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Chapter 21 - Postanesthesia Recovery Period: Analgesics

Published online by Cambridge University Press:  21 February 2025

By
Deborah C. Mokuolu  and
Rebecca E. Lee
Edited by
Dharti Patel ,
Sang J. Kim ,
Himani V. Bhatt  and
Alopi M. Patel
Dharti Patel
Affiliation:
Mount Sinai West and Morningside Hospitals, New York
Sang J. Kim
Affiliation:
Hospital for Special Surgery, New York
Himani V. Bhatt
Affiliation:
Mount Sinai West and Morningside Hospitals, New York
Alopi M. Patel
Affiliation:
Rutgers Robert Wood Johnson Medical School, New Jersey
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Summary

This chapter concisely reviews common situations encountered in the postanesthesia care unit (PACU). Common airway and respiratory scenarios covered include airway obstruction, broncho- or laryngo-spasm, respiratory depression secondary to narcotics to less common situations such as pneumonia to transfusion-related pulmonary pathology. Patients recovering from anesthesia and surgery may experience hypo- or hypertension or arrhythmias postoperatively. Multimodal treatment of frequent events such as pain and postoperative nausea/vomiting are addressed to assist providers in managing difficult to treat patients. As patients transition from anesthesia, they can experience neuromuscular-related complications such as residual weakness, delayed emergence, delirium, and cognitive decline.

Keywords

postanesthesia carePONVpostoperative recoveryPACUpostoperative complicationsmultimodal therapyanalgesia
Type
Chapter
Information
BASIC Essentials
A Comprehensive Review for the Anesthesiology BASIC Exam
 , pp. 114 - 119
Publisher: Cambridge University Press
Print publication year: 2025

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References

Further Reading

Apfel, C. Postoperative nausea and vomiting. In Miller, RD, Eriksson, LI, Fleisher, LA, et al., editors. Miller’s Anesthesia, 8th ed. Elsevier Saunders, 2014, chapter 97, pp 2947–2973.Google Scholar
Butterworth, JF IV, Mackey, DC, Wasnick, JD. Morgan and Mikhail’s Clinical Anesthesiology, 7th ed. McGraw-Hill / Medical, 2022.Google Scholar
Chou, G, Gordon, DB, de Leon-Casasola, OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 2016;17(2):131–157.CrossRefGoogle Scholar
Hindle, A. Intrathecal opioids in the management of acute postoperative pain. Contin Educ Anaesth Crit Care Pain 2008;8(3):81–85.CrossRefGoogle Scholar
Hussain, N, Brull, R, Sheehy, B, et al. Perineural liposomal bupivacaine is not superior to nonliposomal bupivacaine for peripheral nerve block analgesia. Anesthesiology 2021;134(2):147–164.CrossRefGoogle Scholar
Malhotra, A, Malhotra, V, Rawal, N. Perioperative pain management. In Yao, F-S F, Fontes, ML, Malhotra, V, editors. Yao & Artusio’s Anesthesiology: Problem-Oriented Patient Management, 8th ed. Lippincott Williams & Wilkins, 2016; chapter 51.Google Scholar
McNicol, E, Ferguson, M, Hudcova, J. Patient controlled opioid analgesia versus non-patient controlled opioid analgesia for postoperative pain. Cochrane Database Syst Rev 2015;2015(6):CD003348. doi:10.1002/14651858.CD003348.pub3Google ScholarPubMed
Nicholau, TK. The postanesthesia care unit. In Miller, RD, Eriksson, LI, Fleisher, LA, et al., editors. Miller’s Anesthesia, 8th ed. Elsevier Saunders, 2014; chapter 96, pp 2924–2946.Google Scholar
Sinatra, RS, Jahr, JS, Watkins-Pitchford, JM, editors. The Essence of Analgesia and Analgesics. Cambridge Medicine. Cambridge University Press, 2010.CrossRefGoogle Scholar
Weibel, S, Jokinen, J, Pace, NL, et al. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis. Br J Anaesth 2016;116(6):770–783.CrossRefGoogle ScholarPubMed

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