PEDIATRIC PACU (also see Chapter 76 )

Caring for a pediatric patient after anesthesia requires special preparation and knowledge of the potential post-operative complications specific to children. Not all PACUs are dedicated solely to pediatric recovery, so it is important that staff with pediatric experience be available. Children can be safely fast-tracked after ambulatory surgery.^[203]

In addition to basic PACU equipment, an air-O₂ blender is necessary so that a 100% inspired O₂ concentration can be avoided in preterm infants at risk for retrolental fibroplasia. Code carts should be stocked with equipment specific to children, including cuffed and uncuffed endotracheal tubes, several sizes of pediatric masks, oral and nasal airways, laryngoscopes, and a carbon dioxide detector. The cart should also have intraosseous needles in the event that the code team is unable to start an intravenous line. A drug manual (e.g., a laminated sheet attached to the code cart) with common pediatric dosages should be immediately available.

Parental Presence

Although parental presence in phase 2 or step-down recovery is common, parental visitation in the phase 1 PACU remains somewhat controversial. Particular subsets of patients, especially those who suffer from developmental delay or sensory deficit, may benefit from having their parents close by to help calm them when they awaken. Visitation in the PACU may also reduce parental anxiety and increase parental satisfaction.^[204]

Parents in the PACU should be allowed to see their child only after the child has regained consciousness and no longer requires the staff's immediate attention. The nursing staff must be comfortable with having parents in the recovery area. Parents need to be made aware that they may be asked to leave if the child becomes unstable.