Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
The document discusses the history and importance of post-anesthesia care units (PACUs) and outlines their design, equipment, staffing needs, and standard procedures for patient care and monitoring. Key aspects of PACU care include criteria for patient transfer from the operating room to PACU, routine post-anesthesia monitoring and treatment, potential post-operative complications, discharge criteria, and scoring systems used to evaluate patient recovery status.
This document discusses premedication before anesthesia. It defines premedication as the administration of drugs before anesthesia induction. The goals of premedication are to provide anxiolysis, analgesia, amnesia and facilitate induction and recovery from anesthesia. Common drugs used for premedication include benzodiazepines for anxiolysis and sedation, opioids for analgesia, anticholinergics to reduce saliva production, antihistamines for their anticholinergic effects, and antiemetics to prevent nausea and vomiting. Factors like a patient's medical history, surgery type and timing must be considered when determining appropriate premedication.
Post operative care complication managementAftab Hussain
This document discusses standards of care for post-anesthesia care units (PACUs). It provides guidelines for monitoring patients, staffing PACUs appropriately, locating PACUs near operating rooms, and equipping PACUs with necessary medical equipment. Common complications in the PACU like pain, nausea, and respiratory issues are also reviewed. Optimal methods for pain management are outlined, including patient-controlled analgesia, regional techniques like epidurals, and multimodal analgesia.
This document discusses premedication, which is the administration of drugs before anesthesia induction. It has psychological and pharmacological components. Pharmacological premedication aims to provide anxiolysis, analgesia, amnesia and other effects. Common drugs used include benzodiazepines, barbiturates, opioids, NSAIDs, antacids and anticholinergics. Factors like a patient's physical status, surgery type and risk of aspiration are considered. The goals of premedication are to minimize anxiety and discomfort from surgery and anesthesia, while facilitating recovery.
The PACU is designed to monitor and care for patients recovering from anesthesia and surgery. Specially trained nurses make up the PACU staff and are skilled in recognizing postoperative complications. When patients arrive, pertinent medical details are provided. Vital signs are closely monitored including oxygenation, ventilation, circulation, consciousness and temperature. Standards require appropriate post-anesthesia management and evaluation until patients are no longer at risk for complications before discharge from the PACU. Common complications include PONV, upper airway obstruction, hypoxemia, hypertension, hypotension, and delirium.
anesthesia is a vast area for study . to make it simple for paramedics some important rules of anesthesia are explained in the most simplest way. rules of anesthesia can very as per the type of anesthesia.
Epidural anesthesia blocks pain in a specific region of the body by administering local anesthetics into the epidural space surrounding the spinal cord. This results in decreased sensation in the lower half of the body. Epidural anesthesia can be performed at different spinal levels and provides pain relief rather than total lack of sensation. It allows for selective nerve blockade and is commonly used for operations below the diaphragm when general anesthesia is contraindicated or for post-operative pain relief.
The document discusses the history and importance of post-anesthesia care units (PACUs) and outlines their design, equipment, staffing needs, and standard procedures for patient care and monitoring. Key aspects of PACU care include criteria for patient transfer from the operating room to PACU, routine post-anesthesia monitoring and treatment, potential post-operative complications, discharge criteria, and scoring systems used to evaluate patient recovery status.
This document discusses premedication before anesthesia. It defines premedication as the administration of drugs before anesthesia induction. The goals of premedication are to provide anxiolysis, analgesia, amnesia and facilitate induction and recovery from anesthesia. Common drugs used for premedication include benzodiazepines for anxiolysis and sedation, opioids for analgesia, anticholinergics to reduce saliva production, antihistamines for their anticholinergic effects, and antiemetics to prevent nausea and vomiting. Factors like a patient's medical history, surgery type and timing must be considered when determining appropriate premedication.
Post operative care complication managementAftab Hussain
This document discusses standards of care for post-anesthesia care units (PACUs). It provides guidelines for monitoring patients, staffing PACUs appropriately, locating PACUs near operating rooms, and equipping PACUs with necessary medical equipment. Common complications in the PACU like pain, nausea, and respiratory issues are also reviewed. Optimal methods for pain management are outlined, including patient-controlled analgesia, regional techniques like epidurals, and multimodal analgesia.
This document discusses premedication, which is the administration of drugs before anesthesia induction. It has psychological and pharmacological components. Pharmacological premedication aims to provide anxiolysis, analgesia, amnesia and other effects. Common drugs used include benzodiazepines, barbiturates, opioids, NSAIDs, antacids and anticholinergics. Factors like a patient's physical status, surgery type and risk of aspiration are considered. The goals of premedication are to minimize anxiety and discomfort from surgery and anesthesia, while facilitating recovery.
The PACU is designed to monitor and care for patients recovering from anesthesia and surgery. Specially trained nurses make up the PACU staff and are skilled in recognizing postoperative complications. When patients arrive, pertinent medical details are provided. Vital signs are closely monitored including oxygenation, ventilation, circulation, consciousness and temperature. Standards require appropriate post-anesthesia management and evaluation until patients are no longer at risk for complications before discharge from the PACU. Common complications include PONV, upper airway obstruction, hypoxemia, hypertension, hypotension, and delirium.
anesthesia is a vast area for study . to make it simple for paramedics some important rules of anesthesia are explained in the most simplest way. rules of anesthesia can very as per the type of anesthesia.
Epidural anesthesia blocks pain in a specific region of the body by administering local anesthetics into the epidural space surrounding the spinal cord. This results in decreased sensation in the lower half of the body. Epidural anesthesia can be performed at different spinal levels and provides pain relief rather than total lack of sensation. It allows for selective nerve blockade and is commonly used for operations below the diaphragm when general anesthesia is contraindicated or for post-operative pain relief.
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
The post operative period begins from the time the patient leaves the operating room and ends with the follow up visit by the surgeon. The post operative care is provided by – PACU
The document provides information about the Post Anesthesia Care Unit (PACU):
1) The PACU is where patients recover from anesthesia and surgery and are monitored until stable for discharge.
2) The PACU bridges the period from return of consciousness to cardiovascular stability.
3) Standards for PACUs include monitoring patients, staffing requirements, policies for admission and discharge, and guidelines for managing common postoperative complications.
Propofol is a commonly used intravenous anesthetic with the following properties:
- It acts by enhancing the effects of the inhibitory neurotransmitter GABA at GABA-A receptors in the brain, causing sedation and hypnosis.
- It has a rapid onset and context-sensitive half-life, distributing quickly throughout the body before being metabolized in the liver.
