The administration of anesthesia is a critical component of modern surgery, allowing for pain-free and stress-free procedures. However, the period immediately following anesthesia, known as the post-anesthesia period, is equally important for ensuring patient safety and a smooth recovery. During this period, the post-anesthesia exam is a comprehensive evaluation conducted by healthcare providers to monitor and manage an important part of monitoring patients and managing any potential complications arising from anesthesia.
The post-anesthesia exam is essential for several reasons. First, anesthesia, while generally safe, can lead to complications such as respiratory issues, cardiovascular instability, and adverse reactions to medications. Early detection through a thorough post-anesthesia exam can prevent issues from escalating. Second, assessing and managing postoperative pain is crucial for patient comfort and recovery. The exam helps tailor pain relief measures to the individual needs of each patient. Third, evaluating the patient’s return to baseline cognitive and motor functions ensures that they are recovering appropriately from the effects of anesthesia. Finally, identifying and treating symptoms of nausea and vomiting can prevent further complications and improve patient comfort 1,2. Standardizing the post-anesthesia exam is an important goal for improving quality of care 3.
The post-anesthesia exam is comprehensive and covers various aspects of the patient’s recovery. Continuous monitoring of vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation, is critical. It helps detect any deviations from normal ranges that may indicate complications. A neurological assessment also includes checking the patient’s level of consciousness, orientation, and ability to follow commands. Assessing neurological function is vital to ensure that the patient is emerging from anesthesia without any adverse effects. In addition, ensuring that the patient has a clear airway and is breathing adequately is paramount. The exam includes listening to breath sounds, checking for adequate chest rise, and monitoring for any signs of respiratory distress. In parallel, evaluating the heart’s function includes checking for abnormal rhythms, signs of fluid overload or dehydration, and ensuring stable blood pressure and heart rate.
Using pain scales, healthcare providers determine the level of pain the patient is experiencing and administer appropriate analgesics. Effective pain management is essential for patient comfort and recovery. Healthcare providers also assess for symptoms of nausea and vomiting and provide antiemetic medications as needed to ensure patient comfort. Finally, the team checks the surgical site for excessive bleeding, swelling, or signs of infection. Ensuring proper wound care can prevent postoperative complications. The team also monitors fluid intake and output and checks electrolyte levels, ensuring that the patient maintains proper hydration and metabolic balance 1,4.
Most patients will have stable vital signs, indicating a smooth recovery. Minor fluctuations are normal, but significant deviations necessitate immediate attention. It is common, however, for patients to experience mild disorientation or grogginess, which usually resolves within a few hours. Ensuring a calm and supportive environment aids in this recovery. Patients may also frequently report a certain degree of pain or discomfort. Effective pain management strategies, including medications and non-pharmacological methods, are leveraged to address this. Nausea is a common finding and can be managed with antiemetics. Ensuring that patients remain in a semi-upright position can also help alleviate symptoms 5–7.
The post-anesthesia exam is a critical step in the surgical care continuum, ensuring that patients recover safely and comfortably from anesthesia. By thoroughly assessing vital signs, neurological status, respiratory and cardiovascular functions, pain levels, and the surgical site, healthcare providers can detect and manage any complications promptly.
References
1. Nursing guidelines : Routine post anaesthetic observation. Available at: https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Routine_post_anaesthetic_observation/. (Accessed: 20th June 2024)
2. Litwack, K. Post-anesthesia assessment: what medical-surgical nurses need to know. Medsurg Nurs. (1993).
3. Zemedkun, A. et al. Assessment of postoperative patient handover practice and safety at post anesthesia care unit of Dilla University Referral Hospital, Ethiopia: A cross-sectional study. Ann. Med. Surg. (2022). doi:10.1016/j.amsu.2022.103915
4. How to Assess the Post-operative Surgical Patient – OSCE Guide | Geeky Medics. Available at: https://geekymedics.com/how-to-assess-the-postoperative-surgical-patient-osce-guide/. (Accessed: 20th June 2024)
5. Abebe, B. et al. Incidence and factors associated with post-anesthesia care unit complications in resource-limited settings: An observational study. Heal. Sci. Reports (2022). doi:10.1002/hsr2.649
6. Street, M., Phillips, N. M., Kent, B., Colgan, S. & Mohebbi, M. Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): Protocol for a prospective observational study and cost-effectiveness analysis. BMJ Open (2015). doi:10.1136/bmjopen-2014-007200
7. After Surgery: Discomforts and Complications | Johns Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/after-surgery-discomforts-and-complications. (Accessed: 20th June 2024)