Chapter 70. Recovery of the Healthy Patient

1. The postanesthesia care unit (PACU) requires specially trained personnel to recognize and respond to clinical problems of patient care in the immediate postoperative period.

2. The PACU should be located in close proximity to the operating rooms to access key personnel in a timely manner.

3. The majority of patients admitted to the PACU experience an unremarkable recovery and are discharged from the PACU without problems.

4. Prophylaxis for postoperative nausea and vomiting is far more effective than rescue therapy.

5. Effective postoperative analgesia should be initiated during the surgical procedure.

6. Hypoxia is most often the result of residual effects of anesthetic agents.

7. Hypotension unresponsive to fluid resuscitation in a postoperative patient is most likely attributable to bleeding (unless proven otherwise).

Recovery of patients after procedures requiring anesthesia or sedation is most commonly performed in the postanesthesia care unit (PACU) or recovery room. These are specialized areas designed for the observation, treatment, and discharge of postoperative patients. Optimally, the PACU is located near the operating room (OR), thereby minimizing transport time for the patient and affording quick access to anesthesiologists and surgeons who have cared for the patient. The PACU is staffed by nurses specially trained in the care of patients recovering after surgical and other invasive procedures. Under the supervision of an anesthesiologist, the PACU provides care to a broad cross section of postprocedural patients, with the majority subsequently transferred from the PACU to a general care floor of the hospital, or in the case of an ambulatory care facility, discharged home. The diversity of patients and their surgical procedures admitted to the PACU is quite varied. Many postoperative patients are healthy and have an uneventful hospital course, but some patients experience a perioperative course influenced by their preexisting medical conditions or a complicated intraoperative course.

Patients are usually admitted to the PACU at the conclusion of procedures requiring anesthesia or sedation. With some exceptions, such as healthy patients receiving only local anesthetics and carefully selected patients capable of bypassing the PACU (see later discussion), most patients undergoing surgical procedures require a period of postprocedural close observation. Although most patients are admitted to the PACU after surgical procedures in the OR, patients may also undergo procedures under anesthesia that take place outside of the OR in departments such as radiology, cardiology, or gastroenterology. These patients may also receive postprocedural care in remote areas from the hospital's main recovery areas. Regardless of the procedure and its location, personnel trained and experienced in postprocedural recovery of patients must be present to monitor and oversee the recovery phase and must be able to treat or obtain immediate help in the event of an urgent or acute deleterious change in a patient's condition.

Given the wide range of patients recovering in the PACU, the potential postoperative issues are quite varied. Being able to anticipate the common issues in advance facilitates the initiation of appropriate action(s) in a timely manner and may even avoid postoperative complications.