file:///G:/Monitoring%20in%20the%20Recovery%20Room%20(page%201).

htm
Issue 11 (2000) Article 9: Page 1 of 2 Go to page: 1 2

Monitoring in the Recovery Room

Dr Keith Allman,
Royal Devon and Exeter Hospital, Exeter, UK
Formerly Royal Perth Hospital, Australia

Introduction
The recovery room is the area where patients recover from the immediate effects of
anaesthesia and surgery and provides a setting for the detection and treatment of early
post-operative complications. These areas vary considerably in the level of staffing
and monitoring available from the "ideal" fully staffed, fully equipped modern
recovery facility to the somewhat less than perfect dimly lit corridor just outside
theatre.
The commonest causes of recovery room mishaps all result from unidentified changes
in a patient's airway, breathing or circulation and these can almost always be rectified
if identified at an early stage.
In 1993 the Association of Anaesthetists of Great Britain and Ireland published
recommendations for the provision of equipment necessary for a modern day recovery
area. These are shown in table 1.
Table 1: Association of Anaesthetists of Great Britain and Ireland Guidelines
1993
Position of
recovery

situated as close as possible to the operating theatre to minimise the

risks of transporting unstable patients

Size and
temperature

an average of 1.5 recovery bays per operating theatre (9.3m2 per

bay)
room temperature 21-22 oC, relative humidity 38 - 45% and fifteen
changes of air per minute
gas scavenging system and six 13 ampere electricity outlets per bay
well lit with lighting approximating to the daylight spectrum

Equipment in
each bay

oxygen outlets, face masks and breathing systems

pulse oximetry
availability of blood pressure monitoring and ECG
suction units with Yankaur ends
a fully equipped anaesthetic machine with ventilator

drugs and intravenous fluids

a paediatric equipment trolley containing facemasks, airways,
endotracheal tubes and connectors in a range of paediatric sizes
These facilities may not all be available in many recovery areas throughout the world
and some thought is necessary to determine the relative merits of each item on this
long list.
Certainly the two most important pre-requisites of any recovery area should be the
provision of good lighting together with a suitably trained recovery nurse available to
recover each unconscious patient on a one-to-one basis. The nurse must be available
to stay with the patient constantly until awake and able to maintain their own airway.

Clinical patient monitoring

Clinical monitoring can be divided into assessment of airway, breathing and
circulation.
The patient's airway can be assessed by observing for signs of obstruction such as
chest wall or supraclavicular inward movement on inspiration and/or the presence of
noisy breathing. A patent airway is most easily maintained with the patient in the left
lateral ('recovery') position (figure 1) as this allows the tongue and soft palate to fall
forwards away from the oropharyngeal opening.
This will also prevent any blood or secretions pooling in the oropharynx and causing
aspiration or laryngospasm. In patients at risk of further oropharyngeal soiling,
drainage of secretions can be increased by placing a pillow beneath the patient's chest
('tonsillar position'). If the patient has to remain supine for any reason then the use of
jaw thrust or an oropharyngeal (Guedel) airway can be invaluable in airway
maintenance. Maintenance of a patent airway is probably the single most
important aspect of immediate post-operative care. Although few patients in the
UK are now taken to recovery with an endotracheal tube in-situ this depends to some
extent on the anaesthetic agents available. Where slowly eliminated agents are used
(ether and halothane) the endotracheal tube is sometimes best left in-situ until full
return of the laryngeal reflexes. When to extubate is a matter of clinical judgment, but
as a rule it is safer to leave the tube as long as possible as this ensures airway patency.
In children it is common practice to wait until they can remove it themselves.
Suctioning of the oropharynx should be performed before tube removal to avoid
aspiration of any blood or mucus present. The anaesthetist should always be on hand
until a patient is awake and maintaining their own airway in case of severe
laryngospasm necessitating re-intubation.
Respiration can be assessed by monitoring abdominal excursion, chest movement or
by feeling for expiration with a cupped hand at the patient's mouth or nose.

