Acute Pain Management
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
The Post Anesthesia Care Unit (PACU), also known as the postsurgical recovery area, is by definition an intensive care unit. This unit is staffed by physicians and highly skilled nurses in ratios similar to those of an intensive care unit and is therefore able to deliver a level of care higher than what is available on the wards. Predetermined criteria such as hemodynamic stability and adequate pain control must be achieved prior to transfer to other patient care areas or discharge from the hospital. As all patients are monitored with blood pressure, telemetry, and pulse oximetry recording, the PACU is the safest place to initiate a pain treatment regimen. On the floors, review of the PACU records, including opioid requirements and response to treatment, can be a useful guide to determine which medications and dosages to use.
Paediatric Anaesthesia
R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne in Scott-Brown's Essential Otorhinolaryngology, 2022
Only start a case if there are facilities to finish it. In emergency cases without appropriate facilities, the anaesthetic team must oversee the patient's recovery. NEVER start a new case until the last patient is safe. Post-anaesthesia care unit (PACU)—trained competent staff, emergency equipment (drugs, anaesthetic machine).High-dependency unit or intensive care unit.Patients should only be discharged when fully conscious, appropriately hydrated, and pain-free with appropriate analgesia prescribed, and with full handover of the post-operative care to the ward.On discharge, patients should be given information sheets about their procedure that contain contact details should they have any problems.
Anaesthesia for Paediatric Otorhinolaryngology Procedures
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
There is little point in proceeding with complex anaesthesia and surgery if facilities do not exist to care for the patients post-operatively. The post-anaesthesia care unit (PACU) must be staffed to a defined level of competence, and there must be equipment available in the unit to deal with any emergency, including emergency drugs and an anaesthetic machine. More complex cases may require the services of a high dependency or intensive care unit. The basic rule is never to start a case unless you have the facilities to finish it. The Association of Anaesthetists of Great Britain and Ireland has published general recommendations for organization and staffing.13 If an emergency case has to be done where appropriate facilities do not exist, the anaesthetic team must recover the patient. Patients should not be discharged from the PACU until the anaesthetist/recovery staff are sure that the patient is fully conscious, is appropriately hydrated, is not in pain and has had appropriate analgesia prescribed as well as full instructions to the ward on post-operative care. A handover sheet, which can be filled out by staff, is very useful for this purpose.
Analysis of failed discharge after ambulatory surgery: unanticipated admission
Published in Acta Chirurgica Belgica, 2019
Els Van Caelenberg, Melissa De Regge, Kristof Eeckloo, Marc Coppens
Postoperatively patients are monitored in the post anesthesia care unit at UZ1 or UZ2. As the post-anesthesia care unit in UZ1 is located next to DSU, in UZ1 these patients are recollected by DSU nurses, while UZ2 patients are transported from the other side of the hospital back to DSU by transportation logistics. After recovery, patients are discharged from DSU by the surgeon or anesthesiologist when they have stable hemodynamics, minimal pain, minimal nausea, no vomiting, and are able to drink and urinate, according to the modified Post-Anesthesia Discharge Scoring System (PADSS) [12]. Patients have to be escorted by a responsible adult following their discharge. Surgeons are discouraged to start operations under general anesthesia after 4 pm to allow patients enough time to recover since the DSU closes at 7 pm. We hypothesized that as our DSU is a hospital integrated facility, and not a self-contained unit, independent of the rest of the hospital, logistical/organizational issues, as well as demographic and medical condition were reasons for unanticipated admission.
How to minimize peri-procedural complications during subcutaneous defibrillator implant?
Published in Expert Review of Cardiovascular Therapy, 2020
Muhammad R. Afzal, Toshimasa Okabe, Kevin Hsu, Schuyler Cook, Tanner Koppert, Raul Weiss
Initially, all implantation of S-ICDs were performed using general anesthesia (GA). However, as the operators gained more experience and achieved shorter procedure duration, the use of monitored anesthesia care (MAC) began to increase. During a single-center experience, S-ICD implantation was safe and feasible with MAC [29]. The use of MAC is anticipated to decrease complications associated with endotracheal intubation and prevents significant hemodynamic compromise associated with GA. Sufficient analgesic control can be facilitated with intermittent IV bolus of analgesia during critical S-ICD implanting steps, such as pocket creation, lead tunneling, and CT. A recent study that compared 111 patients in MAC and 176 in GA group showed that only one patient (0.9%) in the MAC group required conversion to GA. Despite a similar baseline heart rate (HR) and mean arterial blood pressure (MAP) in both groups, patients with GA had significantly lower HR and MAP during the procedure and more frequently required pharmacological hemodynamic support. Length of the procedure, stay in the post-anesthesia care unit, and postoperative pain was similar in both groups [2].
Can patients safely be admitted to a ward after craniotomy for resection of intra-axial brain tumors?
Published in British Journal of Neurosurgery, 2018
Farhan A. Mirza, Catherine Wang, Thomas Pittman
Patients are extubated in the operating room before being transferred to the post anesthesia care unit (PACU) where they remain for 2-4 hours. In the PACU the nurse to patient ratio is 1:2. Patients are subsequently moved to a regular floor bed on a specialized Neurosurgical floor where they are cared for by nursing staff trained to perform neurological exams, NIH stroke scales, etc. The usual nurse to patient ratio is 1:5. Continuous telemetry is not routinely utilized. Vital signs are obtained by the nursing staff every 4 hours and neurological checks are performed every 2–4 hours. Most of the nurses have worked on the neurosurgical floor for several years and have extensive experience in caring for neurosurgical patients. Patients with EVDs and those who still require a ventilator after surgery are transferred to ICU beds as are those thought, either because of their symptoms or the nature of their procedure, to require closer monitoring. The ICU is a dedicated neurosurgical unit and is also staffed by nurses who specialize in the care of neurosurgical patients. Vital signs and neurologic examinations are checked every hour in the ICU. Nurse to patient ratio is usually 1:2 in the ICU; however, depending on the severity of illness, 1:1 care is utilized as needed. Neurosurgery residents are always available in the hospital to help with patient management.
Related Knowledge Centers
- Ambulatory Care
- Blood Pressure
- Heart Rate
- Local Anesthesia
- Nurse Anesthetist
- Vital Signs
- General Anaesthesia
- Hemodynamics
- Hospital
- Operating Theater