- It can be used for induction and maintenance of general anesthesia, as well as for sedation in the ICU. Common side effects include hypotension, respiratory depression, and pain at the injection site. Rare but serious complications include propofol infusion syndrome.
This document discusses supraglottic airway devices. It begins by introducing supraglottic airway devices as those that maintain airway patency by sitting above the glottic opening. It then classifies devices based on generation, sealing mechanism, number of lumens, and discusses indications, contraindications, advantages, and disadvantages of supraglottic airway devices. Specific devices like LMA Classic, Flexible LMA, Ambu Aura, Soft Seal LMA, and Intubating LMA are then described in more detail. Problems associated with devices and techniques to reduce aspiration are also covered.
This document discusses anesthesia and sedation procedures performed outside the operating room. It outlines common procedures that require anesthesia outside OR settings like radiology suites and ICUs. It also describes the challenges anesthesiologists face in these settings like unfamiliar environments, limited equipment and monitoring, and patient issues. Guidelines are provided for sedation versus general anesthesia based on the procedure and safety standards for monitoring, equipment, and discharge criteria when anesthesia is provided outside the traditional operating room.
This document discusses day care anaesthesia, which involves providing anaesthetic care for elective outpatient surgical procedures and discharging patients on the same day. Key benefits include reduced hospital bed usage, lower costs, and fewer hospital-acquired infections. Patients must meet selection criteria like being ASA physical status I-III with controlled medical conditions, over 6 weeks old, able to recover at home, and having a low-risk procedure under 90 minutes. Contraindications include procedures with major fluid shifts or blood loss, significant postoperative pain or nausea/vomiting, uncontrolled medical issues, or substance abuse.
Regional anesthesia is a technique that induces loss of sensation in part of the body using local anesthetics. It has benefits like lower costs, high patient satisfaction, and decreased risks of DVT and PE compared to general anesthesia. However, it requires skills and may cause issues like hypotension. The main types are topical, intravenous, peripheral nerve blocks, plexus blocks, and neuro-axial blocks. Regional anesthesia can provide anesthesia for surgery, post-op analgesia, or chronic pain treatment. Factors like the anesthetic used, patient position, and injection speed affect its spread. Spinal and epidural blocks involve injecting anesthetic into the subarachnoid or epidural space and have risks like anaphyl
Spinal anesthesia involves injecting local anesthetic into the subarachnoid space of the spinal canal. The summary discusses the key points of spinal anesthesia including:
1. The technique involves preparing equipment and positioning the patient before inserting the spinal needle between vertebrae to inject local anesthetic and induce nerve block.
2. Complications include hypotension from sympathetic blockade and post-dural puncture headache from leakage of cerebrospinal fluid through the puncture site in the dura mater.
3. Indications are for lower body and lower abdominal surgeries, with contraindications including infection, coagulopathies, and anatomical abnormalities that prevent safe needle placement.
This document provides information on spinal anaesthesia. It discusses the history of spinal anaesthesia, indications, contraindications, anatomy, procedure, positions, techniques, drugs used, mechanism of action, adjuvants, and factors affecting block height. The key points are:
- Spinal anaesthesia involves injecting local anaesthetic into the subarachnoid space to block nerve impulses and provide anaesthesia or analgesia.
- Common indications include surgeries of the lower body and patients with medical comorbidities. Contraindications include infection, coagulopathies, and increased intracranial pressure.
- Proper patient positioning, sterile technique, identification of spinal landmarks, and slow injection
Total intravenous anesthesia (TIVA) involves inducing and maintaining general anesthesia exclusively through intravenous drug administration without volatile agents. It utilizes short-acting hypnotic drugs like propofol and analgesic drugs like fentanyl delivered via target-controlled infusion pumps. TIVA provides advantages like rapid titratability of drugs, faster recovery, reduced pollution and side effects like nausea. Precise computer-controlled infusion pumps along with pharmacokinetic models are used to achieve and maintain targeted drug concentrations in the blood and effect sites. Common drugs utilized in TIVA include propofol, fentanyl and muscle relaxants which are administered individually or in combinations based on the patient and procedure.
Intravenous induction agents are drugs given intravenously to induce anesthesia rapidly. Ideal properties include water solubility, stability, rapid onset within one arm-brain circulation time, rapid redistribution and clearance with no active metabolites, minimal effects on vital organs, and a high therapeutic ratio. Common IV induction agents discussed are barbiturates, propofol, ketamine, etomidate, benzodiazepines, and opioids. Each drug has different effects on the cardiovascular, respiratory, and central nervous systems and potential complications.
This is a brief review of airway management (basics, exams and devices).
Special thanks to Dr. S. Malek for kind sharing of his valuable slides on this topic.
This document discusses various methods of monitoring patients under anaesthesia. It covers basic monitoring including vital signs and advanced instrumental monitoring of cardiovascular, respiratory, temperature, neuromuscular and central nervous systems. For each system, both non-invasive and invasive monitoring techniques are described along with their clinical indications, principles of operation, normal values and potential complications. Maintaining vigilance through multimodal monitoring is important to prevent anaesthesia complications.
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
This document discusses non-operating room anesthesia (NORA). It begins by defining NORA as anesthesia provided outside the operating room, such as in radiology, endoscopy suites, MRI, and dental clinics. It then outlines a three step approach to NORA involving thorough patient assessment, appropriate monitoring and anesthesia care, and post-procedure management. Several ASA guidelines for equipment and facilities in NORA locations are also reviewed. Complications associated with NORA and special considerations for procedures like X-rays, MRIs, and IV contrast administration are discussed. The document emphasizes choosing anesthesia techniques based on patient factors and needs for each specific non-operating room procedure.
Rapid sequence intubation (RSI) is a method for quickly securing a patient's airway to prevent aspiration of gastric contents during induction of general anesthesia. It involves pre-oxygenating the patient, administering induction drugs to induce unconsciousness, giving a paralytic to facilitate intubation, and immediately placing an endotracheal tube while applying cricoid pressure. RSI is indicated for patients at high risk of aspiration, such as those with delayed gastric emptying, altered mental status, or a difficult airway. Proper preparation, pre-treatment, paralysis, intubation placement, and post-intubation management are key steps to successfully perform RSI. Complications can include failed intubation,
The document discusses sedation, analgesia, and paralysis in the ICU. It describes the goals of sedation as patient comfort while allowing interaction. The challenges include assessing sedation and altered drug pharmacology. An ideal sedation agent would have rapid onset and offset and lack respiratory depression. Monitoring scales like the Richmond Agitation Scale are used to standardize treatment. Dexmedetomidine, propofol, opioids and paralytics may be used. The optimal sedation approach balances adequate treatment while avoiding oversedation risks.
