Postanesthesia
recovery
Miller R.D. & Pardo M.C. Basics of Anesthesia
6th ed. CH 39 ,page 563-578
報告者:林詩烜
指導醫師:張懷嘉
The postanesthesia care unit (PACU) is the
area designated for the monitoring and care of
patients who are recovering from the immediate
physiologic derangements produced by
anesthesia and surgery.
Admission to the
postanesthesia care unit

The anesthesiologist provides the PACU
nurse with pertinent details of the patient’s
history,medical condition, anesthesia ,and
surgery.

Praticular attention is directed to monitoring
oxygenation, ventilation,and circulation.
PACU complication
Postanesthesia nausea and
vomiting(1)
Factors Associated with Increased Incidence of Postoperative
Nausea and Vomiting (PONV)
Postanesthesia nausea and
vomiting(2)

Prevention and treatment
（1）propofol
（2）droperidol ：0.625-1.25mg IV
（3）dexamethasone：4-8mg IV with
induction of anesthesia
Upper airway obstruction



Loss of pharyngeal muscle tone
Laryngospasm
Airway edema
Loss of pharyngeal muscle
tone(1)



The residual depressant effects of inhaled and
intravenous anesthetics and the persistent effects
of neuromuscular blocking drugs.
Pharyngeal muscles contract synchronously with
the diaphragm to pull the tongue forward.
Breathing pattern consisting of retraction of the
sternal notch and exaggerated abdominal muscle
activity.
Loss of pharyngeal muscle
tone(2)

Treatment
opening the airway with the “jaw thrust maneuver”
or continuous positive airway pressure applied via
a facemask.placement of an oral or nasal
airway ,LMA,or may be endotracheal.
Laryngospasm

Refers to a sudden spasm of the vocal cords
that completely occludes the laryngeal opening.

Treatment
jaw thrust with CPAP,if fail,immediate skeletal
muscle relaxation succinylcholine (0.1-1.0mg/kg
IV or 4mg/kg IM).
Airway edema(1)

Airway edema is an undergoing prolonged
procedures in the prone or Trendelenburg
position and in procedures with large amounts
of blood loss requiring aggressive fluid
resuscitation.

Surgical procedures on the tongue, pharynx,
and neck, can result in upper airway
obstruction because of tissue edema or
hematoma, or both.
Airway edema(2)

Management
＊An
attempt can be made to decompress the
airway by releasing the clips or sutures on the
wound and evacuating the hematoma.
＊Emergency
tracheal intubation is required,
surgical backup for performance of an
emergency tracheostomy.
Postoperative
hypoxemia
Factors
leading to
postoperative
hypertension
Causes of
hypotension
in the
PACU
Factors leading to
postoperative
cardiac
dysrhythmias
Postoperative
oliguria
Delirium(1)

Preoperative risk factors include
(1) advanced age
(2) preoperative cognitive impairment
(3) decreased functional status
(4) alcohol abuse
(5) a previous history of delirium.
Delirium(2)
Postoperative
delirium
Delirium(3)

Management
＊Early identification of patients at risk for delirium
can also guide pharmacologic therapy
postoperatively.
＊Require restraints and additional personnel to
control their behavior and avoid self-inflicted
injury or dislodgment of intravascular catheters
and the endotracheal tube.
Body temperature and shivering
(1)


The incidence of postoperative shivering may be as
frequent as 65% (range 5% to 65%) after general
anesthesia and 33% after epidural anesthesia.
Hypothermia (33-35℃) inhibits platelet function ,
coagulation factor activity, and drug metabolism.It
exacerbates postoperative bleeding, prolongs
neuromuscular blockade, and may delay awakening.
Body temperature and shivering
(2)
Treatment
＊Forced air warmers are used to actively warm the

hypothermic patient.
＊meperidine(12.5 to 25 mg IV) is the most effective
treatment.
Discharge criteria

Patients must be observed until they are no longer
at risk for ventilatory depression,hemodynamic,
peripheral nerve function, and their mental status is
clear or has returned to baseline.
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Questions
(o)1.常見PACU complication有PONV,上呼吸道阻塞,低血壓等等.
(0)2.本單位用來治療預防PONV的藥物有propofol , droperidol,dexamethasone.
(x)3.本單位PACU 使用的discharge criteria有意識,呼吸,活動,循環,SPO2,五項.
(0)4.低體溫會造成抑制血小板及凝血因子活性，加劇了術後出血,和藥物代謝變
慢，延長神經肌肉阻滯，可能延誤的覺醒。
(0)5. Laryngospasm是指聲帶突然痙攣導致完全阻塞喉部呼吸道,處理方面使用提
下顎法將呼吸道打開,給予持續正壓的氧氣,或是lidocaine (1-1.5mg/kg IV),
如果不行,就要使用muscle relaxation succinylcholine (0.1-1.0mg/kg IV
or 4mg/kg IM).