Most patients are awake and responsive before they are transported to the recovery room although they may not remember this period later. In the post- anesthesia care unit, each patient is cared for by a specially trained NEA nurse with the input of the patient’s surgeon and NEA anesthesiologist. In addition, another anesthesiologist is on hand to assist with the care of recovering patients.
Monitoring patient’s blood pressure, temperature, heart and pulse after surgery
Nurses will continue to monitor the patient’s blood pressure, heart rate/rhythm, pulse oximetry and temperature while in the recovery room. Supplemental oxygen is given by a mask, or nasal cannula. Occasionally, a small percentage of patients experience chills or shivering shortly after emerging from anesthesia. Heated blankets and small doses of Demerol will usually relieve these symptoms. Keeping patients warm after surgery is a priority for our recovery room nurses. Avoiding a drop in body temperature helps mitigate against the cardiorespiratory stress of hypothermia.
Treatment of post-operative pain
Another major responsibility of the entire NEA staff is treating post-operative pain. The nurse will discuss a pain scale with zero representing no pain and 10 indicative of severe unremitting discomfort. By definition, a pain scale of 5 is reflective of pain that you can sleep through. The NEA anesthesiologists will order a number of medicines, which can be given intravenously by the nurse, to bring the patient’s perceived pain below a scale of 4. Typically, medicines of different drug categories are used. For instance, you may be given medicines in the narcotic family (e.g. morphine, dilaudid or fentanyl) as well as non-steroidal anti-inflammatory drugs (e.g. toradol or celebrex).
Most patients who received narcotics for their surgery will also receive an antinausea/antiemetic regime in the operating room to prevent nausea and vomiting post-operatively. Patients who are at higher risk for nausea include young, non-smoking women who have a history of motion sickness or have had previous nausea after surgery. