Recovery from anesthesia

Patient selection after recovery

Janusz Andres

PACU (postanesthesia care unit)

• 35 - 40 years ago

• specialized nursing care

• high incidence of potentially life-threatening respiratory and circulatory complications

PACU design

• Localization close to OR, diagnostic

facility, intensive care station, enough

space, electrical outlets

• Equipment

• Staffing

Emergence from general anesthesia

• Potential problems: airway obstruction, shivering, agitation, delirium, pain, nausea and vomiting, hypothermia, autonomic liability, arterial pressure fluctuations

• Inhalation anesthetics : proper ventilation (factors: alveolar ventilation and blood solubility)

• Intravenous anesthesia: pharmacokinetics: redistribution and half time

Delayed emergence

• Definition: when patient fails to regain consciousness 60 - 90 minutes following GA

• More common causes: residual anesthetic, sedative and analgesic drug effects

• Naloxone (0,2 mg) and flumazenil (0,5 mg), physostigmine (1-2 mg)

Other causes of delayed emergence from GA

• Hypothermia (core temp. < 330C)

• Hypoxemia and hypercarbia

• Hypercalcemia, hypermagnesemia,

hyponatremia, and hypo- and

hyperglycemia

• Perioperative stroke

Transport from the operating room

• Stable and patent airway

• Adequate ventilation

• Adequate oxygenation

• Hemodynamically stable

Routine recovery

• General anesthesia

• Regional anesthesia

• Pain control

• Agitation

• Nausea and vomiting

• Shivering

Discharge criteria (color, respiration, circulation, conciousness, activity)

• Easy arousability

• Full orientation

• The ability to maintain and protect the

airway

• Stable vital signs

• No surgical complications

Complications

• Respiratory problems: airway obstruction, laryngospasm, hypoventilation, hypoxemia

• Circulatory problems: hypotension, hypertension, arrhythmias