Expert consensus: recommendations for monitoring and treatment after anesthesia in 2021

、， ，( postanesthesia cure unit，PACU)
。

、，，( postanesthesia cure unit，PACU)
。

Post-anaesthesia monitoring and treatment refers to the management of medicalactivities of
patients undergoing surgery during recovery from anesthesia .

Critically ill patients directly into the ICU (Intensive Care Unit , the ICU) recovery

Post-anaesthesia monitoring and treatment refers to the management of medical activities of

PACU definitions and functions PACU definitions and functions

PACU is also called anesthesia recovery room
.

1873 US Massachusetts General Hospital builtstand first the PACU , the PACU has become a modern hospital anesthesiology standard featureset

PACU is also called anesthesia recovery room

PACU setup requirements PACU setup requirements

PACU design, equipment and staffing should be consistent with the national "General HospitalbuildingdesignmetergaugeFan (GB51039-2014) ", "MedicalAcademyeliminatetoxichealthHealthstandardquasi (GB15982) " and other standards and national health committee documents Compliant
.

PACU design, equipment and staffing should be consistent with the national "General Hospital building design meter gauge Fan (GB51039-2014) ", "Medical Academy eliminate toxic health Health standard quasi (GB15982) " and other standards and national health committee documents Compliant
.

PACU position PACU should be an operating room or other anesthesia or townin close proximity to the medical analgesic quiet area, in order to reduce the transition time to the patient
.

If more thanseparate operating rooms or other needs of anesthesiologists involved in the medical area, it maybe necessary to set up more than the PACU

PACU position PACU should be an operating room or other anesthesia or town in close proximity to the medical analgesic quiet area, in order to reduce the transition time to the patient

PACU 's human resources allocation PACU needs to be equipped with physicians, nurses and necessary auxiliary personnel

The configuration of PACU 's facilities and related medical equipment are basically the same as the requirements of ICU .
(1) monitoring devices : it needs to meet pulse oximetry monitoring, the ECG , noninvasive blood pressure, end-tidal carbon dioxide monitoring function, neuromuscular function, and body temperature measured bedside monitor, according to the needs may be equipped with invasive pressure monitoring ( directly moving pulse pressure measurement, central venous pressure measurement ) special, intracranial pressure monitoring, cardiac output measurement and other monitoring equipment, monitoring equipment has to be in a standby state, the portable monitoring with adequate care patient transport device for use ; (2) respiratory support equipment : should be provided to meet the clinical needs of the ventilator, adjacent to the central operating room PACU should have at least one anesthesia machine ; (3) biochemical test equipment : Anesthesiology or PACU at least required to configure a blood gas analyzer and coagulation monitoring instruments such as thrombosis elastic plotter thrombosis ; (4) the central monitoring and protection station and anesthesia information system

Requirements for transfer from operating room to PACU Requirements for transfer from operating room to PACU

After surgery the procedure set by the anesthesiologists, surgeons, operating roomcommon transport patients and nurses, in transit, transport anesthesia perpetrators responsible forthe safety of the patient, the patient should be continuous monitoring and evaluation and treatment, pay attention to the pre-fall arrester bed , hypoxia, artificial airway, and accidental displacement of the catheter and drainage tube offout
.

The anesthesia practitioner must transfer the postoperative patient to PACU medical staff who have been trained to record the status of the patient when he arrives at the PACU , and hand over the patient’srelevant situation to the PACU medical staff, andprovide consultations for the patient

After surgery the procedure set by the anesthesiologists, surgeons, operating room common transport patients and nurses, in transit, transport anesthesia perpetrators responsible for the safety of the patient, the patient should be continuous monitoring and evaluation and treatment, pay attention to the pre- fall arrester bed , hypoxia, artificial airway, and accidental displacement of the catheter and drainage tube off out

PACU monitoring PACU monitoring

The general anesthesia recovery period of most patients can be divided into four stages : the depth of anesthesia decreases, sensory and motor functions gradually recover ; spontaneous breathing occurs and can gradually maintain normal breathing ; respiratory reflex recovery and wakefulness
.

