Post-anesthesia care unit

Initial handoff

The initial handoff, or otherwise referred as handover, is an interdisciplinary transfer of essential and critical patient information from one healthcare provider to another. Variations do exist depending on certain hospitals, medical facilities, and patient presentations. The most common information includes:

• Patient Name and Date of Birth
• Allergies, Past Medical History, Relevant Home Medications
• Operating Room Course:
  • Preoperative medications received
  • Access for medications (IV lines, Gauges used, Locations)
  • Anesthetics Type
  • Airway, Relaxant, Reversal
  • Antibiotics, Analgesics, Antiemetics Administered
  • Other Medications
  • Fluids administered and volume status
  • Any Complications or concerns
• Relevant information specific for patient's case for PACU staff to monitor
• Specific recommendations for the post-anesthesia plan of care

Monitoring

As the patient remains in the PACU, the following are consistently monitored by medical professionals:

• Vital signs (Heart Rate, Blood Pressure, Temperature, and Respiratory Rate)
• Electrocardiogram
• Saturation of Oxygen (SpO2)
• Airway Patency
• Mental Status
• Neuromuscular Function
• Postoperative pain
• Surgical sites for excessive bleeding, mucopurulent discharge, swelling, hematomas, wound healing, and infection

Vital signs are obtained every 5 minutes for the first 15 minutes. The PACU staff monitor that the Respiratory Rate and Saturation of Oxygen remain as close to baseline of that patient while the heart rate and blood pressure remain within 20% of their baseline values.

More intensive care monitoring may include:

• Preparation and education for the use of patient-controlled analgesia (PCA) units for postoperative pain control
• Preparation and administration of intravenous, epidural, or perineural infusions
• Invasive monitoring such as arterial lines, central venous lines, and ventriculostomies

Postoperative complications

Depending on the use of inhalation anesthestics, post operative nausea and vomiting (PONV) is one of the most common complications to monitor in the immediate postoperative period. Patients do receive antiemetic medications, such as Ondansetron and Dexamethasone, during the surgical procedure if the patient is at risk for it. Along with PONV, there are numerous complications that can happen with many different organ systems, the most threatening of which involves the respiratory system, and cardiovascular system.

Respiratory system/airway complications

Risk Factors are factored into account to assess for complications during the preoperative assessment. Some factors include preexisting factors such as chronic obstructive pulmonary disease (COPD), asthma, obstructive sleep apnea (OSA), obesity, heart failure, and pulmonary hypertension.

Clinical signs and symptoms are assessed to indicate any respiratory system complications, such as Tachypnea (RR 20 breaths/min), Bradypnea (RR

The life-threatening complications that are monitored in PACU include:

• Laryngospasm
• Respiratory arrest
• Airway Edema
• Foreign Body
• Cervical Hematoma
• Bronchospasm
• Pulmonary Edema
• Tension Pneumothorax
• Pulmonary Embolism
• Atelectasis

Cardiovascular system complications

Cardiovascular complications such as arrhythmias and hemodynamic Instability are the third most common postoperative complication. The risk factors that are assessed preoperatively include the severity of any preexisting cardiovascular comorbidities, such as congestive heart failure, valvular heart disease, and myocardial infarctions. The medical professional also assesses if the patient has had any recent traumas and the severity of perioperative stresses such as blood loss, fluid shifts, and hypotension.

Clinical signs and symptoms are assessed to indicate any cardiovascular system complications, specifically hemodynamic instability and vital signs.

Hypotension

Patients who undergo major procedures that deal with volume status perioperatively can be at risk for hypotension due to fluid shifts or significant bleeding. Hemoglobin is measured and monitored if significant bleeding could have occurred. Treatment includes either replacement of the lost blood products as pRBC, or with crystalloid solutions while monitoring electrolyte abnormalities in Lactated Ringers Solution, Normal Saline, or Crystalloid. Patients can also experience life-threatening hypotensive shock due to hemorrhage, sepsis, cardiogenic, or anaphylactic.

References

References

1. "Post Anesthesia Care Unit (PACU) {{!}} Renaissance School of Medicine at Stony Brook University".
2. (March 2013). "Introduction to the postanaesthetic care unit". Perioperative Medicine.
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4. (2021). "Assessment of Staffing and Service Provision in the Post-Anesthesia Care Unit of Hospitals Found in Amhara Regional State, 2020". Drug, Healthcare and Patient Safety.
5. (April 1992). "Complications occurring in the postanesthesia care unit: a survey". Anesthesia and Analgesia.
6. Bemo, Brian. (2024-10-02). "Importance of Post Operation Care - Hair 4 Life Medical".