Download Update 11 - Update in Anaesthesia - WFSA

42Update in AnaesthesiaMONITORING IN THE RECOVERY ROOMDr Keith Allman, Royal Devon and Exeter Hospital, Exeter, UK, previously Royal Perth Hospital, Australia.The recovery room is the area where patients recover fromthe immediate effects of anaesthesia and surgery andprovides a setting for the detection and treatment of earlypost-operative complications. These areas varyconsiderably in the level of staffing and monitoring availablefrom the “ideal” fully staffed, fully equipped modernrecovery facility to the somewhat less than perfect dimlylit corridor just outside theatre.The commonest causes of recovery room mishaps all resultfrom unidentified changes in a patient’s airway, breathingor circulation and these can almost always be rectified ifidentified at an early stage.In 1993 the Association of Anaesthetists of Great Britainand Ireland published recommendations for the provisionof equipment necessary for a modern day recovery area.These are shown in table 1.These facilities may not all be available in many recoveryareas throughout the world and some thought is necessaryto determine the relative merits of each item on this longlist.Certainly the two most important pre-requisites of anyrecovery area should be the provision of good lightingtogether with a suitably trained recovery nurse availableto recover each unconscious patient on a one-to-one basis.The nurse must be available to stay with the patientconstantly until awake and able to maintain their ownairway.Clinical patient monitoringClinical monitoring can be divided into assessment ofairway, breathing and circulation.Table 1: Association of Anaesthetists of Great Britain and Ireland Guidelines 1993Position of recoverysituated as close as possible to the operating theatre to minimise the risks of transportingunstable patientsSize and temperaturean average of 1.5 recovery bays per operating theatre (9.3m 2 per bay)room temperature 21-22 o C, relative humidity 38 - 45% and fifteen changes of airper minutegas scavenging system and six 13 ampere electricity outlets per baywell lit with lighting approximating to the daylight spectrumEquipment in each bayoxygen outlets, face masks and breathing systemspulse oximetryavailability of blood pressure monitoring and ECGsuction units with Yankaur endsa fully equipped anaesthetic machine with ventilatordrugs and intravenous fluidsa paediatric equipment trolley containing facemasks, airways, endotracheal tubes andconnectors in a range of paediatric sizes