In patients undergoing anesthesia recovery after nausea and vomiting, upper airway obstruction, hypotension, hypoxemia and delayed awakening and other high incidence of complications, should therefore PACU patient's condition continued to monitor measured and evaluated to avoid misdiagnosis or delayed diagnosis leads to serious Consequences
.
Postoperative monitoring measurement should follow the principle similar to the operation monitor, it is highly recommended by doctors trained ongoing clinical observation care provider, including the observation pulse oximetry, the air passage and respiration, circulation, and the patient's pain score
.
Should be monitored electrocardiogram, pulse blood oxygen saturation and the NIBP , select other monitoring of the patient and surgical factors ( such as temperature and of the monitoring and urine )
.
Record the patient's vital signs at least every 15 minutes, and record it at any time when the condition changes
.
PACU detailed records should be kept in patient medical records were in
.
Conditional units anesthesia information system network application automatically credited to record and save the patient monitoring data
.
Common monitoring indicators for PACU patients are shown in Table 1
.
Neuraxial anesthesia patients require observation of anesthesia, lower extremity sensory and motor function recovery situation
.

The general anesthesia recovery period of most patients can be divided into four stages : the depth of anesthesia decreases, sensory and motor functions gradually recover ; spontaneous breathing occurs and can gradually maintain normal breathing ; respiratory reflex recovery and wakefulness
.
In patients undergoing anesthesia recovery after nausea and vomiting, upper airway obstruction, hypotension, hypoxemia and delayed awakening and other high incidence of complications, should therefore PACU patient's condition continued to monitor measured and evaluated to avoid misdiagnosis or delayed diagnosis leads to serious Consequences
.
Postoperative monitoring diagnostic test should follow the principle similar to the operation monitoring, it is strongly recommended by doctors trained ongoing clinical observation care provider, including the observation pulse oximetry, the air passage and respiratory, circulatory and pain scores in patients
.
Should be monitored electrocardiogram, pulse blood oxygen saturation and the NIBP , select other monitoring of the patient and surgical factors ( such as temperature and of the monitoring and urine )
.
Record the patient's vital signs at least every 15 minutes, and record it at any time when the condition changes
.
PACU detailed records should be kept in patient medical records were in
.
Qualified units apply anesthesia information system to network and automatically recordRecord and save patient monitoring data
.
Common monitoring indicators for PACU patients are shown in Table 1
.
Neuraxial anesthesia patients require observation of anesthesia, lower extremity sensory and motor function recovery situation
.

Treatment of PACU complications

PACU complications of treatment PACU treatment of complications

Postoperative nausea and vomiting (Postoperative Nausea and vomiting , of PONV) after 6 h incidence of nausea and vomiting in 25% [ 9 ]
.
Prevention of postoperative PONV often with the drug dexamethasone, droperidol and 5-HT3 receptor inhibitors, metoclopramide amine and scopolamine
.
No prevention first postoperative administration of a current PONV , the intravenous administration of 5-HT3 receptor antagonist ( ondansetron, Dora tropisetron or granisetron ) treatment
.
Prophylaxis has been used in patients with postoperative out now PONV be other types of anti-emetic agents
.

Postoperative nausea and vomiting (Postoperative Nausea and vomiting , of PONV) after 6 h incidence of nausea and vomiting in 25% [ 9 ]
.
Prevention of postoperative PONV often with the drug dexamethasone, droperidol and 5-HT3 receptor inhibitors, metoclopramide amine and scopolamine
.
Not preventing the first administration of the postoperative prevention now PONV , the intravenous administration of 5-HT3 receptor antagonist ( ondansetron, Dora tropisetron or granisetron ) treatment
.
Prophylaxis has been used in patients with postoperative out now PONV be other types of anti-emetic agents
.

