POST ANESTHESIA CARE UNIT (PACU)

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Design of PACU
• Near the operating room and other Intensive
Care facilities
• Open ward (to facilitate observation of all
patients simultaneously)
• well lighted (day light)

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Equipment
• Pulse oxymetri
• ECG
• BP monitor
• Warming/cooling blanket
• Emergency trolley
• outlets : oxygen, electrical, suction
• minor set
• infusion/syringe pump

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Before world war II
Post operative death after anesthesia and
surgery is high
This period is characterized by relatively high
incidence of potentially life threatening.
Respiratory and circulatory complications.
After world war II
Success of RR  factor in evaluation of modern
ICU/PACU

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Staffing

• Nurses - trained in care of emerging

Patients ( ACLS)
- I Nurse for 2 Beds ( Patients )
• Medical direction of an Anesthesiologist
Coordinated to Surgeon and any consultants

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Emergence from Anesthesia
• Because post operative is a time of great
physiologic stress.
Ex…….. - Airway obstruction
- Shivering
- Vomite ...etc.
• Delayed Emergence
• When the patients fail to regain
consciousness 60-90 minute following
general anesthesia ( G.A.)
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The causes

• Residual Anesthetic
• Sedative
• Prolong effect of opiate
• Hypothermia
• Metabolic Disturbances
• Perioperative stroke (rare)

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 Post op/post anesthesia Management

•Monitoring: - vital sign - BP

–Pulse/HR
–RR
- Oxygen supplementation (SpO2)
- Temp
- Sensory and motor level (Regional
Anesthesia)

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Pain control
- parenteral
- Regional anesthesia
- Nerve Block
Agitation/Restlessness
- cause ? (hipoxemia, acidosis etc)
Nausea and vomiting
cause ?  hypotension by
- regional anesthesia
- opioid
- vagal tone
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Shivering
cause ?
- Unwarmed I.v. fluids
- Exposure of large wound
- AC
- Hyperthermia
- Metabolic acidosis ect
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Complications in PACU
1. Airway obstruction
- Unconscious patients  tongue
falling back against the posterior
pharynx
- Larynx spasm
- Glottic edema etc

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2. Hypoventilation
- Defined as PaCO2 > 45 mmHg
pH < 7,25
- Causes
- Residual depressant effect of
anesthesia agents (overdose)
- In adequate reversal
- Severe pain
- Tight abdominal dressing
- CO2 production is high
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3. Hypoxaemia
Defined as PaO2 < 70 mmHg
Causes
- Hypoventilation
- Oxygen consumption
- FRC
- Lung - edema

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4. Hypotension
- Defined as A 20-30% reduction of
BP
- Causes
- Hypovolemia
- Ventricular dysfunction
- Impaired cardiac filling

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5. Hypertension
Defined as BP > 20-30% of base line
Causes
Sympathetic activation
- pain
- hypercapnia

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6. Arrhythmia
- Hypercarbia
- Electrolyte disturbances
- Residual effects of cholinesterase
inhibitor

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Discharge criteria
- must be evaluated
- after 60 minutes in the PACU
-Aldrete score
_____________________________________
Parameters Value
____________________________________
color - pink 2
- pale 1
- cyanotic 0
_____________________________________
Respiration - Breathe deeply & cough 2
- Shallow but adequate 1
- apnea 0
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_____________________________________
Circulation
BP within 20% of normal 2
20-50% 1
50% from normal 0
_________________________________________________
Consciousness
- awake/alert 2
- arousable 1
- no response 0
_________________________________________________
Activity
- move all extr 2
- move 2 extr 1
- no movement 0

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Terimakasih

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