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Chapter: Essential Anesthesia From Science to Practice : Clinical management : General anesthesia

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PACU discharge and Outpatients - Anesthesia Early post-operative care

A frequently used checklist is the Aldrete Recovery Score (see Table 6.2). If the sum of points reaches 9 or 10, we can discharge the patient from the PACU.

PACU discharge

A frequently used checklist is the Aldrete Recovery Score (see Table 6.2). If the sum of points reaches 9 or 10, we can discharge the patient from the PACU.


Outpatients

After outpatient procedures under local or peripheral nerve block anesthe-sia, perhaps with parenterally administered CNS depressants, e.g., midazolam (Versed®), propofol or opioids, the patient may bypass the PACU unless a med-ical condition would call for observation. It may be necessary to prescribe an oral analgesic that might include a mild opioid.

If no CNS depressant drug was used during the procedure and if the peripheral nerve block is behaving as expected (surgical anesthesia wearing off, but perhaps analgesia continuing), the patient can be discharged. We still insist that a relative or friend accompany them home because the patient will have been exposed to the stress of an operation – however minor – and will have been fasting and thus be at risk of swooning or even fainting and not being at the height of his reflex responses.

For those patients who required CNS depressants for a short operative proce-dure in which no severe post-operative pain is expected, e.g., a sigmoidoscopy under propofol sedation or a cataract removal under local anesthesia preceded by a small (0.5 to 0.75 mg/kg) dose of methohexital (Brevital®) to minimize the discomfort of the retrobulbar block, the recovery process can be completed in a matter of minutes to an hour, at which point the patient can be discharged into the care of a relative or friend for transportation home. We always assume that drug effects and hormonal disturbances will linger for a matter of several hours to a day, so that upon discharge, the patient cannot be considered ready to drive an automobile or ride a bicycle or even cross the street by himself.

For those patients who remain in the hospital following their operation, PACU discharge signals the phase of continued post-operative care.

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