This document discusses various hazards that can be present in an operating room, including fires/explosions, static electricity, electrical hazards, radiation injury, air pollution, and power failure. It provides details on the causes and risks of each hazard, as well as precautions that can be taken to reduce risks, such as ensuring proper electrical maintenance and inspection, minimizing static electricity through flooring/clothing choices, and having adequate ventilation and fire safety equipment. The document emphasizes that operating rooms involve technologically complex environments with many potential hazards that require close monitoring and safety protocols.
A Postanesthesia Care Unit (PACU) or an area which provides equivalent postanesthesia care. shall be available to receive patients after anesthesia care. PACU and sometimes referred to as post-anesthesia recovery or PAR, or simply Recovery is a vital part of hospitals, ambulatory care centers, and other medical facilities.
Post anesthesia care unit for Residents of Anesthesiamansoor masjedi
The document discusses the post anesthesia care unit (PACU). It provides standards for PACU including that all patients receiving anesthesia should receive post-anesthesia management in the PACU. Upon arrival in the PACU, patients should be re-evaluated and the nurse provided a verbal report. Patients should be continually evaluated in the PACU and a physician is responsible for discharging the patient. The document discusses various early postoperative physiologic changes that can occur including hypoxia, hypothermia, shivering, and cardiovascular instability. It focuses on issues like upper airway obstruction from loss of muscle tone and potential residual neuromuscular blockade.
The document discusses monitored anesthesia care (MAC), which involves administering drugs to provide anxiolytic, hypnotic, amnestic, and analgesic effects without depressing consciousness below a certain level. It provides guidelines on drug selection and dosing for MAC, including opioids like fentanyl and remifentanil, benzodiazepines like midazolam, propofol, ketamine, and dexmedetomidine. It also discusses factors that can lead to patient agitation during MAC and principles of drug administration via continuous infusion or patient-controlled methods.
The post operative period begins from the time the patient leaves the operating room and ends with the follow up visit by the surgeon. The post operative care is provided by – PACU
The document provides information about the Post Anesthesia Care Unit (PACU):
1) The PACU is where patients recover from anesthesia and surgery and are monitored until stable for discharge.
2) The PACU bridges the period from return of consciousness to cardiovascular stability.
3) Standards for PACUs include monitoring patients, staffing requirements, policies for admission and discharge, and guidelines for managing common postoperative complications.
Propofol is a commonly used intravenous anesthetic with the following properties:
- It acts by enhancing the effects of the inhibitory neurotransmitter GABA at GABA-A receptors in the brain, causing sedation and hypnosis.
- It has a rapid onset and context-sensitive half-life, distributing quickly throughout the body before being metabolized in the liver.
- It can be used for induction and maintenance of general anesthesia, as well as for sedation in the ICU. Common side effects include hypotension, respiratory depression, and pain at the injection site. Rare but serious complications include propofol infusion syndrome.
This document discusses supraglottic airway devices. It begins by introducing supraglottic airway devices as those that maintain airway patency by sitting above the glottic opening. It then classifies devices based on generation, sealing mechanism, number of lumens, and discusses indications, contraindications, advantages, and disadvantages of supraglottic airway devices. Specific devices like LMA Classic, Flexible LMA, Ambu Aura, Soft Seal LMA, and Intubating LMA are then described in more detail. Problems associated with devices and techniques to reduce aspiration are also covered.
This document discusses anesthesia and sedation procedures performed outside the operating room. It outlines common procedures that require anesthesia outside OR settings like radiology suites and ICUs. It also describes the challenges anesthesiologists face in these settings like unfamiliar environments, limited equipment and monitoring, and patient issues. Guidelines are provided for sedation versus general anesthesia based on the procedure and safety standards for monitoring, equipment, and discharge criteria when anesthesia is provided outside the traditional operating room.
This document discusses day care anaesthesia, which involves providing anaesthetic care for elective outpatient surgical procedures and discharging patients on the same day. Key benefits include reduced hospital bed usage, lower costs, and fewer hospital-acquired infections. Patients must meet selection criteria like being ASA physical status I-III with controlled medical conditions, over 6 weeks old, able to recover at home, and having a low-risk procedure under 90 minutes. Contraindications include procedures with major fluid shifts or blood loss, significant postoperative pain or nausea/vomiting, uncontrolled medical issues, or substance abuse.
Regional anesthesia is a technique that induces loss of sensation in part of the body using local anesthetics. It has benefits like lower costs, high patient satisfaction, and decreased risks of DVT and PE compared to general anesthesia. However, it requires skills and may cause issues like hypotension. The main types are topical, intravenous, peripheral nerve blocks, plexus blocks, and neuro-axial blocks. Regional anesthesia can provide anesthesia for surgery, post-op analgesia, or chronic pain treatment. Factors like the anesthetic used, patient position, and injection speed affect its spread. Spinal and epidural blocks involve injecting anesthetic into the subarachnoid or epidural space and have risks like anaphyl
Spinal anesthesia involves injecting local anesthetic into the subarachnoid space of the spinal canal. The summary discusses the key points of spinal anesthesia including:
1. The technique involves preparing equipment and positioning the patient before inserting the spinal needle between vertebrae to inject local anesthetic and induce nerve block.
2. Complications include hypotension from sympathetic blockade and post-dural puncture headache from leakage of cerebrospinal fluid through the puncture site in the dura mater.
3. Indications are for lower body and lower abdominal surgeries, with contraindications including infection, coagulopathies, and anatomical abnormalities that prevent safe needle placement.
This document provides information on spinal anaesthesia. It discusses the history of spinal anaesthesia, indications, contraindications, anatomy, procedure, positions, techniques, drugs used, mechanism of action, adjuvants, and factors affecting block height. The key points are:
- Spinal anaesthesia involves injecting local anaesthetic into the subarachnoid space to block nerve impulses and provide anaesthesia or analgesia.
- Common indications include surgeries of the lower body and patients with medical comorbidities. Contraindications include infection, coagulopathies, and increased intracranial pressure.
- Proper patient positioning, sterile technique, identification of spinal landmarks, and slow injection
Total intravenous anesthesia (TIVA) involves inducing and maintaining general anesthesia exclusively through intravenous drug administration without volatile agents. It utilizes short-acting hypnotic drugs like propofol and analgesic drugs like fentanyl delivered via target-controlled infusion pumps. TIVA provides advantages like rapid titratability of drugs, faster recovery, reduced pollution and side effects like nausea. Precise computer-controlled infusion pumps along with pharmacokinetic models are used to achieve and maintain targeted drug concentrations in the blood and effect sites. Common drugs utilized in TIVA include propofol, fentanyl and muscle relaxants which are administered individually or in combinations based on the patient and procedure.
