The Post-Anesthesia Care Unit

2018 ◽  
Author(s):  
Evan R Bohnenblust
Keyword(s):  
Neuromuscular Blockade ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Scoring Systems ◽  
Nausea And Vomiting ◽  
Postanesthesia Care Unit ◽  
Emergence Delirium ◽  
Residual Neuromuscular Blockade ◽  
Hemodynamic Compromise ◽  
Standards And Guidelines

physiologic changes caused by both recent administration of anesthesia as well as the preceding surgical intervention. This general overview of the postanesthesia care unit (PACU) summarizes the most current standards and guidelines for patient care and monitoring. It also details the causes and treatment of the most common complications observed in PACU, such as postoperative nausea and vomiting, hemodynamic compromise, and respiratory insufficiency. Other relevant topics such as residual neuromuscular blockade and emergence delirium are also addressed. Finally, this chapter concludes with a discussion of the development of commonly used discharge scoring systems, including a discussion of the differences between the ambulatory and inpatient surgery populations. Each of these sections discusses current trends in management as supported by the latest literature and guidelines.   This review contains 1 figure, 6 tables, and 50 references Key Words: Aldrete scoring, delayed awakening, emergence delirium, postanesthesia care unit, postanesthesia care unit discharge criteria, postoperative nausea and vomiting, postoperative respiratory failure, residual neuromuscular blockade, sugammadex

Alfentanil Causes Less Postoperative Nausea and Vomiting than Equipotent Doses of Fentanyl or Sufentanil in Outpatients 

1999 ◽  
Vol 91 (6) ◽  
pp. 1666-1666 ◽  
Author(s):  
Stephan Langevin ◽  
Martin R. Lessard ◽  
Claude A. Trépanier ◽  
Jean-Pierre Baribault
Keyword(s):  
Postoperative Nausea ◽  
Randomized Study ◽  
Recovery Period ◽  
Plasma Concentrations ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Oxygen Mixture ◽  
Postanesthesia Care Unit ◽  
Outpatient Basis ◽  
Opioid Administration

Background The relative potencies of alfentanil, fentanyl, and sufentanil as a risk factor for postoperative nausea and vomiting have not been determined. They were compared in a randomized study designed to obtain equipotent plasma concentrations of these three opioids at the beginning of the recovery period. Methods The study included 274 patients treated on an outpatient basis. The steady state opioid plasma concentration providing a predicted 50% reduction of the minimum alveolar concentration of isoflurane was used to determine the relative potency of the opioids. The opioids were prepared in equal volumes at concentrations of alfentanil 150 microg/ml, fentanyl 50 microg/ml, and sufentanil 5 microg/ml and were administered in vol/kg. Anesthesia was induced in a blinded fashion with a bolus of the study opioid (0.05 ml/kg) and 4-6 mg/kg thiopental and was maintained with isoflurane (0.6-1%) in a nitrous oxide-oxygen mixture with a continuous infusion of the study opioid (0.06 ml x kg(-1) x h(-1)). If necessary, up to five additional boluses of opioid (0.02 ml/kg) could be given. This opioid administration protocol was tested by pharmacokinetic simulations. Results The incidence of postoperative nausea and vomiting was not different in the postanesthesia care unit, but in the ambulatory surgery unit it was significantly lower for alfentanil compared with fentanyl and sufentanil (12, 34, and 35%, respectively P < 0.005). Pharmacokinetic modeling showed that the end-anesthesia opioid plasma concentrations were approximately equipotent in the three groups. However, modeling does not support that the difference between groups in the postoperative period can be explained by a more rapid disappearance of alfentanil from the plasma. Conclusions Alfentanil, compared with approximately equipotent doses of fentanyl and sufentanil, is associated with a lower incidence of postoperative nausea and vomiting in outpatients.