Oxygenation can also be assessed to some degree by examining the patient's colour. A
dusky, bluish hue suggests hypoxia, and is often most easily noted around the lips or
tongue. This does, however, require natural daylight or good quality artificial lighting
as some systems produce monochromatic light which makes the appreciation of
colour difficult. Bradypnoea will usually be due to intra-operative opioid use and if so
will be associated with pinpoint pupils. This may resolve spontaneously as the other
anaesthetic agents are eliminated and the patient wakes up. If treatment is indicated
(respiratory rate less than 8 bpm or hypoxia) then first try to rouse the patient and if
this fails consider naloxone (400 microgram diluted into 10 ml saline administering 2
ml boluses intravenously). Where available doxapram (1 mg/kg) is a useful
respiratory stimulant and will not reverse the analgesic effects of opioids. Tachypnoea
can be associated with certain volatile agents (particularly ether), acidosis,
hypovolaemia, pain, hypoxia or other respiratory problem.
Circulation can be assessed by palpating the pulse (thready pulse or tachycardia
suggesting volume depletion) and by feeling the peripheries (cold poorly perfused
hands also suggest hypovolaemia or hypothermia following long operations). Heart
rate should normally be between 60-90 bpm. Bradycardia is usually associated with
deep anaesthesia or vagally stimulating surgery and may need treating if the heart rate
is less than 40-50bpm or if associated with hypotension (give atropine 200-400mcg).
Tachycardia is likely to be due to poor pain control or hypovolaemia, but may rarely
be due to atrial fibrillation or a supraventricular tachycardia. Primary treatment should
be directed at the cause (morphine or a 250ml fluid challenge). As with respiratory
monitoring it is useful to chart the heart rate and blood pressure so that trends over
time can be more easily seen. A developing tachycardia is often an early sign of
unrecognised blood loss. The wound site must also be observed every few minutes to
ensure that any bleeding or haematoma formation is noted early. Drainage from
surgical drains should also be charted.
Conscious level should be monitored by observing the return of reflexes such as the
eyelash reflex, swallowing and the start of vocalisation and response to commands.
Where the patient has undergone regional anaesthesia (spinal or epidural) the height
of the block must be assessed until it is seen to be regressing. This is most easily
tested by measuring the point at which cold can no longer be appreciated (using ethyl
chloride or ice). It is safer not to sit these patients up too early as marked postural
hypotension can occur.
Once the patient is vocalising and is reasonably awake pain levels should be assessed.
Recovery nurses should be capable of administering intravenous analgesia and
achieving adequate analgesia should be a primary goal once airway reflexes have
returned. Pain is most easily treated by administering morphine 1-2 mg aliquots every
3-5 minutes until comfortable. It is very unusual to overdose patients using this
regime, but intravenous naloxone should be available. See also, Update in
Anaesthesia 1997;7:2.
(Continued ...)

Encyclopedia of Surgery: A Guide for Patients and Caregivers :: Pa-St

Recovery room
Ads by Google
Tubal Reversal Surgery - Laparoscopy (Tiny Incision) Method Board-certified
Delaware Surgeons - www.reproductiveassociates.org
How can disease - be detected before it strikes? Siemens. Answers for Life. www.siemens.com/answers
AnesthesiaNow.com - Free access to the latest scientific and clinical literature. www.AnesthesiaNow.com
Surgical Lighting Sales - Amsco, ALM, Berchtold, DRE Skytron, Hanaulux,
Midmark - www.dremed.com

Definition
The recovery room, also called a post-anesthesia care unit (PACU), is a space a
patient is taken to after surgery to safely regain consciousness from anesthesia and
receive appropriate post-operative care.

Description
Patients who have had surgery or diagnostic procedures requiring anesthesia or
sedation are taken to the recovery room, where their vital signs (e.g., pulse, blood
pressure, temperature, blood oxygen levels) are monitored closely as the effects of
anesthesia wear off. The patient may be disoriented when he or she regains
consciousness, and the recovery room nursing staff will work to ease their anxiety and
ensure their physical and emotional comfort.
The recovery room staff will pay particular attention to the patient's respiration, or
breathing, as the patient recovers from anesthesia. A pulse oximeter, a clamp-like
device that attaches to a patient's finger and uses infrared light to measure the oxygen
saturation level of the blood, is usually used to assess respiratory stability. If the
oxygen saturation level is too low, supplemental oxygen may be administered through
a nasal cannula or face mask. Intravenous fluids are also frequently administered in
the recovery room.
Because general anesthesia can cause a patient's core body temperature to drop
several degrees, retaining body heat to prevent hypothermia and encourage good

