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The postanesthesia care unit (PACU), which is run and coordinated by anesthesiologists, delivers general medical supervision as well as close and constant care to patients who have just undergone a surgical procedure under anesthesia. Although PACU management has been considered a standard procedure in many developed countries since the 1940s, Japanese hospitals have tended to cease their management, and only 16.1% of hospitals in Japan currently have PACUs. In today's efficiency-required atmosphere in Japan, we need to consider a better postoperative management method, including facilities similar to the PACU, to prevent serious adverse events and improve the postoperative outcomes and quality of life. Nevertheless, the way postoperative patients are treated and cared for, and the location in which they receive such attention, will likely need to be modified to fit the Japanese style due to Japan's unique medical systems and traditions. Here, we describe the past, present and future of the PACU and postanesthesia care in Japan compared with other countries. [ABSTRACT FROM AUTHOR]

It is evident that immediate skin-to-skin care after birth has the potential to improve breastfeeding outcomes and maternal satisfaction after a caesarean section; hence partners and infants should be present on the postoperative ward. Objective To investigate the intensive care nurses’ experiences of having the infant and partner present on the postoperative ward after emergency caesarean sections. Design Interviews with semi-structured interviews were conducted and analysed using qualitative content analysis. Setting The interviews were conducted at a hospital in Stockholm, Sweden; where close to 10,000 births occur each year. After a caesarean section the mother is treated on a postoperative ward for at least two hours. Eight intensive care nurses participated in the study. Result The analysis yields the theme ‘ The challenges of caring for infants on a postoperative unit ’ covering the following categories; collision between the intensive care nurse and midwife, responsibility versus knowledge and organisational issues. The study concluded that improved routines and increased continuity between involved clinics could improve care. There is also a need for education for staff involved in caesarean section regarding the benefits of early skin-to-skin care between the mother and her infant. [ABSTRACT FROM AUTHOR]

Introduction: We reviewed patients with critical incidents that occurred in the post-anaesthesia care unit (PACU) at a major tertiary hospital, and assessed the effect of these incidents on PACU length of stay and discharge disposition.Methods: A retrospective review was conducted of patients in the PACU over a two-year period from 24 June 2011 to 23 August 2013. Data on critical incidents was recorded in the administrative database using a standardised data form.Results: There were 701 incidents involving 364 patients; 203 (55.8%) patients had American Society of Anesthesiologists (ASA) physical status I or II. The most common critical incidents were cardiovascular-related (n = 293, 41.8%), respiratory (n = 155, 22.1%), neurological (n = 52, 7.4%), surgical (n = 47, 6.7%) and airway-related (n = 34, 4.9%). There were two incidents of cardiac arrest and 25 incidents of unexpected reintubations. Many patients (n = 186, 51.2%) stayed for over four hours in the PACU due to critical incidents and 184 (50.5%) patients required a higher level of care postoperatively than initially planned. Some patients (n = 34, 9.3%) returned to the operation theatre for further management. A proportion of patients (n = 64, 17.6%) had unplanned intensive care unit admissions due to adverse events in the PACU.Conclusion: A wide spectrum of critical incidents occur in the PACU, many of which are related to the cardiovascular and respiratory systems. Critical incidents have a major impact on healthcare utilisation and result in prolonged PACU stays and higher levels of postoperative care than initially anticipated. [ABSTRACT FROM AUTHOR]

