Post-anesthesia care, consisting of the multiphasic activities undertaken to manage a patient following completion of a surgical procedure, is critical to ensuring postoperative patient well-being. As such, guidelines have been developed to ensure a smooth patient emergence, recovery in the post anesthesia care unit, and long term well-being.
Above all, patients are to be carefully assessed and monitored. An American Society of Anesthesiologists (ASA) Task Force developed a set of specific standards to guide patient care in the post anesthesia care unit (PACU) to this end [1]. A patient transported to the PACU should be accompanied by a member of the anesthesia care team who is well-informed about the patient’s operation and current condition. The patient should be continually evaluated and treated during their transport to the PACU in a manner appropriate to the patient’s condition. Upon arrival in the PACU, the patient should be re-assessed and the member of the anesthesia care team should provide a verbal report to the PACU nurse in charge. The patient’s condition should be clinically evaluated thereafter, including by monitoring respiratory, cardiovascular and musculoskeletal function, mental status, temperature, pain levels, nausea, bleeding, and urine output.
Treatment recommendations during recovery in the PACU include the prevention and treatment of any nausea or vomiting, the administration of supplemental oxygen and fluids, the normalization of the patient’s temperature, and the administration of pharmacologic agents aimed at reducing shivering and antagonizing the effects of analgesics, sedatives, and neuromuscular blockade.
The ASA’s guidelines stipulate that a physician should be responsible for the discharge of the patient from the PACU. Some guidelines further suggest that a discharge scoring system may be helpful in documenting a patient’s readiness to be discharged [2]. To this end, the Aldrete score has been successful in evaluating patient recovery by assessing five parameters, including level of consciousness, respiration, circulation, color, and activity level. However, it fails to address some common side effects frequently seen in the PACU, such as pain, nausea, and bleeding – all of which should be carefully monitored by the clinicians in charge.
As some surgical facilities are faced with ineffective processes and reduced patient flow through the PACU, it is important to understand the causes of delayed PACU discharge. Both clinical factors (e.g. obesity, hypertension, age, obstructive sleep apnea) and nonclinical factors (e.g. insufficient staffing, lack of clean beds available, equipment delays, and long waiting times for tests and physician orders) can prolong a PACU stay. In order to optimize a patient’s experience, facilities should assess these factors and modify them such as to have as streamlined and efficient flows as possible.
For optimal patient post-anesthesia care management, recommendations should be individualized to the needs of each patient [3]. In parallel, clinicians have a responsibility to remain well-informed as regards the latest research on clinical best practices in order to ensure the best patient care possible.
References
- Standards for Postanesthesia Care | American Society of Anesthesiologists (ASA). Available at: https://www.asahq.org/standards-and-guidelines/standards-for-postanesthesia-care.
- Chinnappa, V. & Chung, F. What Criteria Should Be Used for Discharge after Outpatient Surgery? Evidence-Based Pract. Anesthesiol. 305–313 (2009). doi:10.1016/B978-1-4160-5996-7.00046-8
- Silverstein, J. H. et al. Practice Guidelines for Postanesthetic Care. Anesthesiology 96, 742–752 (2002). doi:10.1097/ALN.0b013e31827773e9
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