A post-anesthesia care unit, often abbreviated PACU and sometimes referred to as post-anesthesia recovery or PAR, or simply Recovery, is a vital part of
hospitals
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
,
ambulatory care
Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedu ...
centers, and other medical facilities. Patients who received
general anesthesia
General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...
,
regional anesthesia
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...
, or
local anesthesia
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...
are transferred from the
operating room
Operation or Operations may refer to:
Arts, entertainment and media
* ''Operation'' (game), a battery-operated board game that challenges dexterity
* Operation (music), a term used in musical set theory
* ''Operations'' (magazine), Multi-Man ...
suites to the recovery area. The patients are monitored typically by
anesthesiologists,
certified registered nurse anesthetists, and other medical staff.
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.
Initial handoff
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.
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
As the patient remains in the PACU, the following are consistently monitored by medical professionals:
*
Vital signs
Vital signs (also known as vitals) are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a ...
(
Heart Rate
Heart rate (or pulse rate) is the frequency of the heartbeat measured by the number of contractions (beats) of the heart per minute (bpm). The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and excr ...
,
Blood Pressure
Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
, Temperature, and
Respiratory Rate
The respiratory rate is the rate at which breathing occurs; it is set and controlled by the respiratory center of the brain. A person's respiratory rate is usually measured in breaths per minute.
Measurement
The respiratory rate in humans is mea ...
)
*
Electrocardiogram
*
Saturation of Oxygen (SpO2)
* Airway Patency
* Mental Status
* Neuromuscular Function
* Postoperative pain
* Surgical sites for excessive bleeding,
mucopurulent discharge
Mucopurulent discharge is the emission or secretion of fluid containing mucus and pus (''muco-'' pertaining to ''mucus'' and ''purulent'' pertaining to ''pus'') from the eye, nose, cervix, vagina or other part of the body due to infection and i ...
, swelling,
hematoma
A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...
s, 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.
More intensive care monitoring may include:
* Preparation and education for the use of
patient-controlled analgesia
Patient-controlled analgesia (PCA) is any method of allowing a person in pain to administer their own pain relief. The infusion is programmable by the prescriber. If it is programmed and functioning as intended, the machine is unlikely to deliver ...
(PCA) units for postoperative pain control
* Preparation and administration of
intravenous
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
,
epidural
Epidural administration (from Ancient Greek ἐπί, , upon" + ''dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and ...
, or
perineural infusions
* Invasive monitoring such as
arterial line
An arterial line (also art-line or a-line) is a thin catheter inserted into an artery.
Use
Arterial lines are most commonly used in intensive care medicine and anesthesia to monitor blood pressure directly and in real-time (rather than by i ...
s,
central venous lines
A central venous catheter (CVC), also known as a central line(c-line), central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more central ...
, and
ventriculostomies
Postoperative complications
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.
Patients do receive antiemetic medications, such as
Ondansetron
Ondansetron, sold under the brand name Zofran among others, is a medication used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, or surgery. It is also effective for treating gastroenteritis. It can be given by ...
and
Dexamethasone
Dexamethasone is a glucocorticoid medication used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, superior vena cav ...
, during the surgical procedure if the patient is at risk for it.
Along with PONV, there are numerous complications that can happen with many different organ systems, the most threatening of which involves the
respiratory system
The respiratory system (also respiratory apparatus, ventilatory system) is a biological system consisting of specific organs and structures used for gas exchange in animals and plants. The anatomy and physiology that make this happen varies grea ...
, and
cardiovascular system
The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...
.
Respiratory system/airway complications
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
Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, cou ...
,
obstructive sleep apnea (OSA),
obesity
Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...
,
heart failure
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...
, and
pulmonary hypertension.
Clinical signs and symptoms are assessed to indicate any respiratory system complications, such as
Tachypnea
Tachypnea, also spelt tachypnoea, is a respiratory rate greater than normal, resulting in abnormally rapid and shallow breathing.
In adult humans at rest, any respiratory rate of 1220 per minute is considered clinically normal, with tachypnea be ...
(RR > 20 breaths/min),
Bradypnea
Bradypnea is abnormally slow breathing. The respiratory rate at which bradypnea is diagnosed depends on the age of the person, with the limit higher during childhood.
