Cliff Schmiesing, MD and Suma Ramzan, MD
Dept. of Anesthesia
Stanford University School of Medicine
June 13, 2006
LEARNING OBJECTIVES AND CLINICAL RESPONSIBILITIES FOR THE
ANESTHESIA PACU ROTATION
I.
Learning Objectives:
1. Understand the evaluation and management of common immediate postanesthesia
conditions and complications including:
 Airway management
 Acute postoperative pain
 Nausea and vomiting
 Hypothermia
 Hypotension
 Hemorrhage
 Altered mental status
 Cardiac dysrhythmias
2. Understand key issues regarding postoperative pain management through a
variety of techniques including patient controlled IV opiate infusions (PCA’s),
epidural infusions, and peripheral neural blockade
3. Understand relevant discharge criteria
4. Understand normal response to surgery and anesthesia and how this affects
outpatients, i.e., what patients can expect in the days to weeks following surgery
5. Understand strategies for cost-effective patient management in the PACU
6. Review the medical literature relating to postoperative management which will be
included in the rotation materials
7. Attend specific educational conferences which will be held weekly.
II.
PACU Resident Responsibilities:
1. The PACU resident will remain in the main OR PACU beginning at the 7:30
and until 5:00 pm unless urgent clinical needs require them to be elsewhere, or
they are attending educational conferences. The resident will receive a 30minute lunch break as well as 15- minute morning and afternoon breaks as
clinical duties permit.
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2. The resident will utilize the morning prior to the arrival of PACU patient for
reading. The expectation to is to review at least one paper per day.
3. The resident should evaluate all university service postoperative patients (i.e.,
not Palo Alto Clinic or AA cases) upon arrival to the PACU. The resident
should be present for report from the primary anesthesia team. The resident
will help manage the patients while they remain in the PACU.
Management issues may include but are not limited to: reviewing chest x-rays
for line placement, adjusting pain, antiemetic orders, fluid therapy, as well as
ordering and reviewing diagnostic tests as appropriate. The resident should
remain in close communication with the primary anesthesia team should
unexpected developments occur with a patient while in the PACU. The
PACU resident is responsible for signing those PACU patients they follow on
the PACU nursing assessment form. The attending anesthesiologist will be
responsible for signing the patients out during those times the PACU resident
is not present (after 5 p.m.). The attending anesthesiologist will continue to
write the post-anesthesia note in the Progress Note Section.
4. The attending anesthesiologist from the primary anesthesia team will serve as
PACU residents’ immediate backup. If they are not readily available the
secondary backup will be the attending anesthesiologist who is scheduler for
that day (x60249).
5. The resident will be responsible for any postoperative pain procedures that are
placed in the PACU such as epidurals and peripheral nerve blocks.
6. The resident will place the initial epidural orders for patients coming out of
the OR. They will need to inform the Pain service about these patients. The
Pain service will follow these patients on the wards.
7. The resident is expected to attend the Weekly the Afternoon Resident Lecture
Series and Monday Morning Grand Rounds.
III.
PACU Resident Assignments:
1.
The PACU resident will be required to prepare a clinical case report to be
handed in at the end of their rotation based on their experiences in the PACU.
2.
The PACU resident will give a 10-minute in-service talk to the PACU nurses
on a subject matter of their choice.
3.
Keep a log of all procedures performed (i.e. arterial line, intubations, femoral
nerve blocks, epidural)
4.
Review a minimum of one journal article per day.
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