Routine Recovery Cares

Routine Recovery Cares

Following General Anesthesia

Airway patency, vital signs, and oxygenation should be checked immediately on arrival. Subsequent blood pressure, pulse rate, and respiratory rate measurements are routinely made at least every 5 min for 15 min or until stable and every 15 min thereafter. Pulse oximetry should be monitored continuously in all patients recovering from general anesthesia, at least until they regain consciousness. The occurrence of hypoxemia does not necessarily correlate with the level of consciousness. Neuromuscular function should be assessed clinically, e.g., head-lift. At least one temperature measurement should also be obtained. Additional monitoring includes pain assessment, the presence or absence of nausea or vomiting, and fluid input and output including urine flow, drainage, and bleeding. After initial vital signs have been recorded, the anesthetist should give a brief report to the post anesthesia care unit (PACU) nurse that includes the personal data (age, sex...), medical history, medication (preoperative, routine), pertinent intraoperative events (type of anesthesia, the surgical procedure, blood loss, fluid replacement, vital signs and any complications), expected postoperative problems, and post anesthesia orders (analgesia, transfusion, postoperative ventilation, etc).

All patients recovering from general anesthesia should receive 30 - 40% oxygen during emergence because transient hypoxemia can develop even in healthy patients. Patients at increased risk for hypoxemia, such as those with underlying pulmonary dysfunction or those undergoing upper abdominal or thoracic procedures, should continue to be monitored with a pulse oximeter even after emergence and may need oxygen supplementation for longer periods. A rational decision regarding continuing supplemental oxygen therapy at the time of discharge from the PACU can be made based on SpO2 readings on room air. Oxygen therapy should be carefully controlled in patients with chronic obstructive pulmonary disease and a history of CO2 retention. Patients should generally be nursed in the head-up position whenever possible to optimize oxygenation. However, elevating the head of the bed before the patient is responsive can lead to airway obstruction. In such cases, the oral or nasal airway should be left in place until the patient is awake. Deep breathing and coughing should be encouraged periodically.

Following Regional Anesthesia

Patients who are heavily sedated or hemodynamically unstable following regional anesthesia should also receive supplemental oxygen in the PACU. Sensory and motor levels should be periodically recorded following regional anesthesia to document dissipation of the block. Blood pressure should be closely monitored following spinal and epidural anesthesia. Bladder catheterization may be necessary in patients who have had spinal anesthesia for longer than 4 h.