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Post-anesthesia care unit

January 01, 1970

"PACU" redirects here. For the fish, see Pacu.

A post-anesthesia care unit (PACU) and sometimes referred to as post-anesthesia recovery or PAR, or simply recovery, is a part of hospitals, ambulatory care centers, and other medical facilities. Patients who received general anesthesia, regional anesthesia, or local anesthesia are transferred from the operating room suites to the recovery area. The patients are monitored typically by anesthesiologists, nurse anesthetists, and other medical staff.[1][2] Providers follow a standardized handoff to the medical PACU staff that includes, which medications were given in the operating room suites, how hemodynamics were during the procedures, and what is expected for their recovery. After initial assessment and stabilization, patients are monitored for any potential complications, until the patient is transferred back to their hospital rooms.[3][2]

Initial handoff edit

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.[4] 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 edit

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

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.[3]

More intensive care monitoring may include:

Postoperative complications edit

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.[5] Patients do receive antiemetic medications, such as Ondansetron and Dexamethasone, during the surgical procedure if the patient is at risk for it.[1] 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.[5]

Respiratory system/airway complications edit

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 < 12 breaths/min), SpO2 <93%, Anxiety, Confusion, or Agitation with resulting Tachycardia and Hypertension.

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

Cardiovascular system complications edit

Cardiovascular complications such as arrhythmias and hemodynamic Instability are the third most common postoperative complication.[5] 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 edit

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.

See also edit

References edit

  1. ^ a b "Post Anesthesia Care Unit (PACU) | Renaissance School of Medicine at Stony Brook University". renaissance.stonybrookmedicine.edu. Retrieved 2022-03-23.
  2. ^ a b Simpson JC, Moonesinghe SR (March 2013). "Introduction to the postanaesthetic care unit". Perioperative Medicine. 2 (1): 5. doi:10.1186/2047-0525-2-5. PMC 3964324. PMID 24472674.
  3. ^ a b Chang J (2019). Global reconstructive surgery. Edinburgh. ISBN 978-0-323-56860-9. OCLC 1053860785.{{cite book}}: CS1 maint: location missing publisher (link)
  4. ^ Chekol B, Eshetie D, Temesgen N (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. 13: 125–131. doi:10.2147/DHPS.S302303. PMC 8180306. PMID 34104000.
  5. ^ a b c Hines R, Barash PG, Watrous G, O'Connor T (April 1992). "Complications occurring in the postanesthesia care unit: a survey". Anesthesia and Analgesia. 74 (4): 503–509. doi:10.1213/00000539-199204000-00006. PMID 1554116. S2CID 28978751.

Further reading edit

  • Hines R, Barash PG, Watrous G, O'Connor T (April 1992). "Complications occurring in the postanesthesia care unit: a survey". Anesthesia and Analgesia. 74 (4): 503–509. doi:10.1213/00000539-199204000-00006. PMID 1554116. S2CID 28978751.
  • Simpson JC, Moonesinghe SR (March 2013). "Introduction to the postanaesthetic care unit". Perioperative Medicine. 2 (1): 5. doi:10.1186/2047-0525-2-5. PMC 3964324. PMID 24472674.
  • Chang J, Fossum SR, Alderson WC, Pedersen MA (2019). "1.7 - PACU Setup and Requirements". In Chang J (ed.). Global Reconstructive Surgery. Edinburgh: Elsevier. pp. 45–49. doi:10.1016/b978-0-323-52377-6.00007-0. ISBN 978-0-323-52377-6. S2CID 69838906.
  • Chekol B, Eshetie D, Temesgen N (June 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. 13: 125–131. doi:10.2147/dhps.s302303. PMC 8180306. PMID 34104000.

External links edit

  • (eMedicine.com) - discusses laryngospasm.

January 01, 1970
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PACU redirects here For the fish see Pacu A post anesthesia care unit PACU and sometimes referred to as post anesthesia recovery or PAR or simply recovery is a part of hospitals ambulatory care centers and other medical facilities Patients who received general anesthesia regional anesthesia or local anesthesia are transferred from the operating room suites to the recovery area The patients are monitored typically by anesthesiologists nurse anesthetists and other medical staff 1 2 Providers follow a standardized handoff to the medical PACU staff that includes which medications were given in the operating room suites how hemodynamics were during the procedures and what is expected for their recovery After initial assessment and stabilization patients are monitored for any potential complications until the patient is transferred back to their hospital rooms 3 2 Contents 1 Initial handoff 2 Monitoring 3 Postoperative complications 3 1 Respiratory system airway complications 3 2 Cardiovascular system complications 3 2 1 Hypotension 4 See also 5 References 6 Further reading 7 External linksInitial handoff editThe 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 4 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 careMonitoring editAs 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 3 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 ventriculostomiesPostoperative complications editDepending 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 5 Patients do receive antiemetic medications such as Ondansetron and Dexamethasone during the surgical procedure if the patient is at risk for it 1 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 5 Respiratory system airway complications edit 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 gt 20 breaths min Bradypnea RR lt 12 breaths min SpO2 lt 93 Anxiety Confusion or Agitation with resulting Tachycardia and Hypertension 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 edit Cardiovascular complications such as arrhythmias and hemodynamic Instability are the third most common postoperative complication 5 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 edit 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 See also editAldrete s scoring system Anesthesia Anesthesiologist Anesthetic technician Intensive care unit Nurse anesthetist Operating department practitionerReferences edit a b Post Anesthesia Care Unit PACU Renaissance School of Medicine at Stony Brook University renaissance stonybrookmedicine edu Retrieved 2022 03 23 a b Simpson JC Moonesinghe SR March 2013 Introduction to the postanaesthetic care unit Perioperative Medicine 2 1 5 doi 10 1186 2047 0525 2 5 PMC 3964324 PMID 24472674 a b Chang J 2019 Global reconstructive surgery Edinburgh ISBN 978 0 323 56860 9 OCLC 1053860785 a href Template Cite book html title Template Cite book cite book a CS1 maint location missing publisher link Chekol B Eshetie D Temesgen N 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 13 125 131 doi 10 2147 DHPS S302303 PMC 8180306 PMID 34104000 a b c Hines R Barash PG Watrous G O Connor T April 1992 Complications occurring in the postanesthesia care unit a survey Anesthesia and Analgesia 74 4 503 509 doi 10 1213 00000539 199204000 00006 PMID 1554116 S2CID 28978751 Further reading editHines R Barash PG Watrous G O Connor T April 1992 Complications occurring in the postanesthesia care unit a survey Anesthesia and Analgesia 74 4 503 509 doi 10 1213 00000539 199204000 00006 PMID 1554116 S2CID 28978751 Simpson JC Moonesinghe SR March 2013 Introduction to the postanaesthetic care unit Perioperative Medicine 2 1 5 doi 10 1186 2047 0525 2 5 PMC 3964324 PMID 24472674 Chang J Fossum SR Alderson WC Pedersen MA 2019 1 7 PACU Setup and Requirements In Chang J ed Global Reconstructive Surgery Edinburgh Elsevier pp 45 49 doi 10 1016 b978 0 323 52377 6 00007 0 ISBN 978 0 323 52377 6 S2CID 69838906 Chekol B Eshetie D Temesgen N June 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 13 125 131 doi 10 2147 dhps s302303 PMC 8180306 PMID 34104000 External links editKetamine Emergency Applications eMedicine com discusses laryngospasm Retrieved from https en wikipedia org w index php title Post anesthesia care unit amp oldid 1198327540, wikipedia, wiki, book, books, library,

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