Recovery of anesthesia

Sanaa Farag Wasfy
Lecturer of anaesthesia and intensive care
* Recovery is a continual process, the early
stages of which overlap the end of intraoperative
* Patients cannot be considered fully recovered
until they have returned to their preoperative
phsiological state.
-The entire process may last many days
Divided into three phases :
1- Early recovering (awaking and recovery of vital
2- Intermediate recovery (immediate clinical
recovery and home readiness)
3- Late recovery(full recovery and psycholgical
 Early recovery commences on discontinuation
of anesthetic agent, which allows the patient
to awaken, recover protective airway reflexes,
and resume motor activity.
 It traditionaly continues in postanesthsia care
unit (PACU).
 Patients are likely to begin responding to verbal
stimuli when alveolar anesthetic concentrations
are decreased to about 0.5 MAC for the volatile
anesthetic drug (MAC awake) if unimpeded by
other factors.
 Increased ventilation results in a more rapid
decline in alveolar anesthetic concentration
which hastens recovery, provided that the
arterial carbon dioxide pressure is not so low that
it diminshes cerebral blood flow and the removal
of aneshetic agent from the brain.
 Recovery from neuromuscular blockade may
be monitored by peripheral nerve stimulation
and by clinical indices.
 Recovery from intravenous opioids and
hypnotics may be more variable and difficult
to quantify than recovery from inhalation and
neuromuscular blocking agents.
 Transport from the operating room is usually
complicated by the lack of adequate monitors,
access to drugs, or resuscitative equipment.
 Patients should not leave the operating room
unless they have a stable and patent airway,
have adequate ventilation and oxygenation, and
are hemodynamically stable.
 All patients should be taken to the PACU on a
bed that can be placed in either the head down
or head up position.
 The PACU should be located near the operating
rooms. A central location in the operating room
area, Proximity to radiographic, laboratory, and
other intensive care facilities on the same floor is
also highly desirable.
 A ratio of 1.5 beds per operating room is
 Every effort should be made to diminish
unnecessary noise in PACU.
 The PACU should be staffed only by nurses
specifically trained in the care of patients
emerging from anesthesia. They should have
expertise in airway management and
advanced cardiac life support as well as
problems commonly encountered in surgical
patients relating to wound care, drainage
catheters, and post operative bleeding.
 The nurse-to-patient ratio is 1:1 for sick
patients and 1:2 or 1:3 for routine cases.
 Vital signs should be recorded at least every 15
minutes and recorded on a separate sheet. The
patient is encouraged by the nurse to cough,
breathe deeply, and change body position.
 The most important monitor is a well informed
and skilled person; with immediate access to
anaesthetic assistance. Technical support is
important but sophisticated electronic monitors
are not universally essential
Postanaesthesia care problems
1) Pain.
2) PONV.
3) Agitation.
4) Croup.
5) Sore-throat.
6) Headache.
7) Shivering.
8) Increased body temperature.
9) Cardiovascular.
10) Respiratory.
 Scores determines when patients are fit for
discharge from PACU, various criteria for readiness
for discharge from PACUs have been established.
The modified Aldrete score is the most common
system used. A score> or = 9 is required for
 Postaesthesia discharge scoring system(PADSS)
determines home readiness and the optimal
length a patient stays after day-case surgery.
 Scoring system must be practical, simple, easy
to remember, and not place additional burden on
Fast track recovery
 It is the ability to transfer suitably recovered
patients from the OR directly to the phase II
recovery area, by passing the most costly PACU.
 Children derive an additional benefit from fast
tracking in that they are more quickly reunited
with their parents.
 To institute successful fast tracking programs, it
is necessary to modify anesthetic techniques and
to use the newer shorter acting anesthetics,
narcotics and muscle relaxants.
 Modified aldretes scoring system may not be
adequate after day case procedures because
it fails to consider common side effects as
pain nausea and vomiting, therefore a new
fast track scoring system that incorporates
both has been proposed.
Delayed recovery
 It is delayed return of level of conscious.
 There are several causes:
 metabolic and electrolytes.
 Cerebral hypoperfusion.
 Cerebral depression by drugs.
 1. Immediate recovery from anaesthesia is a
concept of care during not just a place to put the
patient after surgery. Responsibility can never be
fully delegated by the anaesthetist to others.
 2. Most problems relate to Airway, Breathing
and/or Circulation; with delayed return of
consciousness and inadequate analgesia being
other common related issues. All these should be
 3. Facilities required are the same as those
necessary for anaesthesia where-ever that might
be administered. If such facilities cannot be
duplicated in a separate location, then the safest
place to recover patients is in the operating
 4. The most important monitor is a well informed
and skilled person; with immediate access to
anaesthetic assistance. Technical support is
important but sophisticated electronic monitors
are not universally essential
 5. Discharge to a general ward should only be
considered when you have a conscious, cooperative and comfortable patient who is well
oxygenated and well perfused; and likely to
remain so.

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