Airway obstruction and hypoxemia

Airway obstruction and hypoxemia

Hypoxemia and respiratory depression is a common respiratory adverse events, airway obstruction is PACU patients with hypoxemia common cause of disease
.
Fall of the tongue, laryngospasm, neck and cervical spine surgery, reflux aspiration, residual effects of anesthetics, etc.
can cause airway obstruction
.
After 3 d hypoxemia and postoperative within 1 year increased mortality, rapid diagnosis and intervention negative airway obstruction may reduce pulmonary edema, hypoxemia and respiratory infections occur
.
Mechanisms of hypoxemia patients have inhaled the gas partial pressure of oxygen down low, hypoventilation ( such as sleep apnea, muscle dysfunction nerve ) , lung-pass gas / perfusion ratio abnormalities ( such as COPD , asthma, interstitial lung disease ) , intrapulmonary shunt ( pulmonary atelectasis, pulmonary edema, A R & lt the DS , pneumonia, pneumothorax ) , diffusion barrier ( such as pulmonary embolism )
.
Treatment measures for hypoxemia include: (1) strictly tracheal extubation, reduce low risk of re-intubation ; (2) evaluate and eliminate the cause of persistent hypoxemia, maintaining airway patency ( such as Jaw insert or oropharyngeal or nasopharyngeal airway pharyngeal obstruction ); (3) oxygen ; (4) antagonize opioid-induced respiratory depression and muscle relaxant drug residue left effect ; (5) support for the treatment of breathing and circulation
.

Hypoxemia and respiratory depression is a common respiratory adverse events, airway obstruction is PACU patients with hypoxemia common cause of disease
.
Fall of the tongue, laryngospasm, neck and cervical spine surgery, reflux aspiration, residual effects of anesthetics, etc.
can cause airway obstruction
.
After 3 d hypoxemia and postoperative within 1 year increased mortality, rapid diagnosis and intervention negative airway obstruction may reduce pulmonary edema, hypoxemia and respiratory infections occur
.
Mechanisms of hypoxemia patients have inhaled the gas partial pressure of oxygen reduction of infection is low, hypoventilation ( such as sleep apnea, neuromuscular dysfunction ) , lung-pass gas / perfusion ratio abnormalities ( such as COPD , asthma, interstitial lung disease ) , intrapulmonary shunt ( pulmonary atelectasis, pulmonary edema, A R & lt the DS , pneumonia, pneumothorax ) , diffusion barrier ( such as pulmonary embolism )
.
Hypoxemia treatment measures include : (1) strictly tracheal extubation, reducing low reintubation risk ; (2) to assess and eliminate the cause of persistent hypoxemia, keeping the airway ( such as child care or jaw insert the oropharyngeal or nasopharyngeal pharyngeal airway obstruction ); (3) oxygen ; (4) antagonize opioid-induced respiratory depression and muscle relaxant drug residue left effect ; (5) support for the treatment of respiratory and circulatory function
.

Abnormal body temperature

Abnormal body temperature

At room temperature should be maintained at 24 deg.
] C or so, note that the patient warm, maintenance maintain normal body temperature of the patient
.
If the patient has signs of hypothermia ( such as chills, cold extremities, etc.
), active warming measures should be taken, such as the use of forced air heating devices and warming intravenous infusion devices
.
The monitoring found that body temperature rises, the cause should be clear after treatment and to take effective measures to ensure, if necessary to take measures to cool down
.

At room temperature should be maintained at 24 deg.
] C or so, note that the patient warm, maintenance maintain normal body temperature of the patient
.
If the patient has signs of hypothermia ( such as chills, cold extremities, etc.
), active warming measures should be taken, such as the use of forced air heating devices and warming intravenous infusion devices
.
The monitoring found that body temperature rises, the cause should be clear after treatment and to take effective measures to ensure, if necessary to take measures to cool down
.

Chills

Chills

Hypothermia is the primary cause of chills.
Patients with chills should use warming measures to improve patient comfort
.
Tramadol, pethidine, dexmedetomidine, and doxapram can be used to treat chills when necessary.
Pay attention to the adverse reactions that these drugs may cause such as respiratory depression, nausea and vomiting, and suppression of consciousness
.

