Abstract
The implementation of the post-anaesthesia care units (PACUs) has the potential to improve patient safety and reduce the incidence of early postoperative complications and mortality, length of hospital stay and hospital costs. Increased availability of the PACU beds resulted in reduced utilisation of intensive care unit resources without compromising patient care after major thoracic surgery. There is an emphasis on early identification and treatment of adverse events occurring in the PACU such as airway obstruction, aspiration of vomitus, postoperative nausea and vomiting, inadequate ventilation from residual anaesthetics or muscle relaxants, anxiety, glycaemic control, pain, hypothermia and cardiopulmonary, renal and surgical complications. This could improve the outcome and reduce mortality after thoracic surgery.
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References
Simpson JC, Moonesinghe SR (2013) Introduction to the postanaesthetic care unit. Perioper Med (Lond) 2:5
Macario A, Glenn D, Dexter F (1999) What can the postanesthesia care unit manager do to decrease costs in the postanesthesia care unit? J Perianesth Nurs 14:284–293
Schweizer A, Khatchatourian G, Ho¨hn L, Spiliopoulos A, Romand J, Licker M (2002) Opening of a new postanesthesia care unit: impact on critical care utilization and complications following major vascular and thoracic surgery. J Clin Anesth 14:486–493
Haret D, Kneeland M, Ho E (2012) Postanesthesia care units. In: Operating room design manual 2012. American Society of Anesthesiologists, Park Ridge. 14. pp 57–72. Permission to use was obtained
Krenk L, Rasmussen LS, Kehlet H (2010) New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand 54:951–956
Practice guidelines for postanesthetic care: a report by the American Society of Anesthesiologists Task Force on Postanesthetic Care (2002). Anesthesiology 96:742–745
Frederico A (2007) Innovations in care: the nurse practitioner in the PACU. J Perianesth Nurs 22:235–242
Nicholau D (2009) The postanesthesia care unit. In: Miller RD (ed) Miller’s anesthesia, 6th edn. Elsevier Chruchill Livingstone, Philadelphia
El Tahan MR (2011) Effects of aminophylline on cognitive recovery after sevoflurane. J Anesth 25:648–656
Aldrete JA (1995) The post-anaesthesia recovery score revisited. J Clin Anesth 7:89–91
Brown I, Jellish WS, Kleinman B, Fluder E, Sawicki K, Katsaros J et al (2008) Use of postanesthesia discharge criteria to reduce discharge delays for inpatients in the postanesthesia care unit. J Clin Anesth 20:175–179
Hoke N, Falk S (2012) Interdisciplinary rounds in the post-anesthesia care unit: a new perioperative paradigm. Anesthesiol Clin 30:427–431
Jokinen J, Smith AF, Roewer N, Eberhart LHJ, Kranke P (2012) Management of postoperative nausea and vomiting. How to deal with refractory PONV? Anesthesiol Clin 30:481–493
Leslie K, Myles PS, Chan MT, Paech MJ, Peyton P, Forbes A et al (2008) Risk factors for severe postoperative nausea and vomiting in a randomized trial of nitrous oxide-based vs nitrous oxide-free anaesthesia. Br J Anaesth 101:498–505
Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS (2008) Residual neuromuscular blockade and critical respiratory events in the post-anesthesia care unit. Anesth Analg 107:130–137
Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS et al (2008) Intraoperative acceleromyographic monitoring reduces the risk of residualneuromuscular blockade and adverse respiratory events in the post-anesthesia care unit. Anesthesiology 109:389–398
