1. Recovery from anesthesia Patient selection after recovery Janusz Andres

2. PACU (postanesthesia care unit) 35 - 40 years ago specialized nursing care high incidence of potentially life- threatening respiratory and circulatory complications

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

4. 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

5. Delayed emergence Definition: when patient fails to regain consciousness 60 - 90 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)

6. 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

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

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

9. 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

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