circulation is also an important part of recovery room care. Patients may be wrapped
in blankets warmed in a heater or covered with a forced warm-air blanket system to
bring body temperature back up to normal. They may also receive heated intravenous
fluids.
The amount of time a patient requires in the recovery room will vary by surgical or
diagnostic procedure and the type of anesthesia used. As the patient recovers from
anesthesia, their post-operative condition is assessed by the recovery room nursing
staff. A physician may order analgesic or antiemetic medication for any pain or nausea
and vomiting, and the surgeon and/or anesthesiologist may come by to examine the
patient.
Both hospitals and ambulatory surgical centers have recovery room facilities, which
are generally located in close proximity to the operating room. A recovery room may
be private, or it may be a large, partitioned space shared by many patients. Each
patient bay, or space, is equipped with a variety of medical monitoring equipment. To
keep the area sterile and prevent the spread of germs, outside visitors may be required
to don a gown and cap or may be prohibited completely. Spouses or partners of
women who are recovering after caesarean section and the parents of children
recovering from surgery are typically excluded from any visitor prohibitions in the
recovery room. In fact, parents are usually encouraged to be with their child in
recovery to minimize any emotional trauma.
In some ambulatory surgery facilities, patients may have a different post-operative
experience if they receive short-acting anesthetic drugs for their procedure. This
protocol, known as "fast tracking," involves either shortening the time spent in the
PACU or, if clinically indicated, bypassing the PACU altogether and sending the
patient directly to what is known as a phase II step-down unit. A step-down unit is an
"in between" transitional care area where patients can rest and recover before
discharge with a lesser degree of monitoring and staff attention then in a PACU.

Normal results
After the effects of anesthesia have worn off completely and the patient's condition is
considered stable, he or she will either be returned to their hospital room (for inpatient
surgery) or discharged (for outpatient surgery). Patients who are discharged will be
briefed on post-operative care instructions to follow at home before they are released.

Resources
BOOKS
Hatfield, Anthea, and Michael Tronson. The Complete Recovery Room Book, 3rd edition. London:
Oxford University Press, 2002.

PERIODICALS
Duncan, Peter, et al. "A Pilot Study of Recovery Room Bypass ("Fast-track Protocol") in a Community
Hospital." Canadian Journal of Anesthesia 48 (2001): 630.

ORGANIZATIONS
American Society of Anesthesiologists. 520 N. Northwest Highway Park Ridge, IL 60068-2573. (847)
825-5586; Fax: (847) 825-1692. .

Paula Ford-Martin

User Contributions:
The following comments are not guaranteed to be that of a trained medical
professional. Please consult your physician for advice.
http://www.surgeryencyclopedia.com/Pa-St/Recovery-Room.html

Recovery Room (PACU)

YOUR TRIP TO THE RECOVERY ROOM (PACU)
When your surgery is complete, you will be brought to the
Recovery Room (PACU). Anyone receiving anesthesia
assistance or sedation during their procedure will be
transferred to the Recovery Room (PACU) while lying on
a stretcher (gurney or portable narrow bed). Patients who
receive a local anesthesia (just the area of the procedure is
numbed) will ambulate to the recovery room with their OR
nursing staff.
UPON ARRIVAL TO THE RECOVERY ROOM (PACU)
Your Recovery Room (PACU) RN will meet you at the first phase of our recovery
room and introduce him/herself. There will seem to be a lot of activity while the RN
receives a report from the surgical team. This helps us to better understand you and
what you have experienced intraoperatively so that we can provide the quality care
that you deserve postoperatively. The nurse will perform an initial assessment and will
place some monitoring equipment on you that you will be already be familiar with
from the Operating Room. The blood pressure cuff is automatic and will be taken
every 15 minutes. You will be assessed frequently for pain management and
monitored for any postoperative symptoms. If you have received anesthesia assistance
or sedation, or if it is medically required, an oxygen mask will be placed on or near
your nose.
HOW LONG WILL I REMAIN IN THE RECOVERY ROOM (PACU)?
For patients who receive anesthesia assistance or sedation intraoperatively, the

