Anaesthesiology
Post-Anaesthesia Recovery
Post-anaesthesia recovery for MBBS: PACU monitoring, airway obstruction and laryngospasm, Aldrete score, PONV, shivering and discharge criteria, mapped to NMC codes AS6.
MedNext Academy | 3 min read
Post-Anaesthesia Recovery
Post-anaesthesia recovery for MBBS: PACU monitoring, airway obstruction and laryngospasm, Aldrete score, PONV, shivering and discharge criteria, mapped to NMC codes AS6.
This chapter covers the safe recovery of the patient after anaesthesia, from monitoring in the post-anaesthesia care unit to the recognition and management of the common early complications. It sets out discharge scoring, the crash cart and equipment, and the management of airway, respiratory, cardiovascular and postoperative nausea problems.
High-yield: Post-Anaesthesia Recovery
- The post-anaesthesia care unit provides close monitoring of the airway, breathing, circulation and conscious level as the patient wakes.
- The commonest early airway problem in recovery is obstruction from the tongue falling back in a still-sedated patient, relieved by a chin lift or jaw thrust.
- Laryngospasm is a sudden reflex closure of the vocal cords, often at light anaesthesia, treated with oxygen, jaw thrust and, if needed, a small dose of succinylcholine.
- The modified Aldrete score assesses activity, respiration, circulation, consciousness and oxygen saturation to decide fitness for discharge from recovery.
- Postoperative hypoxaemia may be due to hypoventilation, residual anaesthetic, atelectasis or diffusion hypoxia, and supplemental oxygen is given routinely on emergence.
- Residual neuromuscular block presents with weakness and a poor head lift, and is confirmed with a nerve stimulator train-of-four ratio below 0.9.
- Postoperative nausea and vomiting is more common in women, non-smokers, those with motion sickness and after opioids and volatile agents.
- Ondansetron, dexamethasone and droperidol act at different receptors, so combining antiemetics is more effective than increasing the dose of one.
- Emergence delirium and delayed recovery should prompt a check for hypoxia, hypercarbia, hypoglycaemia, residual drugs and hypothermia.
- Shivering after anaesthesia raises oxygen demand and is treated with warming and low-dose intravenous pethidine or tramadol.
- Postoperative pain should be assessed with a validated score and treated by a multimodal approach combining paracetamol, non-steroidal drugs and opioids.
- Hypothermia on arrival in recovery delays drug metabolism and wound healing and is corrected with forced-air warming.
- The recovery area must have a fully stocked crash cart, suction, oxygen and monitoring at every bay, checked at the start of each list.
- A patient is discharged from recovery only when stable, protecting their airway, breathing adequately, comfortable and haemodynamically stable.
Common recovery-room complications
- **Airway obstruction:** Tongue falls back in a sedated patient. Chin lift, jaw thrust, airway adjunct.
- **Laryngospasm:** Reflex cord closure at light anaesthesia. Oxygen, jaw thrust, small-dose succinylcholine.
- **PONV:** Common in women, non-smokers, opioid and volatile use. Combine ondansetron, dexamethasone.
- **Shivering:** Raises oxygen demand. Active warming and low-dose pethidine or tramadol.
NMC competencies in this chapter
- **AS6.1:** Principles of monitoring and resuscitation in the recovery room
- **AS6.2:** Crash cart contents and recovery room equipment
- **AS6.3:** Common recovery room complications: recognition and management
Frequently Asked Questions
What is the commonest airway problem in the recovery room?
Obstruction by the tongue falling back in a patient who is still sedated. It is relieved by a chin lift or jaw thrust and, if needed, an oropharyngeal or nasopharyngeal airway.
How is fitness for discharge from recovery assessed?
With a scoring system such as the modified Aldrete score, which grades activity, respiration, circulation, consciousness and oxygen saturation. The patient must be stable and able to protect the airway.
Who is at high risk of postoperative nausea and vomiting?
Women, non-smokers, those with a history of motion sickness or previous PONV, and patients given opioids or volatile agents. Risk is reduced with a combination of antiemetics.
How is postoperative shivering managed?
By active warming to restore normal temperature and low-dose intravenous pethidine or tramadol. Shivering matters because it sharply increases oxygen consumption and myocardial demand.
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