Post-Anesthetic Care Unit

Patients are brought to the Post-Anesthetic Care Unit

(PACU) to recover from anesthesia after a surgical procedure. where he/she is closely monitored and maintains adequate ventilation until the patient awakens and continuously
monitors blood pressure, heart rate and rhythm, oxygen saturation respiratory rate. level of Pain

 The type of anesthetic (general, regional, local or

sedation), duration and type of surgery and other patient factors are taken in to consideration to determine the length of stay in PACU.

 After it is evident that the patient is breathing

normally and that his color, circulatory status, and general condition are satisfactory, it is usually safe to move him to postanesthesia recovery room. During transportation the airway must be maintained carefully by the anesthesiologist.

 When the patient arrives in the postanesthesia recovery

area the nurse checks the patient immediately and reports the vital information to the anesthesiologist or the surgeon. This information (vital signs and quick assessment of the overall condition) is compared with the vital signs taken during surgery as the anesthesiologist gives the PACU nurse report. This report should consist of the ff:
patients name type of anesthetic kinds of surgery performed administered overall evaluation of vital signs

Drugs and Intravenous solutions

If the patient has any special conditions, either prior to

surgery or because of surgery, the nurse should be told. Drains, tubes, or suctions must be also be noted.

 The PACU nurse must totally evaluate the patient and

record the findings. This evaluation is done every 15 mins or more often depending on the patients conditions.
For pulse rate, BP, and respiration every 15 mins. for

the first hour Every 30 mins. For the next 2 hours Temperature is monitored every 4 hours for the first 24 hours.

Airway
The airway is the most important item to check when

the patient arrives in the recovery area.

The nurse must note the amount (large or small) of exhaled air.
If the air volume is small, the nurse would suspect a

partial obstruction or respiratory depression. The partial obstruction may be caused by preoperative or intraoperative drugs that may allow the tongue to relax and obstruct the airway, a more common cause is the position of the patient.

 If the air volume still not increased, respiratory

depression from skeletal muscle relaxants or narcotics is the likely cause in which case an antidote maybe given to increase airway exchange. It is also possible that laryngeal spasm is the caused and the drugs and/ or artificial airway is needed.

These are four main types of artificial airways:

Balloon-cuff endotracheal tube Balloon-cuffed nasotracheal tube

Oropharyngeal airway
Nasopharyngeal airway

Balloon-cuff endotracheal tube

inserted through the mouth and the glottis to a point

above the bifurcation of the trachea.

Balloon-cuffed nasotracheal tube

inserted through the nose and the glottis to a point

above the bifurcation of the trachea.

Oropharyngeal airway
Inserted through the mouth of the pharynx.

Nasopharyngeal airway
inserted through the mouth to the pharynx.

Complications Balloon cuff tubes

Cuff pressure should be maintained between 15-

20mmHg. High Cuff pressure can cause:

Tracheal Bleeding

Ischemia
Pressure necrosis.

Low cuff pressure can cause: Aspiration Pneumonia

 Pharyngeal airways do not prevent obstruction of the

airway that occurs when the patients jaw falls downward. The nurse must push the jaw forward as through making the patients lower teeth just out further than the upper teeth. This will pull the tongue forward and open the airway. When a patient has a airway in place, he needs constant observation because he usually lacks laryngeal cough and gag reflex

 Mucus and other secretions in the mouth must be

removed (usually by suctioning) to prevent aspiration, which would cause other respiratory complications.

 Airways usually are not removed by the nurse if it is

gagging the patient. This is a sign that the patient has regained his laryngeal and pharyngeal reflexes (control of tongue, cough and swallow). Even after the airway is removed the nurse must observed the patient, since his tongue can still fall backward. When the patient is able to cooperate, he should be encouraged to deep breath or cough.

 After the nurse assure that the vital signs are stable

and they are no complications occur patient can now be transfer to the hospital room.

THE END !!!