Background A number of different treatment regimens have been described for post-operative pain management for pediatric tonsillectomy following the widespread discontinuation of the use of codeine due to safety concerns. However, the literature is lacking with regard to the relative efficacy of the treatment regimens. This study is designed to determine the effectiveness of an intraoperative dose of intravenous acetaminophen for pediatric tonsillectomy pain management. Methods Records were reviewed for pediatric patients undergoing tonsillectomy with a single surgeon between 2012 and 2014. Pain scores, need for narcotic analgesics, and recovery times were reviewed for up to 24 postoperative hours. Patients were grouped based on whether they received an intraoperative dose of intravenous acetaminophen (Group 1) or did not receive it (Group 2). The primary outcome measure was pain score during the 24-h post-operative period. Secondary outcome measures include need for narcotic medications for breakthrough pain in the recovery room and time spent in the recovery room and hospital. Results 350 patients were included, of which 116 received an intraoperative dose of intravenous acetaminophen. Patients in Group 1 had lower pain scores during the second postoperative hour (1.27 vs. 2.06, p = 0.008). No significant differences were noted for pain scores during postoperative hours 1 or 3–24. Patients in Group 1 spent less time in the Recovery Room (59.08 min vs. 69.5 min, p = 0.016) but more time in the hospital (24.54 h vs. 19.66 h, p = 0.030). There was no difference between the groups based on whether the patients received narcotics for breakthrough pain in the recovery room (79.3% vs. 70.9%, p = 0.094). Conclusion Intraoperative intravenous acetaminophen may lead to improved pain scores in the early postoperative period and decreased time in the recovery room, but this group also had a longer hospital stay. This information should instigate randomized controlled trials of this intervention. [ABSTRACT FROM AUTHOR]

Postoperative delirium during emergence from anesthesia is the most frequent neuropsychiatric complication in the post-anesthesia care unit. In addition to increased medical and especially nursing care efforts, affected patients are threatened with delayed rehabilitation with a longer hospital stay and an increased mortality. It is therefore essential to identify risk factors at an early stage and to implement preventive measures; however, should a postoperative delirium occur in the post-anesthesia care unit despite the use of these preventive measures, it should be detected and treated at an early stage using suitable screening procedures. In this context, working instructions for delirium prophylaxis and standardized test procedures for detection of delirium have been shown to be useful. An additional drug treatment can be indicated when all nonpharmacological options have been exhausted., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: To determine if reversing a deep or moderate block with sugammadex, compared with a shallow block reversed with neostigmine, reduces the time to operating room discharge after surgery and the time spent in the postanesthesia care unit.Design: A randomized controlled trial.Setting: Monocentric study performed from February 2011 until May 2012.Patients: One hundred consenting women with American Society of Anesthesiologists grade I or II were randomized into 2 groups.Intervention: Laparoscopic hysterectomy was performed under desflurane general anesthesia. For the neostigmine (N) group, 0.45 mg · kg-1 rocuronium was followed by spontaneous recovery. A 5-mg rescue bolus was administered only if surgical evaluation was unacceptable. At the end of surgery, 50 μg · kg-1 neostigmine with glycopyrrolate was administered. For the sugammadex (S) group, a higher intubating rocuronium dose (0.6 mg · kg-1) was followed by 5-mg boluses each time the train-of-four count exceeded 2. Sugammadex (2-4 mg · kg-1) was administered to reverse the block. All patients were extubated after obtaining a train-of-four ratio of 0.9.Measurements: The duration between the end of surgery and operating room discharge and the time spent in the postanesthesia care unit.Main Results: The time till operating room discharge was shorter and more predictable in group S (9.15±4.28 minutes vs 13.87±11.43 minutes in group N; P=.005). The maximal duration in group S was 22 minutes, compared with 72 minutes in group N. The time spent in the postanesthesia care unit was not significantly different (group S: 47.75±31.77 minutes and group N: 53.43±40.57 minutes; P=.543).Conclusion: Maintaining a deep neuromuscular block during laparoscopic hysterectomy reversed at the end of the procedure with sugammadex enabled a faster and more predictable time till operating room discharge than did the classical combination of a shallower block reversed with neostigmine. [ABSTRACT FROM AUTHOR]

No abstract available.

The aim of this research is to verify the correlation between the patient's underlying diseases in the preoperative period and the occurrence of complications during the anesthetic recovery period. This is a quantitative field research, with a non-experimental design, comparative, and prospective. The sample is part of a big study conducted with 42 patients. For this research was selected 24 patients, who were submitted to elective surgery, under general anesthesia, with the American Society Anesthesiologists (ASA) status classification I or II; also they should be healthy and do not have any of the comorbidities listed as a criteria of exclusion from the study. The most common complications found were pain, hypoxia, hypothermia, and changes level of consciousness. Comparing this result with the results obtained with the initial study (conducted with 42 patients), regardless of whether the patient has or not comorbidities or mild diseases, which led them to the surgical procedure, the triad of complications, composed of pain, hypoxemia and hypothermia were the most frequent during the first 60 minutes of patient permanence in the PACU. In the manual analysis of the questionnaires, it was not verified significant agreement between the most common clinical manifestations and the presence of comorbidities. It is recommended that further studies should be conducted in order to properly address the complications presented by patients without comorbidities, when in the anesthetic recovery period.

