabismus surgery2. Ear surgery

3. Laparoscopy

4. Orchiopexy

5. Ovum retrieval6. Tonsillectomy


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Postoperative factors1. Postoperative pain

2. Hypotension


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CARE OF THE PATIENTShivering & 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 CriteriaBefore discharge, patients should have been observed

for respiratory depression for at least 2030 min after the

last dose of parenteral narcotic. Other minimum

discharge criteria for patients recovering from generalanesthesia 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 1530 min

(5) The ability to call for help if necessary

(6) No obvious surgical complications (such as active

bleeding).


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Discharge CriteriaPostanesthetic Aldrete Recovery Score

Oxygenation

SpO2 > 92% on room air2

SpO2 > 90% on oxygen 1

SpO2 < 90% on oxygen 0

Respiration

Breathes deeply and coughs freely2

Dyspneic, shallow or limited breathing 1

Apnea 0


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Discharge CriteriaPostanesthetic Aldrete Recovery Score

CirculationBlood pressure 20 mm Hg of normal 2

Blood pressure 2050 mm Hg of normal 1

Blood pressure more than 50 mm Hg of normal 0

ConsciousnessFully awake 2

Arousable on calling 1

Not responsive 0

ActivityMoves all extremities 2

Moves two extremities 1

No movement 0


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Discharge CriteriaPostanesthesia Discharge Scoring System (PADS)

Vital signs

Within 20% of preoperative baseline 2

Within 2040% 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


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Discharge CriteriaPostanesthesia 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 withoral medication

Yes 2 No 1

Surgical bleeding Minimal: no dressing change required

2

Moderate: up to two dressing changes 1


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RECOMMENDATIONS1) 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.


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Our Aim is to Discharge

Happy Patient


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