Intravenous induction agents are drugs given intravenously to induce anesthesia rapidly. Ideal properties include water solubility, stability, rapid onset within one arm-brain circulation time, rapid redistribution and clearance with no active metabolites, minimal effects on vital organs, and a high therapeutic ratio. Common IV induction agents discussed are barbiturates, propofol, ketamine, etomidate, benzodiazepines, and opioids. Each drug has different effects on the cardiovascular, respiratory, and central nervous systems and potential complications.
This is a brief review of airway management (basics, exams and devices).
Special thanks to Dr. S. Malek for kind sharing of his valuable slides on this topic.
This document discusses various methods of monitoring patients under anaesthesia. It covers basic monitoring including vital signs and advanced instrumental monitoring of cardiovascular, respiratory, temperature, neuromuscular and central nervous systems. For each system, both non-invasive and invasive monitoring techniques are described along with their clinical indications, principles of operation, normal values and potential complications. Maintaining vigilance through multimodal monitoring is important to prevent anaesthesia complications.
1) Day case anesthesia, also known as ambulatory surgery or same-day surgery, allows patients to be admitted for a surgical procedure and investigation but return home the same day without an overnight hospital stay.
2) There has been a rapid expansion in the use of day case surgery over the last 30 years, with approximately 65% of surgeries in the United States now performed on an outpatient basis.
3) Day case anesthesia provides advantages like reduced costs, increased bed availability, and less risk of hospital-acquired infections compared to traditional inpatient surgery.
This document discusses non-operating room anesthesia (NORA). It begins by defining NORA as anesthesia provided outside the operating room, such as in radiology, endoscopy suites, MRI, and dental clinics. It then outlines a three step approach to NORA involving thorough patient assessment, appropriate monitoring and anesthesia care, and post-procedure management. Several ASA guidelines for equipment and facilities in NORA locations are also reviewed. Complications associated with NORA and special considerations for procedures like X-rays, MRIs, and IV contrast administration are discussed. The document emphasizes choosing anesthesia techniques based on patient factors and needs for each specific non-operating room procedure.
Rapid sequence intubation (RSI) is a method for quickly securing a patient's airway to prevent aspiration of gastric contents during induction of general anesthesia. It involves pre-oxygenating the patient, administering induction drugs to induce unconsciousness, giving a paralytic to facilitate intubation, and immediately placing an endotracheal tube while applying cricoid pressure. RSI is indicated for patients at high risk of aspiration, such as those with delayed gastric emptying, altered mental status, or a difficult airway. Proper preparation, pre-treatment, paralysis, intubation placement, and post-intubation management are key steps to successfully perform RSI. Complications can include failed intubation,
The document discusses sedation, analgesia, and paralysis in the ICU. It describes the goals of sedation as patient comfort while allowing interaction. The challenges include assessing sedation and altered drug pharmacology. An ideal sedation agent would have rapid onset and offset and lack respiratory depression. Monitoring scales like the Richmond Agitation Scale are used to standardize treatment. Dexmedetomidine, propofol, opioids and paralytics may be used. The optimal sedation approach balances adequate treatment while avoiding oversedation risks.
This document discusses various hazards that can be present in an operating room, including fires/explosions, static electricity, electrical hazards, radiation injury, air pollution, and power failure. It provides details on the causes and risks of each hazard, as well as precautions that can be taken to reduce risks, such as ensuring proper electrical maintenance and inspection, minimizing static electricity through flooring/clothing choices, and having adequate ventilation and fire safety equipment. The document emphasizes that operating rooms involve technologically complex environments with many potential hazards that require close monitoring and safety protocols.
A Postanesthesia Care Unit (PACU) or an area which provides equivalent postanesthesia care. shall be available to receive patients after anesthesia care. PACU and sometimes referred to as post-anesthesia recovery or PAR, or simply Recovery is a vital part of hospitals, ambulatory care centers, and other medical facilities.
Post anesthesia care unit for Residents of Anesthesiamansoor masjedi
The document discusses the post anesthesia care unit (PACU). It provides standards for PACU including that all patients receiving anesthesia should receive post-anesthesia management in the PACU. Upon arrival in the PACU, patients should be re-evaluated and the nurse provided a verbal report. Patients should be continually evaluated in the PACU and a physician is responsible for discharging the patient. The document discusses various early postoperative physiologic changes that can occur including hypoxia, hypothermia, shivering, and cardiovascular instability. It focuses on issues like upper airway obstruction from loss of muscle tone and potential residual neuromuscular blockade.
The post anesthesia care unit (PACU) is where patients recover after surgery and anesthesia. It is equipped to monitor unstable patients while providing comfort for stable patients. Upon arrival, the anesthesiologist provides a report to the PACU nurse. Vital signs are closely monitored for complications like low oxygen, breathing issues, or irregular heart rate. Standard criteria govern PACU design, staffing, and discharge of stable patients once criteria are met, such as a score of 9 or higher on the Postanesthetic Discharge Scoring System. Common complications include nausea, breathing problems, and low blood pressure, which nurses are trained to quickly identify and treat.
Roles of the postanesthesia care unit nurseNick Alfaro
The roles of the PACU nurse include monitoring patients recovering from anesthesia for complications and ensuring safe recovery. PACU nurses must be skilled in airway management, resuscitation, and caring for surgical drains and catheters. Key responsibilities involve assessing vital signs, pain, nausea and other physiological parameters regularly and providing interventions to address issues like hypoxemia and pain. Discharge criteria involves patients being awake, stable, and without active issues like bleeding or hypothermia before leaving the PACU.
This document summarizes guidelines for oxygen therapy in post-operative care. It recommends that oxygen therapy is an important part of recovery and can reduce post-operative complications. The summary outlines standards for best practice, such as all patients in recovery receiving oxygen according to local guidelines, and all high-risk patients who could benefit from post-operative oxygen being prescribed it and using it correctly. Audit indicators are proposed to measure adherence to these standards.
The document discusses various post-operative complications related to the cardiovascular system (CVS), central nervous system (CNS), and recovery in the post-anesthesia care unit (PACU). Some key points include: common CVS complications are hypotension and hypertension, which can be treated with fluid administration or vasopressors/antihypertensives respectively; arrhythmias are also common after cardiac surgery; common neuropsychiatric complications in PACU include delirium, delayed arousal, and failure to arouse due to various medical causes; and hypothermia is another potential complication addressed by maintaining normothermia.