Radtke FM, Franck M, Hagemann L, Seeling M, Wernecke KD, Spies CD (2010) Risk factors for inadequate emergence after anesthesia: emergence delirium and hypoactive emergence. Minerva Anestesiol 76:394–403
Card E, Pandharipande P, Tomes C, Lee C, Wood J, Nelson D et al (2014) Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit. Br J Anaesth. pii: aeu442
Neufeld KJ, Leoutsakos JM, Sieber FE, Wanamaker BL, Gibson Chambers JJ, Rao V et al (2013) Outcomes of early delirium diagnosis after general anesthesia in the elderly. Anesth Analg 117:471–478
Xará D, Silva A, Mendonça J, Abelha F (2013) Inadequate emergence after anesthesia: emergence delirium and hypoactive emergence in the post-anesthesia care unit. J Clin Anesth 25:439–446
Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Bandeira D et al (2001) Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand 45:298–307
Jellish WS, O’Rourke M (2012) Anxiolytic use in the postoperative care unit. Anesthesiol Clin 30:467–480
Hackman KL, Bailey MJ, Snell GI, Bach LA (2014) Diabetes is a major risk factor for mortality after lung transplantation. Am J Transplant 14:438–445
Russo N (2012) Perioperative glycemic control. Anesthesiol Clin 30:445–466
Lena D, Kalfon P, Preiser JC, Ichai C (2011) Glycemic control in the intensive care unit and during the postoperative period. Anesthesiology 114:438–444
Wenk M, Schug SA (2011) Perioperative pain management after thoracotomy. Curr Opin Anaesthesiol 24:8–12. doi:10.1097/ACO.0b013e3283414175
Khelemsky Y, Noto CJ (2012) Preventing post-thoracotomy pain syndrome. Mt Sinai J Med 79:133–139
Buvanendran A, Kroin JS (2009) Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 22:588–593
Bunchungmongkol N, Pipanmekaporn T, Paiboonworachat S, Saeteng S, Tantraworasin A (2014) Incidence and risk factors associated with ipsilateral shoulder pain after thoracic surgery. J Cardiothorac Vasc Anesth 28:991–994
Imai Y, Imai K, Kimura T, Horiguchi T, Goyagi T, Saito H et al (2015) Evaluation of postoperative pregabalin for attenuation of postoperative shoulder painafter thoracotomy in patients with lung cancer, a preliminary result. Gen Thorac Cardiovasc Surg 63:99–104
Kiekkas P, Poulopoulou M, Papahatzi A, Souleles P (2005) Effects of hypothermia and shivering on standard PACU monitoring of patients. AANA J 73:47–53
Warttig S, Alderson P, Campbell G, Smith AF (2014) Interventions for treating inadvertent postoperative hypothermia. Cochrane Database Syst Rev 11, CD009892
Alfonsi P (2003) Postanaesthetic shivering. Epidemiology, pathophysiology and approaches to prevention and management. Minerva Anestesiol 69:438–442
Li X, Zhou M, Xia Q, Li W, Zhang Y (2014) Effect of parecoxib sodium on postoperative shivering: a randomised, double-blind clinical trial. Eur J Anaesthesiol 31:225–230
Coughlin SM, Emmerton-Coughlin HM, Malthaner R (2012) Management of chest tubes after pulmonary resection: a systematic review and meta-analysis. Can J Surg 55:264–270
Leschber G, May CJ, Simbrey-Chryselius N (2014) Do thoracic surgery patients always need a postoperative chest X-ray? Zentralbl Chir 139(Suppl 1):S43–S49
Goudie E, Bah I, Khereba M, Ferraro P, Duranceau A, Martin J et al (2012) Prospective trial evaluating sonography after thoracic surgery in postoperative careand decision making. Eur J Cardiothorac Surg 41:1025–1030
Imperatori A, Rotolo N, Gatti M, Nardecchia E, De Monte L, Conti V et al (2008) Peri-operative complications of video-assisted thoracoscopic surgery (VATS). Int J Surg 6(Suppl 1):S78–S81
Sirbu H, Busch T, Aleksic I, Lotfi S, Ruschewski W, Dalichau H (1999) Chest re-exploration for complications after lung surgery. Thorac Cardiovasc Surg 47:73–76
