Introduction to the postanaesthetic care unit

Abstract

High-risk, noncardiac surgery represents only 12.5% of surgical procedures, but 83.3% of deaths. The postanaesthetic care unit (PACU) addresses the need for an improved level of care for these patients by providing postoperative high-dependency or intensive care (Level 2 or 3). The PACU aims to improve the structure of care provision for high-risk surgical patients. By maintaining 24-hour cover at the same staffing level, the risk of poorer ‘out-of- hours’ care is reduced. In a PACU, whose remit is solely postoperative care, evidence-based protocols can be established to standardize the care given. The aim is to provide 24 hours of postoperative optimized care, thus targeting the period when these patients are most vulnerable, to reduce the risk of complications developing and identify complications promptly, should they occur. The PACU is set up to facilitate certain processes to aid optimized care in the postoperative period. These include invasive and noninvasive ventilation, goal-directed haemodynamic management, invasive monitoring and optimal pain management. Identification of high-risk patients who might benefit from PACU care is not always straightforward. However, tools are available to aid the clinician, supplementing clinical assessment and basic investigations. These include clinical prediction rules and cardiopulmonary exercise testing. Both the setting up and the running of a PACU clearly have cost implications. However, the reduction in postoperative morbidity, and thus patients’ length of stay, should, overall, reduce costs. The benefits of a PACU should therefore be seen in terms of improved surgical outcomes, reducing postoperative morbidity and mortality, and cost savings.

Post anaesthetic care of emergency laparotomy patient for the optimization of surgical outcome

“…Perioperative risks and associated postoperative outcomes can result from the complex interaction between the patient's physical health status, the actual surgery performed, anaesthetic procedure and intra/ postoperative events (Simpson & Moonesinghe 2013). In this case study, the systematic assessment and management of a 45 year old patient undergoing an emergency laparotomy will be discussed.…”

Nurse-led extubation in the post-anaesthesia care unit

“…With increased demand for postoperative critical care provision for high risk surgical patients, the PACU can provide postoperative high dependency or critical care to patients, where interventions aimed at improving outcomes can be implemented. The impact can be to reduce morbidity, length of hospital stay and demand on crucial intensive care unit (ICU) beds (Simpson & Moonesinghe 2013).…”

“…With an increasing disease burden from an aging population, there is likely to be growing demand for high risk surgical procedures, requiring improved postoperative, critical care for these patients (Simpson & Moonesinghe 2013). Advanced age, co-morbid disease and major, urgent surgery are some of the key factors associated with surgery considered to be high risk, with approximately 12% of high risk patients accounting for 80% of postoperative deaths in the UK (Pearse et al 2011).…”

Etomidate and Ketamine: Residual Motor and Adrenal Dysfunction that Persist beyond Recovery from Loss of Righting Reflex in Rats

“…All anesthetics have the ability to depress brain stem neuronal activity, which can result in apnea and severe arterial hypotension [ 4 ]. Therefore, careful monitoring is obligatory, until sufficient breathing, functional mobility and cognitive functioning are secured [ 5 ].…”