Post-Operative Managment
• The post operative period begins from the time
• The patients leaves the operating room and ends with the
follow up visit by the surgeon.
• The post operative care is provided by
-- PACU
-- SICU
This document discusses day case or ambulatory surgery. It notes that over the last 30 years, there has been rapid expansion in the use of day-case surgery, with the percentage of patients going home the same day increasing from less than 10% to approximately 65%. Suitable procedures are those that take less than 90 minutes, do not cause excessive bleeding or pain, and have minimal postoperative physiological disturbances. The growth of ambulatory surgery has been facilitated by improved anesthetic techniques and shorter-acting drugs that allow for faster recovery.
The document provides guidelines for nursing management of women undergoing obstetric operations. It outlines:
1) Equipment and monitoring required in recovery, including vital signs monitoring every 5 minutes for 30 minutes;
2) Criteria for safe transfer to the postnatal ward once stable, including pain level below 1;
3) Post-operative observations every 30 minutes for 2 hours then every 2 hours for 24 hours, including vital signs, pain, temperature and wound/loss monitoring.
This document discusses perioperative nursing. It defines the three phases of perioperative care as preoperative, intraoperative, and postoperative. It then describes the roles and responsibilities of the surgical team members, types of anesthesia used, principles of surgical asepsis including scrubbing and gowning procedures.
This document discusses day case or ambulatory surgery. It notes that over the last 30 years, there has been rapid expansion in the use of day-case surgery, with the percentage of patients going home the same day increasing from less than 10% to approximately 65%. Suitable procedures are those that take less than 90 minutes, do not cause excessive bleeding or pain, and are accompanied by minimal postoperative disturbances. The growth of ambulatory surgery has been facilitated by improved anesthetic techniques and drugs that allow for faster recovery. Regional anesthesia and nerve blocks can also benefit recovery. Guidelines for safe discharge include stable vital signs and adequate pain control and mobility.
Remove
the catheter and
notify the
physician.
Prevention:
- Secure tubing
and catheter to
prevent snagging
- Use blunt
scissors only near
IV site
- Avoid
reinserting
needles
The National Confidential Enquiry into Peri-operative Deaths (NCEPOD) was established in the UK in 1988 to comprehensively and authoritatively review clinical practice surrounding deaths within 30 days of surgery. NCEPOD aims to maintain and improve standards of care for both adults and children through confidential case reviews, research, and publishing results. The National Early Warning Score (NEWS) is an excellent initiative that helps staff recognize patient deterioration earlier through standardized scoring of physiological parameters, enabling sicker patients to receive timely intensive care.
The document discusses "core measures", which are evidence-based guidelines established by CMS and the Joint Commission for treating patients with certain diagnoses. The core measure patient groups include CHF, pneumonia, AMI, surgical care improvement, psychiatry, and patient satisfaction. Hospitals must follow specific treatment protocols for these patients and are audited to ensure compliance. Identifying core measure patients early and using established protocols and tools is key to improving outcomes and quality measures.
Post operative-care,gynecology and obstetriczaid rasheed
Pre and postoperative care involves careful preparation and management of patients before and after surgery. Preoperative care includes patient education, assessments, preparation through managing medications and comorbidities, and thromboprophylaxis. Immediate postoperative care focuses on monitoring in PACU until stable for discharge. Intermediate care involves continued monitoring on the ward. Post-cesarean and post-gynecological operation care follow specific guidelines around monitoring, wound care, and managing potential complications. Care aims to enable safe and fast recovery.
This document outlines the course objectives and content for a Post Anesthesia Care Unit (PACU) training course. The course objectives cover topics such as postoperative patient transportation and handover, PACU equipment, monitoring and roles, postoperative pain management, complications and their treatment. The document details the sessions that will cover these topics over 4 days. It also provides the assessment methods for the course and reference materials. The overall goal of the PACU training course is to educate medical professionals on providing safe and effective postoperative care to patients in the recovery phase after anesthesia and surgery.
The document discusses the Postanesthesia Care Unit (PACU). It describes the history and development of PACUs over the past 50 years. It outlines PACU staffing, location, equipment, admission reports, postoperative pain management, and discharge criteria. Key topics covered include nausea and vomiting, respiratory complications, failure to regain consciousness, myocardial ischemia, and fever as potential postoperative issues.
The document outlines trauma admission guidelines and response times for specialists at Monroe Carell Jr. Children's Hospital. It provides guidelines for admitting trauma patients based on their injuries and conditions. It also establishes response time requirements for specialists, including the trauma service responding within 15 minutes for level I activations, neurosurgery and spine responding within 30 minutes for indications like increased ICP or unstable spine, and orthopedics responding within 30 minutes for acute limb issues or within 1 hour for open fractures.
The document discusses preoperative, intraoperative, and postoperative care for surgical patients. The preoperative phase includes assessing the patient's medical history and preparing them for surgery. Intraoperatively, the surgical team provides anesthesia and monitors the patient's vital signs. Postoperatively, patients are recovered in the PACU and nurses focus on respiratory, cardiovascular and other body functions as well as wound healing. Potential postoperative complications like pneumonia, hemorrhage, and infection are also outlined.
Peri-operative Nursing/Anesthesia/Pain ManagementWasim Ak
The care provide during surgical intervention (pre-operative, intra-operative and post-operative period) is known as Peri-operative Nursing Care.
Peri-operative Nursing Care includes :
Pre-operative Nursing Care
Intra-operative Nursing Care
Post-operative Nursing Care.
Anesthesia means “loss of sensation with or without loss of consciousness” .
Medications that cause anaesthesia, are called Anesthetics.
Anesthesia is defined as a temporary state consisting of unconsciousness, loss of memory, lack of pain, and muscle relaxation.
Anesthesia is defined as a loss of feeling or awareness caused by drugs or other substances which keeps patient free from feeling pain during surgery or other procedures.
Allergic rhinitis, or hay fever, is a common condition affecting 10-25% of the global population. It is an inflammation of the nasal passages caused by an immune system response to allergens like pollen, dust mites, or pet dander. Symptoms include sneezing, nasal congestion, runny nose, and itchy eyes. Allergic rhinitis can impair quality of life and work or school performance. Intranasal corticosteroids are the most effective treatment for both intermittent and persistent allergic rhinitis. The ARIA guidelines recommend intranasal corticosteroids as first-line treatment alone or in combination with oral antihistamines depending on the severity
Role of anesthesia nurse in operation theatreHIRANGER
The roles of an anesthesia nurse in the operating theatre include:
1. Assisting the anesthesiologist by conducting pre- and post-anesthesia assessments, developing anesthesia plans, administering medications, monitoring patients, and managing emergence from anesthesia.