Litle VR, Swanson SJ (2006) Postoperative bleeding: coagulopathy, bleeding, hemothorax. Thorac Surg Clin 16:203–207, v
Browne SM, Halligan PW, Wade DT, Taggart DP (2003) Postoperative hypoxia is a contributory factor to cognitive impairment after cardiac surgery. J Thorac Cardiovasc Surg 126:1061–1064
Bosînceanu M, Sandu C, Ionescu LR, Roată C, Miron L (2014) Clinical-epidemiological study on the incidence of postoperative complications after pulmonary resection for lung cancer. Rev Med Chir Soc Med Nat Iasi 118:1040–1046
Siddiqui N, Arzola C, Teresi J, Fox G, Guerina L, Friedman Z (2013) Predictors of desaturation in the postoperative anesthesia care unit: an observational study. J Clin Anesth 25:612–617
Martin DS, Grocott MPW (2013) Oxygen therapy in anaesthesia: the yin and yang of O2. Br J Anaesth 111:867–871
Aust H, Eberhart LH, Kranke P, Arndt C, Bleimüller C, Zoremba M et al (2012) Hypoxemia after general anesthesia. Anaesthesist 61:299–309
Pai VB, Vallurupalli S, Kasula SR, Hakeem A, Bhatti S (2014) A change of heart: reopening of a foramen ovale. Can J Cardiol 30:1250. e17-8
Jaber S, De Jong A, Castagnoli A, Futier E, Chanques G (2014) Non-invasive ventilation after surgery. Ann Fr Anesth Reanim 33:487–491
Ferguson MK, Saha-Chaudhuri P, Mitchell JD, Varela G, Brunelli A (2014) Prediction of major cardiovascular events after lung resection using a modified scoring system. Ann Thorac Surg 97:1135–1140
Berry MF, D’Amico TA, Onaitis M (2014) Use of amiodarone after major lung resection. Ann Thorac Surg 98:1199–1206
Hernandez AF, Whellan DJ, Stroud S, Sun JL, O’Connor CM, Jollis JG (2004) Outcomes in heart failure patients after major noncardiac surgery. J Am Coll Cardiol 44:1446–1453
Pedoto A, Amar D (2009) Right heart function in thoracic surgery: role of echocardiography. Curr Opin Anaesthesiol 22:44–49
Ho SY, Nihoyannopoulos P (2006) Anatomy, echocardiography, and normal right ventricular dimension. Heart 92:i2–i13
Mehanna MJ, Israel GM, Katigbak M, Rubinowitz AN (2007) Cardiac herniation after right pneumonectomy: case report and review of the literature. J Thorac Imaging 22:280–282
Wang Z, Zhang J, Cheng Z, Li X, Wang Z, Liu C et al (2014) Factors affecting major morbidity after video-assisted thoracic surgery for lung cancer. J Surg Res 192:628–634
Fernandez FG, Crabtree TD, Liu J, Meyers BF (2013) Incremental risk of prior coronary arterial stents for pulmonary resection. Ann Thorac Surg 95:1212–1218, discussion 1219–20
Licker M, de Perrot M, Spiliopoulos A, Robert J, Diaper J, Chevalley C et al (2003) Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg 97:1558–1565
Evans RG, Naidu B (2012) Does a conservative fluid management strategy in the perioperative management of lung resection patients reduce the risk of acute lung injury? Interact Cardiovasc Thorac Surg 15:498–504
Haase O, Raue W, Neuss H, Koplin G, Mielitz U, Schwenk W (2013) Influence of postoperative fluid management on pulmonary function after esophagectomy. Acta Chir Belg 113:415–422
Acknowledgements
The authors want to express his appreciation for Ms. Angelin Jeba Suja, PACU staff nurse, King Fahd Hospital of the University of Dammam, for preparing the included photographs in this chapter.
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El Tahan, M.R. (2017). How to Organise the PACU? What to Treat in the PACU?. In: Şentürk, M., Orhan Sungur, M. (eds) Postoperative Care in Thoracic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-19908-5_6
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DOI: https://doi.org/10.1007/978-3-319-19908-5_6
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