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Post-Anesthetic Care Unit Patients are brought to the Post-Anesthetic Care Unit

(PACU) to recover from anesthesia after a surgicalprocedure.

where he/she is closely monitored and maintainsadequate ventilation until the patient awakens andcontinuously monitors blood pressure,

heart rate and rhythm,

oxygen saturation

respiratory rate.

level of Pain

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The type of anesthetic (general, regional, local orsedation), duration and type of surgery and other

patient factors are taken in to consideration todetermine the length of stay in PACU.

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After it is evident that the patient is breathing

normally and that his color, circulatory status, andgeneral condition are satisfactory, it is usually safe tomove him to postanesthesia recovery room. Duringtransportation the airway must be maintained

carefully by the anesthesiologist.

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When the patient arrives in the postanesthesia recoveryarea 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 theoverall condition) is compared with the vital signs takenduring 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 tosurgery or because of surgery, the nurse should be told.Drains, tubes, or suctions must be also be noted.

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The PACU nurse must totally evaluate the patient and

record the findings. This evaluation is done every 15mins or more often depending on the patientsconditions.

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 24hours.

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Airway The airway is the most important item to check when

the patient arrives in the recovery area.

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The nurse must note the amount

(large or small) of exhaled air.

If the air volume is small, the nurse would suspect apartial obstruction or respiratory depression.

The partial obstruction may be caused by preoperativeor intraoperative drugs that may allow the tongue to

relax and obstruct the airway, a more common cause isthe position of the patient.

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If the air volume still not increased, respiratorydepression from skeletal muscle relaxants or narcoticsis the likely cause in which case an antidote maybegiven to increase airway exchange.

It is also possible that laryngeal spasm is the causedand the drugs and/ or artificial airway is needed.

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These are four main types of

artificial airways:Balloon-cuff endotracheal tube

Balloon-cuffed nasotracheal tubeOropharyngeal airway

Nasopharyngeal airway

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Balloon-cuff endotracheal tube inserted through the mouth and the glottis to a point

above the bifurcation of the trachea.

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Balloon-cuffed nasotracheal tube inserted through the nose and the glottis to a point

above the bifurcation of the trachea.

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Oropharyngeal airway

Inserted through the mouth of the pharynx.

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Nasopharyngeal airway inserted through the mouth to the pharynx.

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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

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Pharyngeal airways do not prevent obstruction of theairway that occurs when the patients jaw fallsdownward.

The nurse must push the jaw forward as throughmaking the patients lower teeth just out further than

the upper teeth. This will pull the tongue forward andopen the airway.

When a patient has a airway in place, he needsconstant observation because he usually lacks

laryngeal cough and gag reflex

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Mucus and other secretions in the mouth must beremoved (usually by suctioning) to prevent aspiration,

which would cause other respiratory complications.

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Airways usually are not removed by the nurse if it isgagging 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 mustobserved 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.

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After the nurse assure that the vital signs are stableand they are no complications occur patient can nowbe transfer to the hospital room.

THE END

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