Hypothermia is the primary cause of chills.
Patients with chills should use warming measures to improve patient comfort
.
Tramadol, pethidine, dexmedetomidine, and doxapram can be used to treat chills when necessary.
Pay attention to the adverse reactions that these drugs may cause such as respiratory depression, nausea and vomiting, and suppression of consciousness
.

Postoperative restlessness and delirium

Postoperative restlessness and delirium

Postoperative restlessness and delirium are the most common mental disorders in PACU .
The main reasons include hypoxemia, hypotension, hypoglycemia , pain, bladder swelling, electrolyte and acid-base disorders
.
First of all, corresponding treatment measures should be adopted for the reason , such as removing the tracheal tube at the right time, giving adequate oxygen, sedation and analgesia
.

Postoperative restlessness and delirium are the most common mental disorders in PACU .
The main reasons include hypoxemia, hypotension, hypoglycemia , pain, hypoglycemia, bladder inflation, electrolyte and acid-base disorders
.
First of all, corresponding treatment measures should be adopted for the reasons , such as timely removal of the tracheal tube, adequate oxygen, sedation and analgesia
.

Postoperative pain

Postoperative pain

Each patient should be assessed for pain and adequately treated
individually .
The preferred multimodal analgesic analgesia, intravenous use of opioid analgesics, non-steroidal anti-inflammatory drugs (nonsteroidal Anti-inflammatory Drugs , the NSAIDs) or acetaminophen, local infiltration, nerve block, and peer method
.
Patients with insufficient analgesia should take timely remedial analgesia measures
.

Each patient should be assessed for pain and adequately treated
individually .
The preferred multimodal analgesic analgesia, intravenous use of opioid analgesics, non-steroidal anti-inflammatory drugs (nonsteroidal Anti-inflammatory Drugs , the NSAIDs) or acetaminophen, local infiltration, nerve block, and peer method
.
Patients with insufficient analgesia should take timely remedial analgesia measures
.

Postoperative hypotension

Postoperative hypotension

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Acute postoperative hypertension (Hypertension acute , APH) is defined as a systolic blood pressure, diastolic blood pressure above baseline of 20% or more, APH hair green rate of 4% - 35% , the need for timely treatment
.
The purpose of APH treatment is to protect the functions of important target organs such as the heart, brain, and kidneys
.
Actively find and deal with various causes that may cause APH .
You can use esmolol, labetalol, nicardipine, nitroglycerin and other drugs to control APH
.

Acute postoperative hypertension (Hypertension acute , APH) is defined as a systolic blood pressure, diastolic blood pressure above baseline of 20% or more, APH hair green rate of 4% - 35% , the need for timely treatment
.
The purpose of APH treatment is to protect the functions of important target organs such as the heart, brain, and kidneys
.
Actively find and deal with various causes that may cause APH .
You can use esmolol, labetalol, nicardipine, nitroglycerin and other drugs to control APH
.

Delayed awakening

Delayed awakening

The most common cause of narcotic drugs ( inhalation anesthetic, static vein anesthetics, benzodiazepine drugs, muscle relaxants ) effects
.
Detecting blood gas analysis, blood sugar, serum electrolytes and hemoglobin concentration can be excluded substituting Xie reasons
.
Wake up delay caused narcotic drugs can be used to reverse certain drugs : (1) antagonism benzodiazepine class of drugs : flumazenil benzene by competitive inhibition dinitrogen the benzodiazepine receptor blocking drugs central nervous system (2) Antagonize the effects of opioid analgesics : Naloxone should start at the minimum dose for respiratory depression caused by opioids , and pay attention to the possible adverse reactions such as pain, hypertension, tachycardia and acute pulmonary edema ( not recommended for routine fluorine flumazenil or naloxone, but can be used to call or midazolam opioid-induced absorption inhibiting ); (3) antagonistic muscle relaxant effect : Ming antagonistic muscle relaxants commonly neostigmine drug remaining blocking , while use of atropine ; if necessary, can be more comfortable to use glucose , sodium saccharide reversed rocuronium and muscle relaxation of vecuronium
.
Head should be performed when the cause is unknownCT scan to distinguish whether it is a delayed recovery caused by an intracranial disease
.

