Sub-topics

Where you will be

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After your operation or procedure, you are taken to one of several places. Most commonly, this is the recovery room (RR) where there are a number of other patients (depending on the size of the facility) also recovering from their anaesthetics. Other names for this area include the Post-Anaesthetic Recovery Room (PARR) or the Post-Anaesthesia Care Unit (PACU).

If you have undergone a very minor procedure, usually not involving an operation, and in a small surgical clinic or X-ray facility, you may be taken to a recovery ‘bay’ or place for a single patient. Your care should be the same as you would receive in a Recovery Room.

If you have only a local anaesthetic or monitored anaesthesia care, you might be discharged directly to the day care ward - for example, after cataract surgery under nerve block. Either your surgeon (in the case of local anaesthesia) or your anaesthetist makes this decision, on the basis of your being stable after the procedure and well recovered from any drugs which you have received.

If you were very ill before surgery, or you had major or complicated surgery (for example, open heart surgery), or complications arose during the course of anaesthesia or surgery, then you might be transferred to an intensive care unit (sometimes known as Intensive Therapy Unit) or high dependency unit. (These units are often referred to by their initials: ICU, ITU or HDU.) They offer a more highly specialised level of nursing and medical care.

When you are transferred to the Recovery Room, your anaesthetist provides the Recovery Room nurse with a brief report. This will include a description of:

• your preoperative condition, including any medical illnesses and medications
• the surgical procedure
• the course of the anaesthetic, including any problems with your airway, any need for airway control in the Recovery Room, and the adequacy of recovery of muscle strength
• intravenous cannulae
• intraoperative fluid balance ( how much intravenous fluid you were given and how much fluid you lost, including blood loss)
• any other important information.

While this description is being given, the nurse usually places an oxygen mask over your face to give you extra oxygen, and attaches a blood pressure cuff and a pulse oximeter. You may or may not be conscious at this stage. If you are not, then you will probably be positioned on your side, which may become a little uncomfortable as you awaken. This position, known as the ‘coma position’, is commonly used in any situation where a person’s ability to protect his or her airway may be weakened. In this position, the tongue falls forward, rather than backwards where it may obstruct breathing. In addition, if the person were to regurgitate or vomit, the vomitus would drain away from the mouth and not be sucked into the lungs.

You may still have a plastic airway or breathing tube in place. Exactly when this tube is removed depends in part on your condition and why the tube was inserted, and also on how conscious you are. Your anaesthetist might choose to remove the tube while you are still in the Operating Room. If you are still deeply unconscious when you arrive in the Recovery Room, your anaesthetist might leave the tube in until you ‘lighten’ or regain consciousness. (The process of removing the tube is known as extubation.) To many people, the thought of having a breathing tube in place while awake sounds unpleasant. However, what anaesthetists consider to be ‘awake’ in the Recovery Room is not quite the same as being fully conscious. In fact, being able to open the eyes and mouth and to take a breath on command are signs that you are probably awake enough to have the tube removed. Most patients do not remember any of this.

Once your anaesthetist is confident that your vital signs are stable and that your safety is assured, the process of ‘transfer of care to the Recovery Room nursing staff’ occurs. This means that the nurses are now responsible for your care and your anaesthetist may leave you to return to the Operating Room to start the anaesthetic for the next patient on the surgical list.

Who will look after you ?

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The Recovery Room provides specialised nursing staff that has specific training in the management of common problems of partially anaesthetised patients. Following general anaesthesia, patients in the Recovery Room may develop difficulty breathing. For example, after tonsillectomy, there is always the risk of swelling and bleeding from where the tonsils were removed, making it more difficult for patients to breathe. cardiovascular problems are also of concern. Low blood pressure ( hypotension) can occur because of blood loss or from blood pooling in the veins which dilate as body temperature is restored to normal. High blood pressure ( hypertension) may be due to pain, pre-existing hypertension, and an increased concentration of carbon dioxide in the blood or from having a full bladder. Common but less life-threatening problems include pain, nausea and vomiting. Usually your anaesthetist will leave orders for painkillers or analgesics, drugs to combat nausea and vomiting (anti-emetics), and intravenous fluids. These orders may be written after consultation with your surgeon, but your anaesthetist is the doctor in charge of your care in the Recovery Room.