Phases of Anesthesia Care

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

Discharge Criteria

• Includes cardiac, respiratory, and renal assessments, pain management, and other factors

Quiz covering the different stages of anesthesia care, from preanesthesia preparation to postoperative care, including Phase I and Phase II care.