average recovery time is 1 hour. You will stay on the stretcher on which you were
transferred to the Recovery Room (PACU) for approximately one hour of that time.
Once you are alert and awake, you will be provided light nourishment: fluids and
crackers. We will assist you to a recliner chair in our second stage of the recovery
room just a few steps away. For patients who receive local anesthesia (just the area of
the procedure is numbed), the average recovery time is hour. Upon arrival to the
unit you will be provided some light nourishment: fluids and crackers.
VISITING AN ADULT PATIENT
The first phase of your recovery is limited to one visit made by 1-2 of your significant
others for a brief 5 minutes. This provides you with the time needed to recover from
anesthetics, sedation, or the stress from your procedure. Once you are in the second
phase area of the recovery room (PACU), your escort may stay with you for the rest of
your recovery time.
VISITING A PEDIATRIC PATIENT
Parents accompanying children under the age of 18 must remain with their child for
the entire recovery period.
http://www.med.nyu.edu/daysurgery/recovery/

Surgery Recovery Room

The surgery recovery room is an area of a hospital used for the close monitoring of
people who have had an operation in which anesthesia was given. The recovery room
may also be used to perform special procedures. Occasionally, people come from other
parts of the hospital, such as the X-ray department, following a procedure that
involved sedation.

What is the information for this topic?

The recovery room is usually located next door to the operating room. This allows for
the safe transfer of people. There is also ready access to surgeons and the anesthesia
department. As a person starts to wake up from surgery, they are taken to the recovery
room until the effects of anesthesia have worn off.
The first few minutes in the recovery room are usually confusing. It is not unusual for
people to wake up in the recovery room and have no idea where they are. People go
from a deep sleep or heavy sedation to a room they have never seen before. For most
people, the only thing they will remember is the last few minutes before surgery. An
oxygen mask may be in place when the person wakes up. The intravenous or IV that
was put in before surgery will still be in place. The blood pressure, pulse, breathing
rate, and temperature are monitored closely. Nausea is very common when people first
wake up. Vomiting sometimes occurs. Pain medication is given as needed.
The recovery room is often busy with activity. New people come into the room after

surgery as others are leaving. There may be loud beeping noises made by the different
monitoring machines.
When the person is ready for discharge from the recovery room, they will either go to
the surgical inpatient unit, the intensive care unit or the same-day surgery area. They
will continue to recover and will be sent home when appropriate.

Heart Surgery & Recovery

Important New Book to support you through the challenging recovery
www.OpenHeartCoach.com/TheBook.html

The Luxury you Deserve

Buy a Vacation Property,Golf, Marina, White Beach, in Caribbean
www.InversionesAides.com

Hospitaltechnik AG
Profis im Krankenhaus-Innenausbau - OP-Tren, OP-Wnde, Intensiv-Wnde,
www.hospitaltechnik.de

Gallbladder Surgery Info

Who should have gallbladder surgery? Is it painful? Recovery?
www.HealthInfoArticles.com

Consultant Surgeon S'pore

Dr See Ju Yaw. Ambulatory SurgiCare at S'pore's new Novena Medical Cte
TakeMeToAsia.com/Drs/DrSeeJuYaw

Advertise on this site

Author: Adam Brochert, MD
Reviewer: Gail Hendrickson, RN, BS
Date Reviewed: 07/24/01
http://www.healthopedia.com/surgery-recovery-room/

Recovery Room / Post-Anesthesia Care Unit

Recovery Room / Post-Anesthesia Care Unit

Where will my child recover from surgery?
Once surgery has been completed, your child will be brought to the recovery room,
also called the post-anesthesia care unit (also called PACU). In the recovery room,
registered nurses, anesthesiologists, and other healthcare professionals will closely
monitor your child as he/she "awakens" from anesthesia. The length of time spent in
recovery depends on the type of surgery performed, your child's response to surgery
and anesthesia, and your child's medical condition. While your child is in recovery,
the staff will (when applicable) complete the following:

monitor vital signs such as blood pressure, pulse, and breathing

monitor for any signs of complications
take your child's temperature
monitor your child's level of consciousness
check tubes or drains
check the wound
check intravenous (IV) infusions
monitor your child's urine output
maintain your child's comfort with pain medication and body positioning.
make sure your child is awake enough to swallow effectively before offering
something to drink