Introduction: The recovery ward is a vital unit to care patients awaking from anesthesia and is a standard requirement for the operating room. Recovery ward is located adjacent to the operation room and is easily accessible to trained and skilled individuals. The unit must have adequate equipment for surveillance and monitoring of patients and required medication should also be provided. Methods: This study is a cross-sectional conducted in one phase through referring to hospital facilities and equipment. Physical space, personnel and their skill levels and other factors that are involved in the care of patients in the recovery have been investigated. The instruments used in this study were a check list and observe sheet which were completed by the researchers. Data analysis was conducted by SPSS software. Results: The results showed that the standards of buildings and physical space in the researched areas were mostly nonstandard. Equipment standards were to some extent in line with the criteria set by American Association of Anesthesia. Besides, some equipment was blow standard levels. Personnel standards regarding the number of nurses toward the number of recovery beds did not meet the standard criteria in most of the cases. Conclusion: The research shows that building standards in most cases are not in line with mentioned references. Undertaking equipment standards in the hospital recovery wards needs reviewing and providing controlling equipment for preventing the complications of recovery phase of anesthesia in recovery wards.

مقدمه: ترس شدید از دندان‌پزشكي و ناتوانی ذهنی از موارد استفاده‌ی بیهوشی عمومی در دندان‌پزشكي است. بیهوشی دندان‌پزشكي اغلب به صورت سرپایی انجام می‌شود و کاهش زمان و عوارض ریکاوری اهمیت زیادی در آن دارد. هدف از مطالعه‌ی حاضر بررسی مقایسه‌ای زمان و عوارض ریکاوری داروی بیهوشی پروپوفول در دو گروه سالم و ناتوان ذهنی بود که خدمات دندان‌پزشكي را تحت بیهوشی عمومی دریافت کردند. روش‌ها: در این مطالعه‌ی بالینی، 34 بیمار ناتوان ذهنی و 34 بیمار سالم، کاندید دریافت خدمات دندان‌پزشكي تحت بیهوشی عمومی، انتخاب شدند. در هر دو گروه تحت شرایط یکسان بیهوشی با پروپوفول صورت گرفت. پس از پایان بیهوشی زمان و عوارض ریکاوری در هر دو گروه ثبت گردید. نتایج توسط آزمون‌های آماری Independent samples t-test و Mann-Whitney مورد آنالیز قرار گرفت. یافته‌ها: زمان ریکاوری در گروه ناتوان ذهنی به صورت معنی‌داری از گروه سالم ذهنی بیشتر بود (05/0 > P)، اما عوارض ریکاوری در دو گروه اختلاف معنی‌داری نداشت (05/0 < P). در هر دو گروه ارتباط مستقیمی بین زمان بیهوشی و زمان ریکاوری مشاهده شد (05/0 > P). نتیجه گیری: زمان ریکاوری در بیماران ناتوان ذهنی بیشتر بود که ممکن است به دلیل نیاز به درمان طولانی‌تر باشد؛ اما عوارض ریکاوری در دو گروه مشابه بود. در هر دو گروه ناتوان ذهنی و سالم افزایش زمان بیهوشی مانند مطالعات گذشته باعث افزایش زمان ریکاوری گردید.

Objective To explore the complications neurosurgical patients with general anesthesia in neurosurgical postanesthesia care unit (PACU), and analyse the probable cause to enhance the safety of neurosurgical patients in perioperative period. Methods The clinical monitor data (March, 2009-January, 2010) of 2414 patients in neurosurgical PACU after neurosurgical operation were reviewed. The causes of complication were analysed and characteristics of prevention and treatment were summarized. Results The mean monitor duration in PACU was 2 hours. The incidence of complication was 52.57% (1269/2414). There were 486 patients (20.13% ) suffered from 2 or more than 2 complications. The incidence of arrhythmia, hypertension, pain, shivering, nausea and vomiting, and delirium was 14.08%, 13.79%, 13.67%, 10.19% , 9.20% and 8.91% , respectively. The incidence of hypoxemia, respiratory obstruction, delayed recovery and hypotension was 3.27% , 1.99% , 1.41% and 0.50% , respectively. Three patients with consciousness delay or pupil size anisocoria diagnosed as cerebral edema or intracranial hematoma by computed tomography (CT) underwent recraniotomy. All complications were treated in time. Conclusion The incidence of neurosurgical postoperative complications is fairly high. Different kinds of disease and operation may present special related complications. All complications should be monitored and treated promptly and accurately to secure the safety of patients in PACU. DOI：10.3969/j.issn.1672-6731.2010.04.013

