POSTANESTHESIA CARE UNIT
Requirements for medical direction, nursing education, and the
quality of services provided in PACUs are discussed in Chapter
71
. With the evolution of new surgical procedures, it is now recognized
that the same degree of vigilance that is vital in the OR must continue in the PACU.
For example, the widespread use of laparoscopic procedures requires increased vigilance
for unrecognized hemorrhage or bowel perforation, as well as early treatment of common
emetic responses to the carbon-dioxide insufflating gas used for these procedures
(see Chapter 57
).
In the past, management of postoperative patients and the resources
of the PACU was poorly defined. Now, a medical director must be designated, and
it is his or her responsibility to ensure the delivery of appropriate standards of
care. This responsibility is gaining importance because of the increasing regulations
and severity of illness seen in these settings. The anesthesiologist can
effectively manage the PACU to maximize the efficiency of that unit while providing
the best possible anesthetic care.
The use of shorter-acting drugs and the prompt institution of
effective pain relief, combined with acknowledged standards for PACU admission and
discharge, have altered the approach to anesthetic recovery.[30]
If a patient meets both anesthetic and surgical PACU criteria for discharge to a
second-stage unit, there is no reason not to go directly to the secondary recovery
area immediately from the operating room. This type of flexibility, much more than
anesthetic drug costs, can influence labor costs crucial to cost containment in the
PACU.[31]
It also merits mention that many PACUs serve as mini-ICU's for
patients operated upon when the ICU is "full" and the complete panoply of critical
care skills is needed to provide postoperative care.
