TRANSPORT FROM THE OPERATING ROOM TO THE PACU
This seemingly short period may be complicated by the lack of adequate monitoring, medication access, or resuscitative equipment. Formerly anesthetized patients should not leave the operating room unless they have a patent airway, have adequate ventilation and oxygenation, and are hemody-namically stable; qualified anesthesia personnel must attend the transfer. Supplemental oxygen should be administered during transport to patients at risk of hypoxemia. Some studies suggest that transient hypoxemia (Spo2<90%) may develop in as many as 30% to 50% of otherwise “normal” patients during transport while breathing room air; supplemental oxygen may therefore be advisable for all transported patients, especially if the PACU is not in immediate proximity to the operating room. Unstable patients should remain intubated and should be transported with a portable monitor (ECG, Spo2, and blood pressure) and a supply of emergency drugs.
All patients should be taken to the PACU onbed or gurney that can be placed in either the head-down (Trendelenburg) or back-up position. The head-down position is useful for hypovolemic patients, whereas the back-up position is useful for patients with underlying pulmonary dysfunction. Patients at increased risk of vomiting or upper airway bleeding (eg, following tonsillectomy) should be transported in the lateral position. This position also helps prevent airway obstruction and facilitates drainage of secretions.
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