Equipment
An automated blood pressure device, pulse oximetry, electrocardiographic
monitoring, and intravenous supports should be located by each bed. An area for
charting
and storage of bedside supplies is also necessary, with sterile suction, catheters,
needles, syringes, gloves, and a titratable oxygen flow meter available at every
bedside. Capability for arterial and central venous pressure monitoring, as well
as intracranial pressure monitoring, is also required in hospitals where critically
ill postoperative patients use the PACU.
A supply of immediately available emergency equipment should also
be located in the PACU and should include an airway cart consisting of oral and nasal
airways; orotracheal, nasotracheal, and tracheostomy tubes; laryngoscopes; bronchoscopes;
and hand ventilating devices. Self-inflating bags with positive end-expiratory pressure
(PEEP) valves are also useful. A defibrillator capable of synchronized defibrillation
should be available, as well as an electrocardiograph, pacemaker, and pacing wires.
A "crash cart" containing cardiopulmonary resuscitation equipment
and emergency drugs should be available and fully stocked at all times. Chest tube
trays, cut-down trays, and tracheostomy trays are necessary.
Automated patient tracking systems that use computers to provide
real-time information on the location and status of surgical patients in the operating
room suite may become more prevalent. These systems provide video displays of real-time
surgical case information. The information is maintained by the use of bar code
scanners, magnetic readers, or common keyboard-based input terminals.
Automated patient tracking systems can provide the PACU with information
regarding room utilization, delays and cancellations, in-transit times, and expected
arrival at the recovery room. This information may facilitate staffing. It is not
known how these operating room management information systems affect PACU efficiency.
Computer-assisted charting of patient vital signs, notes, and laboratory data is
becoming more common. Again, their impact on PACU efficiency is unknown.
TABLE 71-2 -- Recovery parameters after propofol versus desflurane
|
|
|
Following Commands (P
Value) |
Sitting (P
Value) |
PACU Discharge (P
Value) |
Reference |
Duration of General Anesthesia, min (SD) |
Numbers of Subjects (Propofol,
Desflurane) |
Mean Recovery Time with Propofol —
Recovery Time with Desflurane (min) |
Juvin[27]
|
200 (65) |
14, 14 |
6.9 (P < .02) |
|
-11 (NS) |
Song[28]
|
161 (7) |
40, 40 |
4.9 (P < .05) |
|
-15 (NS) |
Boldt[29]
|
115 (27) |
20, 20 |
|
|
1 (NS) |
Lebenbom-Mansour[30]
|
91 (32) |
14, 16 |
3 (NS) |
|
-53 (P < .05) |
Rosenberg[31]
|
Not given |
25, 25 |
|
|
-14 (P = .09) |
Raeder[32]
|
63 (25) |
31, 30 |
1.2 (P < .02) |
-2 (NS) |
-2 (NS) |
Van Hemelrijck[33]
|
62 (34) |
23, 23 |
1.9 (NS) |
-2 (NS) |
-5 (NS) |
Rapp[34]
|
49 (37) |
23, 22 |
-0.4 (NS) |
-47 (P < .01) |
-3 (NS) |
Wrigley[35]
|
43 |
15, 15 |
0.6 (NS) |
-4 (NS) |
|
Ashworth[36]
|
24 (11) |
30, 30 |
1.5 (NS) |
-2 (NS) |
-1 (NS) |
Graham[37]
|
20 (7) |
13, 15 |
0.3 (NS) |
1 (NS) |
|
NS, not significant. |