Recovery and Discharge for Procedures Conducted Outside of the Operating Room

2018 ◽  
Author(s):  
Hairil R. Abdullah ◽  
Frances Chung
Keyword(s):  
Operating Room ◽  
Recovery Period ◽  
Scoring Systems ◽  
Nausea And Vomiting ◽  
Postanesthesia Care Unit ◽  
Significant Pain ◽  
Assessment And Monitoring ◽  
Standards And Guidelines ◽  
Recovery Assessment

This chapter provides contemporary perspectives on the issues of recovery assessment and monitoring, as well as an overview of the criteria-related discharge following anesthesia outside the operating room. The need for appropriate monitoring in the recovery period is argued based on data from an outcomes and claims registry. Discharge scoring systems are also discussed together with pertinent postanesthesia issues that may delay discharge from the postanesthesia care unit, such as nausea and vomiting, significant pain, as well as the need for mandatory patient escort. The standards and guidelines mentioned in this chapter apply not only to the anesthesiologists, but also to other physicians who supervise the recovery of patients in different units.

scholarly journals Chronic Atypical Antipsychotic Use Is Associated With Reduced Need for Postoperative Nausea and Vomiting Rescue in the Postanesthesia Care Unit

2020 ◽  
Vol 130 (1) ◽  
pp. 141-150 ◽  
Author(s):  
Craig S. Jabaley ◽  
Dennis W. Gray ◽  
Gaurav S. Budhrani ◽  
Grant C. Lynde ◽  
Panagiotis Adamopoulos ◽  
...  
Keyword(s):  
Atypical Antipsychotic ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Postanesthesia Care Unit

Prophylactic Ondansetron in Prevention of Postoperative Nausea and Vomiting following Pediatric Strabismus Surgery

2000 ◽  
Vol 92 (4) ◽  
pp. 1035-1042 ◽  
Author(s):  
Senthilkumar Sadhasivam ◽  
Dilip Shende ◽  
Rashmi Madan
Keyword(s):  
Placebo Group ◽  
Outcome Measures ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Strabismus Surgery ◽  
Nausea And Vomiting ◽  
Postanesthesia Care Unit ◽  
Assessment Scores ◽  
Parental Assessment ◽  
Prophylactic Use

Background This study evaluated the antiemetic effectiveness, dose-response, and clinical usefulness of prophylactic ondansetron in the prevention of postoperative nausea and vomiting (PONV) in children undergoing strabismus repair. Method The authors observed 180 children, American Society of Anesthesiologists physical status I or II, 2-12 yr of age, who were undergoing strabismus repair. After induction of anesthesia with halothane and nitrous oxide in oxygen or intravenous thiopental, children received either placebo (saline) or intravenous ondansetron in doses of 25, 50, 75, 100, and 150 /microg/kg (n = 30). The trachea was intubated and ventilation was controlled. Perioperative analgesic and fluid requirements were standardized. Episodes of nausea and vomiting were recorded for the first 24 h postoperatively. Data such as nonsurrogate (parental satisfaction scores and duration of postanesthesia care unit stay) and therapeutic (numbers needed to prevent and harm) outcome measures were collected. Results The incidences of PONV in the placebo and 25-, 50-, 75-, 100-, and 150-,microg/kg ondansetron groups were 83, 77, 47, 30, 30, and 27%, respectively. The incidence was less in the 75(P = 0.002), 100- (P = 0.002), and 150-microg/kg (P < 0.001) ondansetron groups compared with placebo. Duration of stay in the postanesthesia care unit was shorter in the 75-, 100-, and 150-microg/kg ondansetron groups (P < 0.002) compared with the placebo group. Parental assessment scores for the child's perioperative experience and the positive number needed to prevent PONV were also better and favorable in the 75-, 100-, and 150-microg/kg ondansetron groups compared with the placebo group. The incidence (P > 0.99) and severity (P = 0.63) of PONV were similar in the 75- and 150-microg/kg ondansetron groups. Surrogate, nonsurrogate, and therapeutic outcome measures revealed that 75 microg/kg ondansetron provided the same benefits as did 100 and 150 microg/kg. Conclusion The routine prophylactic use of ondansetron at a dose of 75 microg/kg is as effective as 150 microg/kg in preventing PONV and improving the "true" outcome measures after strabismus repair in children.

scholarly journals Reversal of Neuromuscular Blockade with Neostigmine Has No Effect on the Incidence or Severity of Postoperative Nausea and Vomiting