2. Working in operating rooms, post-anesthesia recovery areas, and post-anesthesia care units during the perioperative period to support patients before, during, and after surgery.
3. Recognizing and responding to patient responses and changes in condition during the perioperative period in order to safely support life functions.
Cystic fibrosis is a genetic disorder that causes thick, sticky mucus to build up in the lungs and digestive tract. It is most common in Caucasians and affects the lungs, pancreas, liver, and intestines. The main symptoms include salty-tasting skin, chronic lung infections, and poor growth due to problems with digesting and absorbing food. It is diagnosed via a sweat test and treated with airway clearance techniques, antibiotics, enzymes, and a high-calorie diet. With improvements in treatment, life expectancy for those with cystic fibrosis has increased but lung disease remains the primary cause of mortality.
Aha resuscitation guidelines 2015 what's newHIRANGER
The document is a summary by Dr. Rajesh T. Eapen of the 2015 resuscitation guidelines. It discusses the new recommendations for resuscitation, including updates to protocols and procedures. Dr. Eapen compiled the summary as an anesthesiologist at Atlas Hospital in Ruwi, Oman.
This document provides an overview of acute myocardial infarction (MI or heart attack). It defines MI as diminished blood supply to the heart muscle leading to cell damage and death. Risk factors include age, family history, smoking, diabetes, hypertension, hyperlipidemia, obesity, and physical inactivity. Symptoms may include chest pain, nausea, sweating, and changes in vital signs. Diagnosis involves electrocardiograms and cardiac enzyme levels. Treatment aims to restore blood flow and includes medications, fibrinolytic therapy, angioplasty, and bypass surgery. Nursing focuses on monitoring for ischemia, controlling chest pain, educating patients, and modifying risk factors.
The document discusses the history and types of anesthesia, from ancient civilizations using plants for pain management to the development of modern general anesthesia with ether and chloroform in the 1800s. It also covers regional anesthesia techniques like spinal blocks and local infiltration, as well as the different classes of drugs used for induction, maintenance, analgesia, and muscle relaxation during general anesthesia. The choice of anesthesia depends on factors like the procedure, patient health, and surgeon requirements.
This document discusses various conditions affecting the external ear canal, including:
- Otitis externa (swimmer's ear), which can range from mild to severe bacterial infections. Pseudomonas and Staph are common causes. Treatment involves cleaning, topical antibiotics, and pain control.
- Otomycosis is a fungal infection of the ear canal most often caused by Aspergillus or Candida. Symptoms are similar to bacterial otitis but with more pruritus. Treatment involves thorough cleaning and topical antifungals.
- Necrotizing external otitis is a potentially lethal Pseudomonas infection seen in diabetics and immunocompromised patients.
This document discusses nephrotic syndrome, which is characterized by proteinuria, hypoalbuminemia, and edema. It defines nephrotic syndrome and outlines its causes, which include genetic, secondary, and idiopathic factors. The pathophysiology involves disturbances in the immune system and mutations affecting glomerular filtration. Clinical features and laboratory findings are provided for different types. Management involves treating symptoms, infections, and relapses with corticosteroids and immunosuppressants. Complications include edema, infections, thrombosis, and renal failure. Prognosis depends on response to steroids, with minimal change disease having a good prognosis and focal segmental glomerulosclerosis having poorer outcomes.
This document outlines important aspects of antenatal care based on NICE/RCOG guidelines. It discusses the aims and timeline of antenatal visits, including initial screening and testing at 10 weeks to check pregnancy and general health. Regular checks are recommended to monitor pregnancy progress and detect any issues. The document also describes screening protocols for common conditions like anemia, gestational diabetes, and infections. Common symptoms are discussed along with lifestyle and treatment recommendations. Interventions not routinely needed are also noted.
The document discusses cerebrovascular accidents (strokes), including types of strokes, risk factors, signs and symptoms, nursing management in the acute and hyperacute phases, and collaborative care approaches for prevention, diagnosis, and treatment. It provides an overview of strokes, their causes, impact, and the critical role of nurses in monitoring patients, administering treatments, and coordinating multidisciplinary care.
Subarachnoid hemorrhage occurs when there is bleeding into the subarachnoid space surrounding the brain. It is usually caused by the rupture of an intracranial aneurysm. Risk factors include age, family history, smoking, and hypertension. Patients often present with a sudden and severe headache described as "the worst headache of my life". Diagnosis is typically made through CT scan or lumbar puncture. Treatment involves securing the aneurysm through clipping or coiling to prevent rebleeding, as well as managing complications such as cerebral vasospasm, seizures, and hydrocephalus.
Health Tech Market Intelligence Prelim Questions -Gokul Rangarajan
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
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The Ultimate Guide in Setting Up Market Research System in Health-TechGokul Rangarajan
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
But Why do they skip it?
Limited resources—time, money, and manpower—are common culprits.
"In fact, a survey by CB Insights found that 42% of startups fail due to no market need, which is like building a spaceship to Mars only to realise you forgot the fuel."
Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
Overconfidence in their product’s success leads founders to assume it will naturally find its market, especially in health tech where patient needs, entire system issues and regulatory requirements are as complex as trying to perform brain surgery with a butter knife. Additionally, the pressure to launch quickly and the belief in their own intuition further contribute to this oversight. Yet, thorough market research in health tech could be the key to transforming a startup's vision into a life-saving reality, instead of a medical mishap waiting to happen.
Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
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Cancer treatment has advanced significantly over the years, offering patients various options tailored to their specific type of cancer and stage of disease. Understanding the different types of cancer treatments can help patients make informed decisions about their care. In this ppt, we have listed most common forms of cancer treatment available today.
Nursing management of the patient with Tonsillitis PPTblessyjannu21
Prepared by Prof. Blessy Thomas MSc Nursing, FNCON, SPN. The tonsils are two small glands that sit on either side of the throat.
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5. Introduction
Recovery from anesthesia can range from
completely uncomplicated to life-threatening.
Must be managed by skilled medical and
nursing personnel.
Anesthesiologist plays a key role in optimizing
safe recovery from anesthesia
Must be carried out in a well planned, protocol
based fashion
2/4/2015 3:47:52 PM 5
6. PAC
Definition
It is the specialized care given
to the patients who have
undergone anaesthetic
management, by a team of
well trained professionals, in a
specially designed, equipped
and designated area of the
hospital
2/4/2015 3:47:52 PM 6
7. PURPOSES
To enable a successful and faster recovery of
the patient post operatively.
To reduce post operative mortality rate.
To reduce the length of hospital stay of the
patient.
To provide quality care service.
