Post-Anesthesia Recovery (PACU) — Study Notes

Purpose: Specialized recovery unit for patients immediately after anesthesia and surgery.

Environment:

• Open layout for visibility and rapid response.

• Patients arrive on gurneys, placed in monitored stalls.

• Staffed by Registered Nurses (RNs) trained in post-anesthesia monitoring.

Patient Flow: Pre-op → OR → PACU → (Inpatients) Hospital Floor / (Outpatients) Home

2. PACU Admission: Hand-Off Process

Transfer of Care: From anesthesia provider + circulating nurse → PACU nurse.

Report Includes:

1. Patient history and comorbidities

2. Surgical procedure performed

3. Type and duration of anesthesia; drugs administered

4. Estimated blood loss (EBL)

5. Wound status, drains, and initial drainage

6. ASA Score (1–5): Pre-op physical status

7. Intraoperative complications

8. Family and post-op communication notes

3. Ongoing PACU Assessment

A. Respiratory System

• Assess airway patency (obstruction common post-extubation).

• Auscultate lung sounds; monitor rate, rhythm, and oxygenation.

• ABGs as needed for hypoxia or ventilation concerns.

B. Cardiovascular & Perfusion

• Capillary refill: >2 sec = poor perfusion

• Skin color: Pink = good, Blue = hypoxia

• Continuous ECG and BP monitoring

C. Thermoregulation

• Risk: Hypothermia from cold OR, anesthesia, exposed skin

• Interventions: Warming blankets, warm IV fluids/irrigation

D. Gastrointestinal (GI)

• Inspect abdomen for distension, rigidity (possible bleeding).

• Auscultate bowel sounds; watch for paralytic ileus.

E. Fluids & Electrolytes

• Monitor IV fluids, urine output, and labs for electrolyte balance.

F. Neurological Function

• Assess Glasgow Coma Scale (GCS):

  • 15 = alert

  • ≤8 = comatose

• Evaluate eye, motor, and verbal responses.

G. Pain Assessment

• Assess using appropriate scales; consider tolerance, history, and cultural factors.

H. Renal Function

• Observe urine output, color, clarity-ensures renal perfusion.

I. Wound & Site Care

• Inspect dressing, drains, and IV sites for bleeding or infection.

• Bright red, copious drainage = possible active bleeding.

J. Psychosocial Care

• Reorient and reassure patient post-anesthesia.

• Communicate with family and support emotional comfort.

4. Common Post-Operative Complications

System	Complication	Notes / Management
Respiratory	Airway obstruction	Often due to tongue relaxation — life-threatening
	Hypoxia	Cyanosis = low O₂; manage with airway support, O₂
	Laryngospasm / Bronchospasm	Airway muscle spasm; may need reintubation
	Aspiration / Pneumonia	Inhaled secretions; higher risk in elderly/immobile
	Atelectasis	Lung collapse; encourage deep breathing
	Pulmonary embolism	Clot to lungs; sudden SOB, chest pain
Cardiovascular	Hemorrhage	Pale skin, hypotension, tachycardia, distension
Thermoregulation	Hypothermia	Common; use warming measures
	Malignant Hyperthermia	Rare, life-threatening; signs: rising CO₂, temp, ↓O₂; treat with Dantrolene, stop triggers, cool patient
GI	Nausea & Vomiting (PONV)	Very common; antiemetic treatment
Neurological	Altered consciousness	From anesthetics, meds, or sleep deprivation

5. PACU Discharge

A. Discharge Criteria

• Stable vitals & airway

• Aldrete Score: Evaluates movement, breathing, circulation, consciousness, O₂ saturation

• Orientation: Awake, responsive, able to maintain airway

B. Discharge Planning & Education

• Must leave with responsible adult/medical transport

• Home readiness and safety assessed

• Education:

  • Starts pre-op with surgeon

  • Verbal + written instructions (simple language)

  • Includes prescriptions, wound care, diet, activity limits

C. Unanticipated Outcomes

• AMA Discharge: Patient leaves before safe criteria met

• Death in PACU: Rare; requires compassionate family support

6. Key Points for Surgical Technologists

• Anticipate Recovery: OR actions (warming, documentation, drain setup) affect PACU outcome.

• Be Emergency-Ready: Know MH protocol (Dantrolene prep, ice packs).

• Communication: Accurate, detailed hand-off = safe recovery.