1997 ◽  
Vol 85 (6) ◽  
pp. 1359-1361 ◽  
Author(s):  
Jaromir Hovorka ◽  
Kari Korttila ◽  
Kaisa Nelskyla ◽  
Anne Soikkeli ◽  
Johanna Sarvela ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting

Effect of Antiemetic Therapy on Recovery and Hospital Discharge Time

1995 ◽  
Vol 83 (5) ◽  
pp. 956-960 ◽  
Author(s):  
Peter J. Davis ◽  
Francis X. McGowan Jr. ◽  
Ira Landsman ◽  
Karen Maloney ◽  
Paul Hoffmann
Keyword(s):  
Length Of Stay ◽  
Hospital Discharge ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Antiemetic Therapy ◽  
Hospital Length Of Stay ◽  
Postanesthesia Care Unit ◽  
Discharge Time ◽  
Dental Surgery

Abstract Background Postoperative nausea and vomiting continue to be a significant problem for pediatric ambulatory surgery patients. Although ondansetron has been demonstrated to be effective in the prophylactic treatment of postoperative nausea and vomiting (surrogate end point) no one has demonstrated a benefit of antiemetic therapy on patient recovery, postanesthesia care unit length of stay, and hospital length of stay (nonsurrogate end points). In a double-blind manner, the effects of ondansetron, droperidol, and placebo on the incidence of emesis, postanesthesia care unit stay, and hospital discharge time were evaluated in children undergoing dental surgery.

Substance P (Neurokinin-1) Antagonist Prevents Postoperative Vomiting after Abdominal Hysterectomy Procedures

2000 ◽  
Vol 93 (4) ◽  
pp. 931-937 ◽  
Author(s):  
Zsuzsanna Gesztesi ◽  
Phillip E. Scuderi ◽  
Paul F. White ◽  
William Wright ◽  
Ronald H. Wender ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Abdominal Hysterectomy ◽  
Nausea And Vomiting ◽  
Gynecologic Surgery ◽  
Postanesthesia Care Unit ◽  
Interaction Study ◽  
Dose Ranging ◽  
Neurokinin 1

Background The safety and antiemetic efficacy of CP-122,721, a novel neurokinin-1 antagonist, was evaluated when administered alone or in combination with ondansetron. Methods Using a randomized, double-blind, placebo-controlled study design, CP-122,721 was initially compared with placebo and subsequently to ondansetron alone and in combination for prophylaxis against postoperative nausea and vomiting in 243 women undergoing abdominal hysterectomy. In the dose-ranging studies (n = 86), patients received either CP-122,721 100 mg (vs. placebo) or 200 mg (vs. placebo) orally 60-90 min before induction of anesthesia. In the interaction study (n = 157), patients received CP-122,721 200 mg or placebo 60-90 min before induction of anesthesia, and ondansetron 4 mg or saline 2 ml intravenously 15-30 min before the end of surgery. Patients assessed their level of nausea and pain on arrival in the postanesthesia care unit and at 0.5-, 1-, 1.5-, 2-, 4-, 8-, 12-, and 24-h intervals postoperatively. Emetic episodes, need for rescue antiemetic-antinausea medication, postoperative complications, and patient satisfaction were recorded. Results In the initial dose-ranging study, only 10% of the patients experienced emesis within the first 8 h after surgery with CP-122,721 200 mg compared with 50% in the placebo group. CP-122,721 200 mg also decreased the need for rescue medication (25% vs. 48%). CP-122,721 100 mg was less effective than 200 mg in decreasing the incidence of repeated episodes of emesis. In the interaction study, 6% of the patients receiving CP-122,721 200 mg orally experienced emesis less than 2 h after surgery compared with 17% with ondansetron alone. With combined therapy, only 2% experienced emesis. In addition, the median times for 75% of patients to remain free from postoperative nausea and vomiting were 82, 75, and 362 min in the ondansetron, CP-122,721, and combination groups, respectively. Conclusions Oral CP-122,721 200 mg decreased emetic episodes compared with ondansetron (4 mg intravenously) during the first 24 h after gynecologic surgery; however, there was no difference in patient satisfaction.

Sign in / Sign up

Export Citation Format

Share Document