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  1. Preparation for recovery begins before the child arrives in the preoperative area for surgery.

  2. The postanesthesia care unit (PACU) must be equipped and staffed for full resuscitation if that becomes necessary.

  3. Good communication between anesthesia and recovery staff at handoff from the operating room (OR) is crucial.

  4. Perioperative agitation is common in children and is multifactorial; emergence delirium is a specific entity in the postoperative period that may be best managed by prophylaxis.

  5. There are many causes for respiratory insufficiency in the postoperative period. Management should focus on rapid diagnosis and symptomatic treatment.

  6. Postoperative nausea or vomiting (PONV) is more common in children than in adults. Identified risk factors should be sought and prophylaxis considered if found.

  7. Children can have difficulty communicating pain; a multimodal approach to analgesia in the perioperative period offers many benefits.

  8. Good communication with parents on PACU discharge is necessary to achieve an acceptable post-op course.

Preparation for recovery begins long before the child arrives on the unit; there are a number of things that can be done starting in the preoperative area that will influence emergence and wakeup. There is some evidence that a quiet induction in a calm child is more likely to result in a quieter wakeup.1,2 It also appears to be the case that slower, more gradual emergence combined with minimal stimulus during that emergence may also decrease agitation in the PACU.3 Preemptive pain management will decrease pain as an element, and PONV prophylaxis, including avoidance of risks factors and medications, can also be valuable especially in those at higher risk.


Physical Space Requirements

The PACU should ideally be located in close proximity to the operating room (OR); both to decrease transport times and to ensure readily availability of personnel and support in case of emergency. An open plan is frequently employed to facilitate monitoring, but provision should be made for either separation of spaces (ie, curtain) or physical movement to a different area to provide some privacy for child and parents in the later stages of recovery.

Personnel Requirements

Nursing staff must be competent in recognizing and initiating treatment for commonly encountered issues and recognizing when assistance is desirable/necessary. They should have experience and training in pediatric resuscitation, including airway management and cardiovascular support, in recognizing and assessing pain, and good interpersonal ability to manage parents. Skills should be frequently assessed and updated to maintain competency; practice sessions or simulations can be invaluable. Clear delineation of physician supervision must be established and a clear policy of whom to call for assistance known to all staff. Also clearly indicated must be handoff and signout protocols.

Equipment Requirements

The recovery space must be equipped to handle all potential issues that may arise during the recovery process. ...

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