Phases of Anesthesia Care

Questions and Answers

What is the primary goal of a multimodal approach to analgesia in the PACU?

To use opioids as the primary source of pain control

To prolong the duration of postoperative pain management

To reduce the dose of a single analgesic agent (correct)

To minimize the risk of respiratory depression (correct)

What is a critical component of discharge criteria from the PACU?

Patient's vital signs remain stable for at least 30 minutes (correct)

Patient is able to ambulate without assistance

Patient has a resting oxygen saturation of at least 95% on room air

Patient has a pain score of 0 on a 0-10 scale

What is a key strategy for minimizing cardiac risk in the PACU?

Administering beta blockers to all patients

Monitoring the patient's electrocardiogram continuously (correct)

Maintaining a hemoglobin level above 10 g/dL

Controlling hypertension through aggressive medication management

How is hypoxemia typically treated in the PACU?

By administering oxygen through a nasal cannula Signup and view all the answers

How is respiratory risk assessed in the PACU?

By monitoring the patient's oxygen saturation Signup and view all the answers

What is a common component of multimodal analgesia in the PACU?

Opioids, NSAIDs, and acetaminophen Signup and view all the answers

What is a key consideration when evaluating discharge criteria from the PACU?

The patient's ability to void Signup and view all the answers

How is respiratory compromise assessed in the PACU?

By evaluating the patient's oxygen saturation Signup and view all the answers

What is a common risk associated with hypoxemia in the PACU?

All of the above Signup and view all the answers

What is a key component of cardiac risk management in the PACU?

Monitoring the patient's electrocardiogram continuously Signup and view all the answers

Study Notes

Phases of Perianesthesia Care

Continuum of care includes preanesthesia preparation, intraoperative care, postoperative care, Phase I: Postanesthesia/ICU care, and Phase II: Outpatient care
Purpose of postoperative care is critical assessment and stabilization of patients with prevention and detection of complications

Transport

Notify PACU of impending patient, extraordinary equipment needed, urgent procedures, and acuity of the patient
Decide on transport mode: general anesthesia to sedated, spontaneous ventilation requirement, responsive or unconscious patient, and airway reflexes
Stabilize patient: assure stable condition, administer O2 as needed, monitor ventilation, monitor level of consciousness, and use essential monitors, medications, and resuscitation equipment

PACU Triage

Admission involves collaboration between CRNA and PACU staff
Evaluate patient's clinical condition, length/type of procedure, length/type of anesthetic, and potential for complications
Immediately assess respiratory and cardiac status, note deviations between preop/intraop/postop status
Anesthesia's role: stabilize, oxygenate, and assess

Initial Assessment

Determine physiologic status of patient
Evaluate periodically to identify trends and establish a baseline of medical conditions
Assess surgical site and prevent/treat complications

Aldrete Scoring System

Evaluates activity, respiration, circulation, consciousness, and oxygen saturation
Fit for discharge or transfer = score ≥ 9

Major Body Systems Assessment

Cardiac, Respiratory, Neuro, Renal, LDAs, and Surgical site

PACU Handoff

Critical time: exchange of essential information between anesthetist and PACU RN
Prevent failures of information exchange, which can result in sentinel events and poor patient outcomes

PACU Report

General Information: name, DOB, surgical procedure, surgeon, and anesthesia providers
Patient History: acute/chronic conditions, allergies, comorbidities, medications
Intraoperative Course: anesthetic related, unexpected response, preoperative sedatives, reversal agent, and multimodal analgesics
Postoperative Plan: concerns, interventions, lab and hemodynamic limits, discharge criteria, and contact person

PACU Complications

Postoperative Nausea/Vomiting (PONV): incidence, consequences, and risk factors (female, non-smoker, history of PONV, postoperative opioid use, etc.)
Prophylaxis is key! Identify who is at risk using Apfel simplified risk score
Evaluate risks and treatments for common perioperative complications