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DR. AHMED S. KOMI, MD
Dep. Of Anesth. & Intensive care
Farwaniya Hospital
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POSTANESTHESIA CARE UNITDesign
Equipment
Staffing
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POSTANESTHESIA CARE UNITDesign
Located near the operating rooms
Proximity to radiographic, laboratory, and other
intensive care facilities on the same floor
Open ward design
Each patient space should be well lighted Multiple electrical outlets and at least one outlet for
oxygen, air, and suction
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POSTANESTHESIA CARE UNITEmergency Equipment
1. Oxygen cannulas2. Masks
3. Oral and nasal airways
4. Laryngoscopes , ndotracheal tubes, laryngeal
mask airways, and self-inflating bags for ventilation
5. Defibrillation device
6. Tracheostomy, chest tube, and vascular cutdown
trays
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POSTANESTHESIA CARE UNITRespiratory therapy equipment
1. Continuous positive airway pressure (CPAP)
2. Ventilators
3. Bronchoscope
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CARE OF THE PATIENT
EMERGENCE FROM GENERAL ANESTHESIA TRANSPORT FROM THE OPERATING ROOM
ROUTINE RECOVERY
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CARE OF THE PATIENTEMERGENCE FROM GENERAL ANESTHESIA
Recovery from general or regional anesthesia is a timeof great physiological stress for many patients.
Emergence from general anesthesia should ideally
be a smooth and gradual awakening in a controlled
environment
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CARE OF THE PATIENT
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CARE OF THE PATIENTResidual anesthetic, sedative, and analgesic drug
effectHypothermia
Hypoxemia and hypercarbia
Hypercalcemia, hypermagnesemia, andhyponatremia
Hypoglycemia and hyperglycemia
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CARE OF THE PATIENTTRANSPORT FROM THE OPERATING ROOM
This period is usually complicated by the lack of
adequate monitors, access to drugs, or resuscitative
equipment
Patients should not leave the operating room
unless they have a stable and patent airway, haveadequate ventilation and oxygenation, and are
hemodynamically stable
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CARE OF THE PATIENTTRANSPORT FROM THE OPERATING ROOM
All patients should be taken to the PACU on a bed or
trolley that can be placed in either:
Head down (Trendelenburg) hypovolemic patients
Head-up position pulmonary dysfunction
lateral position prevent airway obstruction andfacilitates drainage of secretions.
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CARE OF THE PATIENTROUTINE RECOVERY
a) Airway patency, vital signs, and oxygenation should be
checked immediately on arrival
b) 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
c) Pulse oximetry should be monitored continuously
d) Neuromuscular function should be assessed clinicallye) At least one temperature measurement
f) Pain assessment
g) Presence or absence of nausea or vomiting
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CARE OF THE PATIENTAgitation
Pain is often manifested as postoperative
restlessness
Systemic disturbances
Hypoxemia
Acidosis
Hypotension Bladder distention
Surgical complication (such as occult intraabdominal
hemorrhage)
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CARE OF THE PATIENTNausea & Vomiting
Patient factors
1. Young age2. Female gender, particularly if menstruating on day
of surgery of in first trimester of pregnancy
3. Large body habitus
4. History of prior postoperative emesis5. History of motion sickness
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CARE OF THE PATIENTNausea & Vomiting
Anesthetic techniques
1. General anesthesia2. Drugs
a. Opioids
b. Volatile agents
c.
Neostigmine
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CARE OF THE PATIENTNausea & Vomiting
Surgical procedures
1. Strabismus surgery2. Ear surgery
3. Laparoscopy
4. Orchiopexy
5. Ovum retrieval6. Tonsillectomy
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CARE OF THE PATIENTNausea & Vomiting
Postoperative factors1. Postoperative pain
2. Hypotension
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CARE OF THE PATIENTShivering & Hypothermia
Intraoperative hypothermia
Cold ambient temperature in the operating room Prolonged exposure of a large wound
Use of large amounts of unwarmed intravenous fluids
High flows of unhumidified gases
Effects of anesthetic agents Immediate postpartum period
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Discharge CriteriaBefore discharge, patients should have been observed
for respiratory depression for at least 2030 min after the
last dose of parenteral narcotic. Other minimum
discharge criteria for patients recovering from generalanesthesia usually include the following:
(1) Easy arousability
(2) Full orientation
(3) The ability to maintain and protect the airway(4) Stable vital signs for at least 1530 min
(5) The ability to call for help if necessary
(6) No obvious surgical complications (such as active
bleeding).
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Discharge CriteriaPostanesthetic Aldrete Recovery Score
Oxygenation
SpO2 > 92% on room air2
SpO2 > 90% on oxygen 1
SpO2 < 90% on oxygen 0
Respiration
Breathes deeply and coughs freely2
Dyspneic, shallow or limited breathing 1
Apnea 0
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Discharge CriteriaPostanesthetic Aldrete Recovery Score
CirculationBlood pressure 20 mm Hg of normal 2
Blood pressure 2050 mm Hg of normal 1
Blood pressure more than 50 mm Hg of normal 0
ConsciousnessFully awake 2
Arousable on calling 1
Not responsive 0
ActivityMoves all extremities 2
Moves two extremities 1
No movement 0
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Discharge CriteriaPostanesthesia Discharge Scoring System (PADS)
Vital signs
Within 20% of preoperative baseline 2
Within 2040% of preoperative baseline 1
> 40% of preoperative baseline
0
Activity level
Steady gait, no dizziness, at preoperative level
2
Requires assistance 1
Unable to ambulate 0
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Discharge CriteriaPostanesthesia Discharge Scoring System (PADS)
Nausea and vomiting Minimal, treated with oral medication
2
Moderate, treated with parenteral medication
1 Continues after repeated medication
0
Pain: minimal or none, acceptable to patient, controlled withoral medication
Yes 2 No 1
Surgical bleeding Minimal: no dressing change required
2
Moderate: up to two dressing changes 1
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RECOMMENDATIONS1) Patients should not leave the operating room
unless they have a stable and patent airway, have
adequate ventilation and oxygenation, and are
hemodynamically stable.
2) Before discharge, patients should have been
observed for respiratory depression for at least 20
30 min after the last dose of parenteral narcotic.
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Our Aim is to Discharge
Happy Patient
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