The most common cause of narcotic drugs ( inhalation anesthetic, static vein anesthetics, benzodiazepine drugs, muscle relaxants ) effects
.
Detecting blood gas analysis, blood sugar, serum electrolytes and hemoglobin concentration can be excluded substituting Xie reasons
.
Wake up delay caused narcotic drugs can be used to reverse certain drugs : (1) antagonism benzodiazepine class of drugs : flumazenil benzene by competitive inhibition dinitrogen the benzodiazepine receptor blocking drugs central nervous system (2) Antagonize the effects of opioid analgesics : Naloxone should start at the minimum dose for respiratory depression caused by opioids , and pay attention to the possible adverse reactions such as pain, hypertension, tachycardia and acute pulmonary edema ( not recommended for routine fluorine flumazenil or naloxone, but can be used to call or midazolam opioid-induced absorption inhibiting ); (3) antagonistic muscle relaxant effect : Ming antagonistic muscle relaxants commonly neostigmine drug remaining blocking , while use of atropine ; if necessary, can be more comfortable to use glucose , sodium saccharide reversed rocuronium and muscle relaxation of vecuronium
.
Head should be performed when the cause is unknownCT scan to distinguish whether it is a delayed recovery caused by an intracranial disease
.

Standards for transferring out of PACU

Transfer out of PACU standard transfer out of PACU standard

End of surgery to patients with full recovery can be divided into 3 stages : (1) early recovery : from the end of anesthesia to patient awareness, protective airway reflexes and motor function recovery ; (2) medium-term recovery : patients achieve conformity to leave PACU standards sent Going to the general ward, or day surgery patients can go home ; (3) Late recovery ( physical and psychological recovery period ): full recovery ( including psychological recovery ) , return to normal daily activities
.
The anesthesiologist in the PACU is responsible for deciding whether to transfer the patient out of the PACU
.
Patients Transferred to develop the ICU , intensive care units, general wards directly or standard hospital to go home, the maximum reduction nerve, respiratory and circulatory system depression risk
.
PACU stay time should be determined according to the specific situation
.
Steward Su awake score table andAldrete scoring table (POST Anesthesia Recovery , PA R & lt rates ) are used clinically to turn out whether the patient PACU amount table
.
Generally, Steward recovery score> 4 points or Aldrete score sheet> 9 points can be considered for transfer to PACU
.

End of surgery to patients with full recovery can be divided into 3 stages : (1) early recovery : from the end of anesthesia to patient awareness, protective airway reflexes and motor function recovery ; (2) medium-term recovery : patients achieve conformity to leave PACU standards sent Going to the general ward, or day surgery patients can go home ; (3) Late recovery ( physical and psychological recovery period ): full recovery ( including psychological recovery ) , return to normal daily activities
.
The anesthesiologist in the PACU is responsible for deciding whether to transfer the patient out of the PACU
.
Patients Transferred to develop the ICU , intensive care units, general wards directly or standard hospital to go home, the maximum reduction nerve, respiratory and circulatory system depression risk
.
PACU stay time should be determined according to the specific situation
.
Steward Su awake score table andAldrete scoring table (POST Anesthesia Recovery , PA R & lt rates ) are used clinically to turn out whether the patient PACU amount table
.
Generally, Steward recovery score> 4 points or Aldrete score sheet> 9 points can be considered for transfer to PACU
.

Original source

Original source

Chinese Medical Association of Anesthesiology .
Monitored anesthesia therapist consensus .
Journal of Clinical Anesthesiology 2021 Nian 1 month second 37 Volume 1 Qi J Clin Anesthesiol , January 2021 , Vol .
37 , No .
1

Chinese Medical Association of Anesthesiology .
After anesthesia monitoring treatment expert consensus consensus .
Journal of Clinical Anesthesiology 2021 Nian 1 month second 37 Volume 1 Qi J Clin Anesthesiol , January 2021 , Vol .
37 , No .
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