When your child is awake and his/her vital signs are stable, he/she will be brought
back to a regular hospital room or discharged home.
Click here to view the
Online Resources of The Child Having Surgery
http://www.childrensnyp.org/mschony/P03025.html#top

Recovery Room
Definition
The recovery room, also called a post-anesthesia care unit (PACU), is a space a
patient is taken to after surgery to safely regain consciousness from anesthesia and
receive appropriate post-operative care.
Description
Patients who have had surgery or diagnostic procedures requiring anesthesia or
sedation are taken to the recovery room, where their vital signs (e.g., pulse, blood
pressure, temperature, blood oxygen levels) are monitored closely as the effects of
anesthesia wear off. The patient may be disoriented when he or she regains
consciousness, and the recovery room nursing staff will work to ease their anxiety and
ensure their physical and emotional comfort.
The recovery room staff will pay particular attention to the patient's respiration, or
breathing, as the patient recovers from anesthesia. A pulse oximeter, a clamp-like
device that attaches to a patient's finger and uses infrared light to measure the oxygen
saturation level of the blood, is usually used to assess respiratory stability. If the
oxygen saturation level is too low, supplemental oxygen may be administered through
a nasal cannula or face mask. Intravenous fluids are also frequently administered in
the recovery room.
Because general anesthesia can cause a patient's core body temperature to drop
several degrees, retaining body heat to prevent hypothermia and encourage good
circulation is also an important part of recovery room care. Patients may be wrapped
in blankets warmed in a heater or covered with a forced warm-air blanket system to
bring body temperature back up to normal. They may also receive heated intravenous
fluids.
The amount of time a patient requires in the recovery room will vary by surgical or
diagnostic procedure and the type of anesthesia used. As the patient recovers from
anesthesia, their post-operative condition is assessed by the recovery room nursing
staff. A physician may order analgesic or antiemetic medication for any pain or nausea
and vomiting, and the surgeon and/or anesthesiologist may come by to examine the
patient.
Both hospitals and ambulatory surgical centers have recovery room facilities, which
are generally located in close proximity to the operating room. A recovery room may
be private, or it may be a large, partitioned space shared by many patients. Each
patient bay, or space, is equipped with a variety of medical monitoring equipment. To
keep the area sterile and prevent the spread of germs, outside visitors may be required

to don a gown and cap or may be prohibited completely. Spouses or partners of

women who are recovering after caesarean section and the parents of children
recovering from surgery are typically excluded from any visitor prohibitions in the
recovery room. In fact, parents are usually encouraged to be with their child in
recovery to minimize any emotional trauma.
In some ambulatory surgery facilities, patients may have a different post-operative
experience if they receive short-acting anesthetic drugs for their procedure. This
protocol, known as "fast tracking," involves either shortening the time spent in the
PACU or, if clinically indicated, bypassing the PACU altogether and sending the
patient directly to what is known as a phase II step-down unit. A step-down unit is an
"in between" transitional care area where patients can rest and recover before
discharge with a lesser degree of monitoring and staff attention then in a PACU.
Normal Results
After the effects of anesthesia have worn off completely and the patient's condition is
considered stable, he or she will either be returned to their hospital room (for inpatient
surgery) or discharged (for outpatient surgery). Patients who are discharged will be
briefed on post-operative care instructions to follow at home before they are released.
Resources
Books

Hatfield, Anthea, and Michael Tronson. The Complete Recovery Room Book, 3rd
edition. London: Oxford University Press, 2002.
Periodicals

Duncan, Peter, et al. "A Pilot Study of Recovery Room Bypass ("Fast-track Protocol")
in a Community Hospital." Canadian Journal of Anesthesia 48 (2001): 630.
Organizations

American Society of Anesthesiologists. 520 N. Northwest Highway Park Ridge, IL

60068-2573. (847) 825-5586; Fax: (847) 825-1692. http://www.asahq.org.
Paula Ford-Martin
http://www.answers.com/topic/recovery-room