O presente artigo tem por objetivo identificar a concepção de enfermeiros acerca do conteúdo de website sobre sala de recuperação pósanestésica (SRPA). Pesquisa de campo, descritiva, realizada durante o 8º Congresso Brasileiro de Enfermagem em Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização com docentes de enfermagem e enfermeiros. 95,65% dos enfermeiros consideraram importante um website com disponibilização de informações sobre SRPA e apresentou uma grande diversidade entre os assuntos que devem fazer parte do conteúdo do website, porém todos os aspectos devem ser abordados desde que sejam informações seguras e confiáveis. É importante saber a opinião e expecta tivas de enfermeiros relacionadas a um website que disponibilize informações sobre SRPA.El presente artículo pretende identificar el diseño de las enfermeras sobre el contenido del sitio web en la sala de recuperación postanestésica. Búsqueda de campo, descriptivo, celebrada durante el 8º Congreso Brasileño de Enfermería en la Sala de Operaciones, Anestesia y Centro de Recuperación de Materiales y Esterilización con los maestros, enfermeras y enfermería. El 95,65% de las enfermeras consideran importantes con un sitio web para proporcionar información SRPA y presentó una gran diversidad entre las cuestiones que deben que deben formar parte de los contenidos del sitio web, sino a todos los aspectos deben abordarse si son seguros y de la información fiable. Es importante escuchar la opinión de las enfermeras y expectivas en relación con un sitio web que proporciona información sobre SRPA.The present article has as its objective to identify the concept of the registered nurses in relation to the contents in a website about the post-anesthetic recovery room. The descriptive field research was done during the 8th Brazilian Nursing Congress in Surgical Nursing, Anesthetic Recovery and the Central Supply, Sterilization and Material Preparation room with nurses involved in the teaching field and also nurses working in these areas. 95.65% of the nurses considered a website important in relation to the availability of information about SRPA and these nurses presented a large diversity about the subjects that should make up the contents of the website, however all aspects should be presented only when the information is secure and correct. It is important to know the opinion and expectations of the nurses in relation to a website that contains information about SRPA.