To reduce hospital and patient cost during
post operative period.
2/4/2015 3:47:53 PM 7
8. PAC Vs. Post operative care
PAC is provided to
anyone who has undergone anaesthesia
anaesthesia might not be for a surgical
procedure
patients undergoing ECT, Narco analysis
patients under going Endoscopies
+
all the patients who have undergone
surgeries
2/4/2015 3:47:53 PM 8
9. PACU
Definition : It is the
Specially designated
Specially designed
Specially located
Specially staffed
Specially equipped
for a
Specific purpose !
2/4/2015 3:47:53 PM 9
10. History of the PACU
Methods of anesthesia have been available for more
than 160 years, but the PACU has only been common
for the past 70 years.
One can trace it to “Lady of the lamp”: F. N.
1920’s and 30’s: several PACU’s opened in the US and
abroad.
It was not until after WW II that the number of PACUs
increased significantly. This was due to the shortage of
nurses in the US.
In 1947 a study was released which showed that over an
11 year period, nearly half of the deaths that occurred
during the first 24 hours after surgery were preventable.
1949: having a PACU was considered a standard of
care.
2/4/2015 3:47:55 PM 10
11. PACU Location
Shouldbe locatedclose to the OperatingTheater
Immediateaccess to x-ray, bloodbank,bloodgas and clinical
labs.
An openwardis optimalfor patientobservation,with at least
oneisolationroom.
Centralnursingstation.
Requiresgoodventilation,becausethe exposureto waste
anestheticgasesmay be hazardous.
NationalInstituteof OccupationalSafety (NIOSH) has
establishedrecommendedexposurelimitsof 25 ppm for
nitrousoxide and2 ppm for volatileanesthetics.
2/4/2015 3:47:55 PM 11
12. Design of PACU
Size:
Ideal 1.5 PACU bed for every Operating Room
120 square foot per patient
Minimum of 7 feet between beds
Facilities:
Fowler’s cot with side rails
Piped Oxygen, Vacuum and Air
Multiple electrical outlets
Large doors
Good lighting
Isolation for Immuno-compromised patients
2/4/2015 3:47:55 PM 12
13. PACU
PACU should be sound
proof, painted in soft colour,
isolated and these features
will help the patient to
reduce anxiety and promote
comfort.
2/4/2015 3:47:55 PM 13
17. PACU Staffing
One nurse to one patient for the first 15
minutes of recovery.
Then one nurse for every two patients.
The anesthesiologist responsible for the
anesthetic remains responsible for managing
the patient in the PACU.
Adequate no. of ancillary staff, such as
technicians, ward boys and female attenders.
2/4/2015 3:47:56 PM 17
18. PACU Equipment
Multi-parametric monitors (Automated BP,
pulse ox, ECG) and intravenous supports
should be located at each bed.
Area for charting, bed-side supply storage,
suction, and oxygen flow meter at each bed-
side.
Immediately available - Emergency
equipment, Crash cart, Defibrillator.
2/4/2015 3:47:56 PM 18
20. Routine Post-Anaesthesia Care
Criteria for shifting from
OR---to---PACU
Haemo dynamic stability
Clinical evaluation and
complete recovery from
NM blockade
Maintenance of Oxygen
Saturation
Normothermia
2/4/2015 3:47:56 PM 20
21. PACU Standards
1. All patients who have received general anesthesia,
regional anesthesia, or monitored anesthesia care
should receive post-anesthesia management.
2. The patient should be transported to the PACU by
a member of the anesthesia care team that is
knowledgeable about the patient’s condition.
3. Upon arrival in the PACU, the patient should be re-
evaluated and a verbal report should be provided to
the nurse.
4. The patient shall be evaluated continually in the
PACU.
5. Anaesthesiogist, concerned is responsible for
discharge of the patient.
2/4/2015 3:47:56 PM 21
22. PHASES OF POST OP UNIT
Two phases-
Phase I
Phase II
2/4/2015 3:47:56 PM 22
23. Phase I
It is the immediate recovery phase
and requires intensive nursing care
to detect early signs of complication.
Receive a complete patient record
from the operating room which to
plan post operative care.
It is designated for care of surgical
patient immediately after surgery
and patient requiring close
monitoring
2/4/2015 3:47:56 PM 23
24. Phase II
Care of the surgical patient who has
been transferred from the Phase I
post op unit.
Patient requiring less observation
and less nursing care than Phase I
This phase is also known as Step
down or progressive care unit.
2/4/2015 3:47:56 PM 24
25. Admission Report
Preoperative history
Intra-operative factors:
Procedure
Type of anesthesia
Estimated Blood Loss (EBL)
Urine output
Assessment and report of current status
Post-operative instructions
2/4/2015 3:47:56 PM 25
26. Postoperative Pain Management
Intravenous opioids
Diclofenac, I.V. Paracetamol and anti-
inflammatory drugs
Midazolam for anxiety
Epidural : LAAs and their adjuvants
Regional analgesic blocks
PCA (Patient controlled analgesia) and PCEA
2/4/2015 3:47:56 PM 26
32. NURSING MANAGEMENT IN POST
OP UNIT
To provide care until the
patient has recovered from
the effect of anesthesia.
Assessing the patient
Monitor vitals-pulse volume
and regularity, depth and
nature of respiration.
Assessment of patient’s O2
saturation.
Skin colour.
2/4/2015 3:47:57 PM 32
36. Protect airway
By proper positioning of
patient’s head.
By clearing airway.
Oxygen therapy.
Pharyngeal obstruction
can occur when the
patient lies on the back
as there are chances for
tongue to fall back.
2/4/2015 3:47:57 PM 36
37. Maintaining IV Stability
Hypovolemic shock: can be
avoided by timely administration of
IV Fluids, blood and blood
products and medication.
Replacement of fluids.[colloids
and crystalloids]
Monitor intake and output balance.
2/4/2015 3:47:57 PM 37
38. ASSESSMENT OF THE SURGICAL SITE
Hemorrhage
It is a serious
complication of surgery
that can result in death.
It can occur in
immediate post
operatively or up to
several days after
surgery.
If left untreated cardiac
output decreases and
blood pressure and Hb
level will fall rapidly.
2/4/2015 3:47:57 PM 38
39. Blood transfusion if
necessary.
The surgical site + incision
should always be inspected.
If bleeding- pressure dressing
placed.
If the bleeding is concealed,
the patient is taken in OR for
emergency exploration of
concealed hemorrhage in
body cavity.
