Post-Anesthesia Monitoring

Post-Anesthesia Monitoring

General anesthesia has allowed for great advancements in the surgical field. It is typically used in lengthy procedures or procedures that cause heavy blood loss or affect the patient’s airway or breathing [4]. The goal is for the surgical patient to feel no discomfort or pain and to remain motionless for the duration of the operation. As successful as anesthetics have been towards expanding medical capabilities in more severe or threatening health problems, no major medical change comes without its own risks and challenges. Careful post-anesthesia monitoring is essential to patient safety. 

In the short term, as in from immediately after the patient wakes up until one or two days after, there are many side effects that patients can experience. These can include nausea or grogginess upon awakening, vomiting, dry mouth, a sore throat, chills and shivering, confusion, muscle aches, itchiness if narcotics were used, bladder problems, and or dizziness. More seriously, patients may experience postoperative delirium which causes confusion, memory loss, and disorientation. These symptoms typically subside after a week, however, and most patients do not experience them [4]. For high risk patients, postoperative cognitive dysfunction (POCD) is also a concerning possibility. POCD is associated with ongoing memory and cognitive impairment problems. Patients most susceptible to POCD include people over the age of 60 and patients with a history of stroke, heart, lung, kidney, Alzheimer’s, or Parkinson’s disease; obstructive sleep apnea; obesity; high blood pressure; diabetes; smoking; or heavy alcohol use [4]. 

In a more specific case, obstructive sleep apnea (OSA) puts surgical patients at an especially high risk for pulmonary and cardiovascular complications after the procedure. In a study of middle aged, obese patients who had OSA, 65% of the 66 cases had brain damage or died postoperatively. These adverse outcomes were less common when respiratory monitoring was applied and supplemental oxygen was used [1].   

As anesthesia carries significant risks, even in the postoperative period, it is crucial to monitor the patient during this time. In fact, the American Society of Anesthesiologists has stated that all patients who have received general, regional, or monitored anesthesia care should also receive post-anesthesia monitoring in a Post-Anesthesia Care Unit, or PACU. Their guidelines state that the patient should be continuously monitored and evaluated during every step of their transport to, arrival at, and stay in the PACU. Especially upon arrival, their current status should be documented, along with information about their preoperative conditions and surgical and anesthetic course [2]. Additionally, the initial assessment should consider the patient’s airway and breathing state, circulation, baseline respiratory rate and effort, oxygenation, heart rate, blood pressure, temperature, urine output, and consciousness. Following the initial assessment, observations on the patient’s vitals, sedation score, pain score, and nausea score should be made every 15 minutes to recognize any signs of deterioration as soon as possible [3]. In doing so, measures may be taken to rapidly combat any adverse side effects of anesthesia. 

To maximize the safety and well-being of patients and minimize long-term side effects, post-anesthesia monitoring must be implemented throughout the recovery period. 

References

[1] Bolden, N., MD, et al. Postoperative Critical Events Associated With Obstructive Sleep Apnea: Results From the Society of Anesthesia and Sleep Medicine Obstructive Sleep Apnea Registry, Anesthesia & Analgesia: October 2020 – Volume 131 – Issue 4 – p 1032-1041. doi: 10.1213/ANE.0000000000005005  

[2] Committee on Standards and Practice Parameters. (2019, October 23). ​Standards for Postanesthesia Care. https://www.asahq.org/standards-and-guidelines/standards-for-postanesthesia-care  

[3] The Royal Children’s Hospital Melbourne. (2019, November). Routine post Anaesthetic Observation. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Routine_post_anaesthetic_observation/  

[4] Axtell, B. (2018, September 17). Side Effects of General Anesthesia: Short-Term and Long-Term Effects. https://www.healthline.com/health/side-effects-of-general-anesthesia  

[5] Wickramasinghe, H., MD. (2020, September 15). Obstructive Sleep Apnea (OSA). https://emedicine.medscape.com/article/295807-overview