Age ranges
* Age 0–1 year < 30 breaths per minute
* Age 1–3 years < 25 br ...
(RR < 12 breaths/min), SpO2 <93%, Anxiety, Confusion, or Agitation with resulting
Tachycardia
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal (su ...
and
Hypertension
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
.
The life-threatening complications that are monitored in PACU include:
*
Laryngospasm
Laryngospasm is an uncontrolled or involuntary muscular contraction (spasm) of the vocal folds. The condition typically lasts less than 60 seconds, but in cases partial blocking it may last 20 to 30 minutes and hinder inspiration, while exhala ...
*
Respiratory arrest
Respiratory arrest is a sickness caused by apnea (cessation of breathing) or respiratory dysfunction severe enough it will not sustain the body (such as agonal breathing). Prolonged apnea refers to a patient who has stopped breathing for a long p ...
*
Airway Edema
*
Foreign Body
A foreign body (FB) is any object originating outside the body of an organism. In machinery, it can mean any unwanted intruding object.
Most references to foreign bodies involve propulsion through natural orifices into hollow organs.
Foreign bo ...
* Cervical
Hematoma
A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...
*
Bronchospasm
Bronchospasm or a bronchial spasm is a sudden constriction of the muscles in the walls of the bronchioles. It is caused by the release (degranulation) of substances from mast cells or basophils under the influence of anaphylatoxins. It causes di ...
*
Pulmonary Edema
Pulmonary edema, also known as pulmonary congestion, is excessive edema, liquid accumulation in the parenchyma, tissue and pulmonary alveolus, air spaces (usually alveoli) of the lungs. It leads to impaired gas exchange and may cause hypoxemia an ...
*
Tension Pneumothorax
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve is ...
*
Pulmonary Embolism
Pulmonary embolism (PE) is a blockage of an pulmonary artery, artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include dyspnea, shortness of breath, chest pain p ...
*
Atelectasis
Atelectasis is the collapse or closure of a lung resulting in reduced or absent gas exchange. It is usually unilateral, affecting part or all of one lung. It is a condition where the alveoli are deflated down to little or no volume, as distinct ...
Cardiovascular System Complications
Cardiovascular complications such as
arrhythmias
Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
and
hemodynamic Instability
Hemodynamics or haemodynamics are the dynamics of blood flow. The circulatory system is controlled by homeostatic mechanisms of autoregulation, just as hydraulic circuits are controlled by control systems. The hemodynamic response continuously m ...
are the third most common postoperative complication.
The risk factors that are assessed preoperatively include the severity of any preexisting cardiovascular comorbidities, such as
congestive heart failure
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...
,
valvular heart disease
Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart (the aortic and mitral valves on the left side of heart and the pulmonic and tricuspid valves on the right side of heart). These ...
, and
myocardial infarctions
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may tra ...
. 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
Vital signs (also known as vitals) are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a ...
.
Hypotension
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
Ringer's lactate solution (RL), also known as sodium lactate solution, Lactated Ringer’s, and Hartmann's solution, is a mixture of sodium chloride, sodium lactate, potassium chloride, and calcium chloride in water. It is used for replacing f ...
Solution,
Normal Saline
Saline (also known as saline solution) is a mixture of sodium chloride (salt) and water. It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses, and help with dry eyes. By injection into a vein it ...
, or
Crystalloid. Patients can also experience life-threatening hypotensive shock due to
hemorrhage
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
,
sepsis
Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
,
cardiogenic, or
anaphylactic
Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of use of emergency medication on site. It typically causes more than one of the follow ...
.
See also
*
Anesthesia
Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...
*
Anesthesiologist
Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, ...
*
Intensive care unit
220px, Intensive care unit
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensiv ...
*
Nurse anesthetist
A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. They are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy.
A survey pu ...
*
Operating department practitioner
*
Anesthetic technician
*
Aldrete's scoring system
Aldrete's scoring system is a commonly used scale for determining when postsurgical patients can be safely discharged from the post-anesthesia care unit (PACU), generally to a second stage (phase II) recovery area, hospital ward, or home. It was d ...
References
Further reading
*
*
*
*
External links
Ketamine: Emergency ApplicationseMedicine.com) - discusses laryngospasm.
{{Authority control
Hospital departments
Anesthesia