TY  - CHAP
M1  - Book, Section
TI  - Practice Guidelines for Postanesthetic Care
A1  - Bailin, Michael
A1  - Spanakis, Spiro
PY  - 2000
T2  - Guidelines
AB  - |PrintPractice  Guidelines  for  Postanesthetic  CareComments  by  Michael  T.  Bailin,  MDGuideline  purpose:  to  improve  outcome  of  care  for  post-operative  /  post-sedation  patientsActionsLiterature  EvidenceRecommendationsPostoperative  Assessment  &  Monitoring  of:Respiratory  function1)  Consultants  and  ASA  members  agree  on  recommendations2)  New  literature  insufficient  to  further  evaluatePerform  periodic  assessment  of  airway  patency,  respiratory  rate,  and  SpO2Cardiovascular  functionInsufficient  on  whether  CV  assessment  decreases  perioperative  complicationsMonitoring  of  pulse  and  BP  should  be  performed.  ECG  monitors  should  be  immediately  available.Neuromuscular  function1)  Suggests  that  neuromuscular  blockade  monitors  are  effective2)  New  literature  insufficient  to  further  evaluateNeuromuscular  function  testing  valuable  during  emergence  and  recovery  for  patients  who  have  received  nondepolarizing  neuromuscular  blockersMental  statusInsufficient  regarding  whether  MS  assessment  decreases  complications  Mental  status  should  be  periodically  assessedTemperatureInsufficient  regarding  routine  assessment  leading  to  fewer  complicationsPatient  temperature  should  be  periodically  assessedPainInsufficient  regarding  routine  assessment  of  pain  decreases  complicationsPain  should  be  periodically  assessedNausea  and  vomitingInsufficient  whether  routine  assessment  leads  to  fewer  complicationsRoutine  assessment  of  nausea  and  vomiting  should  be  performedFluid  statusInsufficient  regarding  benefits  of  fluid  status  assessmentAssess  postoperative  hydration  status  in  the  PACU  and  manage  as  necessaryUrine  output  and  voidingInsufficient  regarding  measurement  of  urine  output  and  association  with  postop  complicationsAssess  urine  output  and  voiding  on  a  case-by-case  basisDrainage  and  bleedingInsufficient  on  impact  of  measurementAssess  drainage  and  bleeding  when  indicatedActionsLiterature  EvidenceRecommendationsEmergence  &  Recovery:Prophylaxis  &  Treatment  N/VSupports  pre-  and  intraoperative  use  of  antiemetics  and  insufficient  on  efficacy  of  multiple  agents  to  treat  N/VUse  antiemetic  agents  to  prevent  and  treat  nausea  and  vomiting  when  indicated.  Supplemental  oxygenSupports  use  of  oxygen  to  reduce  incidence  of  hypoxemiaSupplemental  oxygen  can  prevent  and  treat  hypoxemia.  Consultant  experts  remain  equivocal  on  the  routine  use  of  oxygen  during  transport  and  in  PACU.Normalizing  patient  temperatureInsufficient  in  showing  fewer  adverse  outcomesNormothermia  is  desirable  during  emergence  and  recovery.  Treating  hypothermia  with  forced  air  warming  systems  is  appropriatePharmacologic  agents  for  reduction  of  shiveringMeperidine  is  more  effective  than  other  opioid  agonists  or  agonist-antagonistsMeperidine  should  be  used  to  treat  patient  shivering  during  emergence  and  recovery  when  clinically  indicated.  Hypothermia,  should  be  treated  by  rewarming.  Antagonism  of  benzodiazepinesSupports  efficacy  of  flumazenilSpecific  antagonists  should  be  availableAntagonism  of  opioidsSupports  efficacy  of  naloxone  in  reducing  time  to  emergence  and  spontaneous  ventilationSpecific  antagonists  should  be  availableAntagonism  of  NM  Blockade  Supports  efficacy  of  anticholinesterase  agentsSpecific  antagonists  should  be  administered  for  reversal  of  residual  neuromuscular  blockadeActionsLiterature  EvidenceRecommendationsProtocol  for  Discharge:Voiding  before  dischargeInsufficient  to  evaluate  benefitsRequiring  urination  before  discharge  only  necessary  for  selected  patientsDrinking  clear  fluids  without  vomitingOriginal  literature  equivocal,  new  literature  insufficient  to  evaluate  benefitsDrinking  clear  fluids  not  generally  necessary;  determine  case-by-caseResponsible  individual  to  accompany  patient  home  Insufficient  to  evaluate  benefitsAll  patients  should  have  a  responsible  escortMinimum  mandatory  stay  in  recoveryInsufficient  to  evaluate  benefitsObserve  until  patient  no  longer  at  increased  risk;  mandatory  minimum  time  not  requiredSource:  Anesthesiology  2013;  118(2):291-307.  [go  to  full  text  of  guideline]  
SN  - 
PB  - The McGraw-Hill Companies, Inc.
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=5010063
ER  -