Este estudo objetivou identificar complicações prevalentes em Sala de Recuperação Pós-Anestésica (SRPA); relacionar as complicações às intervenções de enfermagem realizadas; relacionar o esquema de jornada de trabalho dos enfermeiros às complicações. A amostra compôs-se de 400 prontuários de pacientes maiores de 18 anos, submetidos a procedimentos cirúrgicos de grande e médio porte, admitidos na unidade de SRPA, com tempo de permanência superior à uma hora. As complicações prevalentes foram: dor e hipotermia. Complicações que apresentaram relação estatisticamente significante com intervenção de enfermagem - dor: rotina, oxigenioterapia, medicação e curativo; agitação/ansiedade: rotina e oxigenioterapia; hipotensão: hidratação, exames complementares e observação; hipertensão: observação; tremor: manta térmica, transfusão sanguínea; náuseas/vômitos: rotina, medicação e sondagem vesical de alívio; sangramento: rotina, medicação e curativos; hipoxemia: rotina e oxigenioterapia; hipotermia: rotina, manta térmica e medicação. A dor, náuseas/vômitos, agitação e sangramento obtiveram relação estatisticamente significante com o enfermeiro fixo em SRPA.Este estudio objetivó identificar las complicaciones prevalentes en la Sala de Recuperación Postanestésica (SRPA); relacionar las complicaciones a las intervenciones de enfermería realizadas; relacionar el esquema de jornada de trabajo de los enfermeros con las complicaciones. La muestra estuvo compuesta de 400 fichas de pacientes mayores de 18 años, sometidos a procedimientos quirúrgicos de grande y medio porte, admitidos en la unidad de SRPA, con tiempo de permanencia superior a una hora. Las complicaciones prevalentes fueron: dolor e hipotermia. Complicaciones que presentaron relación estadísticamente significativa con la intervención de enfermería - dolor: rutina, oxigenoterapia, medicación y curativo; agitación/ansiedad: rutina y oxigenoterapia; hipotensión: hidratación, exámenes complementares y observación; hipertensión: observación; tremor: manta térmica, transfusión sanguínea; náuseas/vómitos: rutina, medicación y sondaje vesical de alivio; hemorragia: rutina, medicación y curativos; hipoxemia: rutina y oxigenoterapia; hipotermia: rutina, manta térmica y medicación. El dolor, náuseas/vómitos, agitación y hemorragia obtuvieron relación estadísticamente significativa con el enfermero fijo en SRPA.The objective of this study was to identify the prevalent complications in the post-anesthesia recovery room (PARR), and correlate nurses' work hours with the complications. The sample consisted of 400 records of patients older than 18 years, who had major and medium surgical procedures, admitted at the PARR unit, with a stay of at least one hour. The prevalent complications were pain and hypothermia. The following complications showed a statistically significant relationship with the nursing intervention: pain: routine, oxygen therapy, medication and bandages; agitation/anxiety: routine and oxygen therapy; hypotension: hydration, complementary exams, and observation; hypertension: observation; tremor: mat heater, blood transfusion; nausea/vomiting: routine, medication and urinary catheterization; bleeding: routine, medication and bandages; hypoxemia: routine and oxygen therapy; hypothermia: routine, mat heater, and medication. Pain, nausea/vomiting, agitation and bleeding showed a statistically significant relationship with the PARR nurse.

Patient handover from anaesthesia to postanaesthesia unit: An analysis of the current situation in three Swiss hospitals Abstract: Background: To assess the current status of patient handovers from anaesthesia staff to recovery room nurses. Aim: To assess the current status of patient handovers from anaesthesia staff to recovery room nurses. Method: After a literature search an observation protocol for patient handovers according to the SBAR concept (von Dossow & Zwißler, 2016) was developed. Using this checklist, non-participant observations were conducted in three Swiss hospitals and evaluated with statistical analysis. Results: A total of 98 observations were made. The report receiving person felt integrated into the handover and received the necessary information. Deficiencies in patient identification and a joint control of lines after surgical interventions could be identified. The subjectively rated quality of patient handover did not differ between the three hospitals (X 2 (2)=,927, p =,629) and also not according to the time of day (X 2 (2)=3,604, p =,216). There was also no difference between the subjective quality of the handover and the delivering professional group (X 2 (3)=4,507, p =,212). Conclusions: The subjective quality of patient handover did not differ between the three hospitals. However, the patient handover protocols need to be adapted to ensure that patient identification and a joint assessment including control of lines and drains are performed.

Background/aims: Data on the incidence of adverse respiratory events during recovery from gastrointestinal endoscopy are limited. The aim of this study was to investigate the incidence of these complications., Methods: In this retrospective cohort study, data were obtained from the electronic records of 657 consecutive patients, who underwent gastroenterological procedures under sedation., Results: Pulse oximetry oxygen saturation (SpO2) <90% for <60 seconds occurred in 82 patients (12.5%) and in 11 patients (1.7%), SpO2 of <90% for >60 seconds occurred in 79 patients (12.0%) and in 11 patients (1.7%), and SpO2 <75% occurred in four patients (0.6%) and in no patients during the procedure and recovery period, respectively. No major complications were noted. The occurrence of desaturation during recovery was correlated with desaturation during the procedure (p<0.001). American Society of Anesthesiologists score (odds ratio [OR], 1.867; 95% confidence interval [CI], 1.008-3.458), ischemic heart disease (OR, 1.815; 95% CI, 0.649-5.080), hypertension (OR, 1.289; 95% CI, 0.472-3.516), and diabetes mellitus (OR, 2.406; 95% CI, 0.950-6.095) increased the occurrence of desaturation during recovery., Conclusion: We found no major complications during recovery after balanced propofol-based sedation administered by a gastroenterologist-nurse team. Patients with the identified risk predictors must be monitored carefully.

