about post anesthesia care

1. Post anesthesia care unit
Presented by
Muhammad Akhtar
Operation theatre technology
Roll No ( 21102)

2. During The Presentation
• Put cell phones on silent mode.
• Take emergency call outside.
• Maintain silence.

3. Learning object
Number of post anesthesia care unit bed?
Patient ,family ,and staff traffic patterns?
Equipment needed at each bedside ?
Standards for post anesthesia care ?
Early post op physiological changes ?
Location with respect to the operating room ?

4. Introduction
“Post anesthesia care unit is the area designated for the monitoring
and care of the patients who are recovering from the immediate
physiological derangements produce by anesthesia and surgery”

5. PURPOSES
• To enable a successful and faster recovery of the patient
postoperatively.
• To reduce post operative mortality rate.
• To reduced the length of hospital stay of the patient.
• To provide quality care services .
• To reduce hospital and patient cost during post operative period.

6. HISTORY
• Method of anesthesia have been available for more than 160 years
• PACU has only been common for the past 70 years.
• After world war 2 the number of PACUs increased significantly.
• Nearly half of the death that occurred during the first 24 hours after
surgery were preventable.
• In 1949 having a PACU was considered a standard of care.

7. PACU LOCATION
• Should be located close to the operation theatre.
• Immediate access to x-ray, blood bank, blood gas, clinical labs.
• An open ward is optimal for patient observation , with at least one
isolation room .
• Central nursing station.
• Required good ventilation ,because the exposure to waste anesthetic
gases may be hazardous .
• Entrance and exit doors must be extra wide .

8. DESIGN OF PACU
SIZE:
• Ideal 1.5 PACU bed for every operating room
• 150 -200 square foot per patient
• Minimum of 7 feet between beds.
• At least 12 sq foot of shelf space for supplies and equipment .
• At least one isolation or side room connected with pacu
• Patient privacy is a major concern.
• Two fire exit at opposite ends of the room are recommended

9. PACU FLOOR PLAN
• Square floor plan with one wall accommodating the nurses ,desk and
support areas and other three walls having patient bed slot.
• This design offers direct sight lines to the patients and the shortest
distance between point in the PACU.
• Pods of four beds at right angles located in the middle of a large space
Utility drop from the ceiling or come up into a tower like structure
called utility tree .
• Open ward design facilitate simultaneous observation of all patients

11. FACILITIES
• Fowlers cot with side rails.
• Piped oxygen , vacuum and air .
• Multiple electrical outlets
• Large doors
• Good lighting
• Isolation for immune compromised patients
• Should be sound proof ,painted in soft color isolated.

12. 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 number of ancillary staff ,such as technicians ,ward boys
and female attenders .
• One anesthesiologist assigned to be responsible for final medical
decisions In PACU.

13. PACU lighting
• Some daylight visible to patients in the PACU.
• Bright fluorescent bright will be used in ceiling fixture in the general
common areas.
• Each bed space needs three levels of lighting co0ntrolled button
within bed space
• A low level nightlight for observation of sleeping patients.
• A fluorescent fixture centered in the ceiling.
• One procedure light for each bed.
• At least one portable light.

14. PACU environment
• Average temperature in in a PACU should be about 75F .
• Humidity should be maintained at 40%-60%.
• Slightly positive air pressure in the PACU room .
• Minimum of six air changes per hour ,two of which are fresh outside
air.

15. Electrical power
• At least six to eight regular outlets on the head wall or on the utility
center for each bed space .
• Two outlet should be connected to an emergency power system that
has kick in time of less than 10 seconds during a power failure.
• These outlets should be marked with red face plate.
• 240 volt plugs to allow the use of portable x-ray machines.

16. Medical gases
• At least two and preferably three oxygen outlets having flow meter
installed all the times.
• There should be three to five suction outlets at the head of each bed
slot.
• A tracheal /gastrointestinal suction regulators bottle installed at all
times.
• One Outlets for chest tubes, drains .
• One compressed air outlet at each bed space to allow the use of a
blender for respiratory therapy.

17. PACU communication
• Cordless telephones be quite useful since they allow the nurse to talk
on the telephone without leaving the bedside.
• A dedicated intercom system exclusive to the surgical suite area is
viable alternative.
• Paging system with loudspeakers for large PACUs.
• Alarm system that summon help in a crisis.

19. Central equipment in the PACU
• A full resuscitation set an obvious necessity.
• Respiratory equipment ,and cut down set all times .
• Warming devices
• Vacuum tubes that can be used to send paper work.
• Supply of flashlights and battery power lanterns.
• Tray with labeled emergency drugs.

20. PACU –REQUIREMENT
 MONITORS:
ECG
Pulse oximeter
Etco2
Non invasive BP
Invasive pressure monitor
Temperature

21. PACU –REQUIREMENT
• Airway maintenance kit;
Laryngoscope (all size blade)
Endotracheal tubes (all size)
Face mask ,airways ,ambu bag ,venture masks
Cricothyriodectomy set
Tracheostomy set
Transport ventilator

22. Essential equipment for each bed space
• There must be oxygen tubing and associated oxygen delivery devices
such as nasal cannula ,regular face mask ,and rebreathing mask .
• Electronic monitoring system.Eg.cardiac monitor
• A flashlight for regular use and in power failure.
• Nasal and oral airways and tracheal suction catheters .
• A capnograph , a self inflating resuscitator bag ,a pressure bag for
rapid iv infusion ,blood tubes ,blood gas kits
• Basic nursing tools eg. gloves ,pads ,tape , scissors .

23. Discharge criteria
Aldrete score:
• Simple sum of numerical values assigned to activity , respiration
,circulation ,consciousness, and oxygen saturation
• A score 9 out of 10 shows readiness for discharge from PACU.

25. References
• American society of anesthesiology
• Simpson, J.C. and Moonesinghe, S.R., 2013. Introduction to the
postanaesthetic care unit. Perioperative medicine, 2(1), p.5.