2/4/2015 3:47:57 PM 39
40. KEEP THE PATIENT WARM
Use warmer(Bair
Hugger) blankets
Use warm lights
2/4/2015 3:47:58 PM 40
41. Relieving pain +Anxiety
Administer opioid
analgesia as per
Doctor’s order.
Epidural analgesia.
NSAIDS.
Psychological support to
relieve fear+To give
support.
2/4/2015 3:47:58 PM 41
42. Post Operative Complications
Nausea and Vomiting
Respiratory Complications
Failure to Regain Consciousness
Circulatory Complications
Fever
2/4/2015 3:47:58 PM 42
43. Controlling Nausea + Vomiting
This is common
problem in post
operative period.
Medication can be
administered as per
doctor’s order.
Example:
Inj Metoclopramide
Inj Ondansetron
(Emeset /Zofran)
2/4/2015 3:47:58 PM 43
47. Discharge criteria from PACU
Neither an arbitrary time limit nor a discharge
score can be used to define a medically
appropriate length stay in the PACU accurately
All patients must be evaluated by
anesthesiologist/trained staff prior to discharge
from PACU
Criteria for discharge developed by the
Anesthesia department
Criteria depends on where the patient is sent –
ward, ICU, home
2/4/2015 3:47:58 PM 47
48. Discharge criteria from PACU
Easy arousability
Full orientation
Ability to maintain & protect airway
Stable vital signs for at least 15 – 30
minutes
The ability to call for help if necessary
No obvious surgical complication (active
bleeding)
2/4/2015 3:47:58 PM 48
49. Discharge From the PACU
Standard Aldrete Score:
Simple sum of numerical values assigned to
activity, respiration, circulation, consciousness,
and oxygen saturation.
A score of 9 out of 10 shows readiness for
discharge.
Post-anesthesia Discharge Scoring System:
Modification of the Aldrete score which also
includes an assessment of pain, N/V, and surgical
bleeding, in addition to vital signs and activity.
Also, a score of 9 or 10 shows readiness for
discharge.
2/4/2015 3:47:58 PM 49
50. ALDRETE SCORE
Post-Anesthesia Score
A total discharge score of 8-10 is necessary
Post-Anesthesia Score
PRE-ANESTHESIA VITAL SIGNS/SOURCE TIME ADM 15" 30" 45" 1' 2' 3' 4' DISCHARGE
SYSTOLIC BP 20% OF PRE-ANESTHETIC LEVEL
2
CIRCULATION 20-50% 1
> 50 0
FULLY AWAKE 2
CONCIOUSNES
S
AROUSABLE ON CALLING 1
NOT RESPONDING 0
WARM, DRY SKIN W/ PREPROCEDURAL
COLORING 2
COLOR PALE, DUSKY, BLOTCHY, JAUNDICED, OTHER
1
CYANOTIC 0
ABLE TO DEEP BREATHE & COUGH FREELY
2
RESPIRATION DYSPNEA OR LIMITED BREATHING APKEIC
1
0
ABLE TO MOVE 4 EXTREMITIES 2
ACTIVITY ABLE TO MOVE 2 EXTREMITIES 1
ABLE TO MOVE 0 EXTREMITIES 0
COMMENTS TOTAL2/4/2015 3:47:58 PM 50
51. Aldrete Score
Activity Respiration Circulation Consciousness Oxygen
Saturation
2: Moves all
extremities
voluntarily/ on
command
2:Breaths deeply
and coughs
freely.
2: BP + 20 mm of
pre-anesthetic
level
2:Fully awake 2: Spo2 > 92%
on room air
1: Moves 2
extremities
1: Dyspneic,
shallow or limited
breathing
1: BP + 20-50 mm
pre-anesthetic
level
1: Arousable on
calling
1:Supplemental
O2 required to
maintain Spo2
>90%
0: Unable to
move
extremities
0: Apneic 0: BP + 50 mm of
preanestheic level
0: Not responding 0: Spo2 <92% with
O2
supplementation
2/4/2015 3:47:58 PM 51
52. 2/4/2015 3:48:01 PM 52
Interpretation of Aldrete’s score
Lowest score = 0 – 2
Score for patient to be shifted to next level of
care = 9
Since some patients on arrival to PACU will meet the
score of 8, it is very illogical to fix a number for
shifting the patient
Ideally it should be decision of the Anesthesiologist
regarding the shifting from the PACU to next level of
care taking into account the anesthetic plan & the
drugs given intra-operatively as well as in PACU
53. Post-anesthesia Discharge Scoring
System (PADSS)
Vital Signs
(BP and
Pulse)
Activity Nausea and
Vomiting
Pain Surgical
Bleeding
2: Within 20% of
preoperative
baseline
2: Steady gait,
no dizziness
2: Minimal: treat
with PO meds
2: Acceptable
control per the
patient;
controlled with
PO meds
2: Minimal: no
dressing
changes
required
1: 20-40% of
preoperative
baseline
1: Requires
assistance
1: Moderate:
treat with IM
medications
1: Not
acceptable to the
patient; not
controlled with
PO medications
1: Moderate: up
to 2 dressing
changes
0: >40% of
preoperative
baseline
0: Unable to
ambulate
0: Continues:
repeated
treatment
0: Severe: more
than 3 dressing
changes
2/4/2015 3:48:01 PM 53
54. Discharge from the Post Operative Unit
A patient remains in the post op unit, until
the patient has fully recovered from
anesthesia.
Following measures are used to
determine the patient ready for
discharge from post operative unit:-
Stable vital signs
Orientation to Person, Place
Time or events
Adequate oxygen saturation level.
Urine out put at least 30ml/hour
Minimal pain.
Adequate respiratory function.
Aldrete score more than ‘ 9 ‘
2/4/2015 3:48:01 PM 54
55. Teaching, Patient Self Care
Expected out comes
Immediate post
operative changes
Written instructions like
Wound care
Activity+dietary
recommendation
Medications
Follow up
2/4/2015 3:48:01 PM 55
56. Safe guidelines for discharging to
home after ambulatory surgery
Patient should be able to stand & take a few
steps ( sit on bed if C/ I for standing)
Should be able to sip fluids
Should be able to urinate
Should be able to repeat post-operative
management
Should be able to identify the escort
(cognitive function)
2/4/2015 3:48:01 PM 56
57. Summary & Conclusion
Anaesthesia is becoming very sophisticated!
PAC is an absolutely essential care given by a
team of professionals!!
Anaesthesiologists and Trained nursing staff
are the most important members of PACU!!!
Thorough understanding of pathophysiology of
this period is very essential!!!!
With a well organized PACU, one can prevent
lot of post-operative morbidity & mortality!!!!!!
2/4/2015 3:48:01 PM 57