To identify the validated instruments used for screening and detecting postoperative delirium (POD) during Post Anesthesia Recovery (PAR) period, and the incidence and associated risk factors with POD. A scoping review. The study search occurred in May 2021 in the PubMed, Embase, Scopus, CINAHL, Web of Science and LILACS databases. Primary studies that used validated instruments for screening and detecting POD in the PAR period were included. A total of 38 articles were included. The most used instruments were CAM-ICU, Nu-DESC, and RASS. The instruments that screened and detected delirium earliest were the Nu-DESC and CAM-ICU. POD incidence was up to 20% in more than half of the included studies. Cardiovascular comorbidities, chronic kidney disease, low functional reserve, chronic obstructive pulmonary disease and postoperative pain were among the primary risk factors. The instrumentsshowing the greatest accuracy for screening and detecting POD in the PAR period were the Nu-DESC and CAM-ICU. [ABSTRACT FROM AUTHOR]

Background: Postoperative hypoxemia is common complication in early postoperative period. Upper abdominal surgery significantly impairs the respiratory mechanics for ventilation resulting in hypoxemia. Aim and Objectives: To observe the incidence, severity and duration of early postoperative hypoxemia in adults undergoing elective upper and lower abdominal surgeries. Material and Methods: This study was conducted in 50 patients of 20- 50 years, posted for various abdominal surgeries, SPO levels were recorded 2 for all the patients when breathing room air, in the recovery room by pulse oximeter. Results: In the recovery room, while patients breathed room air, SpO2 was 91.1% in upper abdominal surgery patients (Group I) then increased gradually but SpO was 94.4% in lower 2 abdominal surgery patients (Group II) and improved over a shorter period than the Group I. SpO returned to 2 >95% in all patients of Group II after 15 minutes of operation. However, in Group I patients SpO levels had 2 reached 95% by 3 h after the operation. Conclusion:The degree of arterial desaturation and the incidence of hypoxemia were closely related to the operative sites in the upper abdominal surgery and lower abdominal surgery in the immediate postoperative period. Hence requires close respiratory monitoring and oxygen therapy during the early postoperative period. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have been made on the incidence of residual paralysis from nondepolarizing relaxants in people over 65 years old; however, estimating the number of cases and treatment thereof are both important. Objective: To study the incidence of residual paralysis with non-depolarizing relaxants in patients over 65 years of age and discuss treatment. Methodology: Analytical observational study based on a cohort design. Results: The pre-extubation residual paralysis was estimated at 23.2% and at 9.2% at patient admission to the Recovery Suite. Pharmacological reversal showed 89.4% and 100% success rates with Neostigmine and Sugammadex respectively, with similar times at T4/T1 > 0.9. Conclusions: The incidence of pre-extubation residual paralysis was lower than the figure published worldwide. Pharmacological reversal therapies were typically highly effective. [ABSTRACT FROM AUTHOR]

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Background. Clinical application of point-of-care ultrasound in immediate postoperative period is still to be evaluated. The aim of this report is to present the possible application of the critical care ultrasound protocols for early detection of the most common postoperative complications. Material and methods. 73 women between 27 and 74 years of age, ASA (American Society of Anesthesiologists) grade 1-3, up to 6 hours after gynecological procedures or cesarean sections were evaluated. Examination consisted of lung ultrasound and fluid status assessment. Results. In 5 laparotomy cases interstitial pulmonary oedema was noted, which was associated with mildly decreased oxygen saturation readings of 92-95%. In only one of these cases fluid status indices were suggestive of hypervolemia, while the remaining four have shown the sonographic signs of hypovolemia. Subpleural consolidations were detected in one patient. In 2 cases pleural effusion and atelectasis were found. One case of postoperative hemorrhage was shown. In 23% of patients fluid status indices were suggestive of hypovolemia, while in 6% hypovolemia was shown to be severe. Conclusion. It appears that ultrasound imaging may help to improve the quality of postoperative care in terms of early detection of possible complications and fluid status assessment. [ABSTRACT FROM AUTHOR]