History of anesthesia recovery - ANSWER Recovery rooms have been in existence for
less than 40 years in most medical centers. Prior to that time there was an increased
number of postoperative deaths that occurred immediately after anesthesia and surgery
Now a PACU is used as an area of residence for the postoperative client during the time
the anesthesia effects are worn off. This timeframe is usually marked by a high
incidence of possibly life-threatening respiratory and or circulatory complications
PACU RN's may not be familiar with these complications so YOU MUST BE!
o pr two phases of anesthesia recovery - ANS Phase I: from emergence to PACU
discharge criteria are met
Phase II: lower level of care that assures the patient is ready to be discharged
-Fast-tracking in this phase for outpatients that may bypass phase I
-Common with eye procedures, local/MAC cases, endoscopies
Requirements of a PACU - ANSWER Staff should have special training in:
Maintenance of airway
ACLS
Hypertension
Hypotension
Post operative pain
Nausea & Vomiting
Malignant Hyperthermia
Drainage catheters/post op bleeding
The average PACU stay - ANSWER 1 hour, with the average procedure about 2 hours
This would imply that a PACU should have a patient nurse ratio of 2:1, and about 1.5
beds per OR
, Location of the PACU - ANSWER Alongside the OR to allow easy access by the
anesthesia staff
Equipment Available at each bedside - ANSWER Oxygen
Suction
ECG monitor
Blood pressure monitor
Pulse oximetry
Equipment Readily Available - ANSWER Thermometer
Advanced organ support- vent, intravascular tranducers, code cart, IV, Bair Hugger
Transport from OR to PACU - ANSWER Patient should NOT leave the OR unless they
have a stable and patent airway, adequate ventilation AND oxygenation, and are
hemodynamically stable
Most patients should be transported with supplemental oxygen
Temporary hypoxemia (SpO2 < 90%) may develop in as many as 30-50% of patients on
room air from - ANSWER Unstable patients, or those with questionable
ventilation/oxygenation, should be left intubated & maybe transported to ICU
PACU admission - ANSWER a. The first responsibility is to evaluate respiratory and
circulatory function
b. Report to PACU RN begins with a report including history, medical conditions, type of
surgey, type of anesthetic, intraoperative events, blood loss, UO, fluid intake, any
anticipated post-op problems, and any post-op orders
c. VS monitored minimum of every 15 mins
PACU discharge and criteria - ANSWER d.Policy may require 2nd evaluation by
anesthesia services
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