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
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