Post Anesthesia Care Unit (PACU)

Post Anesthesia Care Unit (PACU)

• The role of the anesthetist is not limited to theatres. There may be a number of postoperative responsibilities to undertake, both in the recovery room and on the surgical ward.
• After receiving anesthesia for a surgery or procedure, a patient is sent to the PACU to recover and wake up.
• The PACU is a critical care unit where the patient’s vital signs are closely observed, pain management begins, and fluids are given.
• The nursing staff is skilled in recognizing and managing problems in patients after receiving anesthesia.
• The PACU is under the direction of the Department of Anesthesiology.

Admission to PACU

Steps

• Coordinate prior to arrival
• Assess airway
• Administer oxygen
• Apply monitors
• Obtain vital signs
• Receive report from anesthesia personnel

Monitoring in the PACU

• Baseline vital signs
• Respiration
  • RR/min, Rhythm
  • Pulse oximetry
• Circulation
  • PR/min & Blood pressure
  • ECG
• Level of consciousness
• Pain scores

Aldrete Score

Score	Activity	Respiration	Circulation	Consciousness	Oxygen Saturation
2	Moves all extremities	Breaths deeply and coughs freely.	BP ± 20 mm of preanesth. level	Fully awake	Spo2 > 92% on room air
1	Moves 2 extremities	Dyspneic, or shallow breathing	BP ± 20-50 mm of preanesth. level	Arousable on calling	Spo2 >90% With suppl. O2
0	Unable to move	Apneic	BP ± 50 mm of preanesth. level	Not responding	Spo2 <92% With suppl. O2

Discharge From the PACU

• Standard Aldrete Score:
  • Simple sum of numerical values assigned to activity, respiration, circulation, consciousness, and oxygen saturation.
  • A score of 9 out of 10 shows readiness for discharge.
• Post-anesthesia Discharge Scoring System:
  • Modification of the Aldrete score which also includes an assessment of pain, N/V, and surgical bleeding, in addition to vital signs and activity.
  • Also, a score of 9 or 10 shows readiness for discharge.