Recovery from anesthesia Patient selection after recovery Janusz Andres

PACU (postanesthesia care unit) years ago specialized nursing care high incidence of potentially life- threatening respiratory and circulatory complications

PACU design Localization close to OR, diagnostic facility, intensive care station, enough space, electrical outlets Equipment Staffing

Emergence from general anesthesia Potential problems: airway obstruction, shivering, agitation, delirium, pain, nausea and vomiting, hypothermia, autonomic liability, arterial pressure fluctuations Inhalation anesthetics : proper ventilation (factors: alveolar ventilation and blood solubility) Intravenous anesthesia: pharmacokinetics: redistribution and half time

Delayed emergence Definition: when patient fails to regain consciousness minutes following GA More common causes: residual anesthetic, sedative and analgesic drug effects Naloxone (0,2 mg) and flumazenil (0,5 mg), physostigmine (1-2 mg)

Other causes of delayed emergence from GA Hypothermia (core temp. < 33 0 C) Hypoxemia and hypercarbia Hypercalcemia, hypermagnesemia, hyponatremia, and hypo- and hyperglycemia Perioperative stroke

Transport from the operating room Stable and patent airway Adequate ventilation Adequate oxygenation Hemodynamically stable

Routine recovery General anesthesia Regional anesthesia Pain control Agitation Nausea and vomiting Shivering

Discharge criteria (color, respiration, circulation, conciousness, activity) Easy arousability Full orientation The ability to maintain and protect the airway Stable vital signs No surgical complications

Complications Respiratory problems: airway obstruction, laryngospasm, hypoventilation, hypoxemia Circulatory problems: hypotension, hypertension, arrhythmias