Postanesthetic Care

Periodic assessment of airway patency, respiratory rate, and oxygen saturation should be done during emergence and recovery.

• Particular attention should be given to monitoring oxygenation and ventilation.

Routine monitoring of pulse and blood pressure should be done during emergence and recovery, and electrocardiographic monitors should be immediately available. Assessment of neuromuscular function should be performed during emergence and recovery for patients who have received nondepolarizing neuromuscular blocking agents or who have medical conditions associated with neuromuscular dysfunction. Mental status should be periodically assessed during emergence and recovery. Patient temperature should be periodically assessed during emergence and recovery. Pain should be periodically assessed during emergence and recovery. Periodic assessment of nausea and vomiting should be performed routinely during emergence and recovery. Postoperative hydration status should be assessed in the postanesthesia care unit and managed accordingly.

• Certain procedures involving significant loss of blood or fluids may require additional fluid management.

Assessment of urine output and of urinary voiding should be done on a case-by-case basis for selected patients or selected procedures during emergence and recovery. Assessment of drainage and bleeding should be performed.

Antiemetic agents should be used for the prevention and treatment of nausea and vomiting when indicated. Multiple antiemetic agents may be used for the prevention or treatment of nausea and vomiting when indicated.

Administering supplemental oxygen during transportation or in the recovery room should be done for patients at risk of hypoxemia. Normothermia should be a goal during emergence and recovery.

• When available, forced air warming systems should be used for treating hypothermia.

Meperidine should be used for the treatment of patient shivering during emergence and recovery when clinically indicated.

• Hypothermia, a common cause of shivering, should be treated by rewarming.

• Practitioners may consider other opioid agonists or agonist–antagonists when meperidine is contraindicated or not available.

Specific antagonists should be available whenever benzodiazepines are administered.

• Flumazenil should not be used routinely, but may be administered to antagonize respiratory depression and sedation in selected patients.

• After pharmacologic antagonism, patients should be observed long enough to ensure that cardiorespiratory depression does not recur.

Specific antagonists should be available whenever opioids are administered.

• Opioid antagonists (e.g., naloxone) should not be used routinely but may be administered to antagonize respiratory depression in selected patients.

• After pharmacologic antagonism, patients should be observed long enough to ensure that cardiorespiratory depression does not recur.

• The Task Force reminds practitioners that acute antagonism of the effects of opioids may result in pain, hypertension, tachycardia, or pulmonary edema.

Specific antagonists should be administered for reversal of residual neuromuscular blockade when indicated.

The routine requirement for urination before discharge should not be part of a discharge protocol and may only be necessary for selected patients. The requirement of drinking clear fluids should not be part of a discharge protocol and may only be necessary for selected patients, determined on a case-by-case basis (e.g., diabetic patients) As part of a recovery room discharge protocol, all patients should be required to have a responsible individual accompany them home. Patients should be observed until they are no longer at increased risk for cardiorespiratory depression.

• A mandatory minimum stay should not be required.

• Discharge criteria should be designed to minimize the risk of central nervous system or cardiorespiratory depression after discharge.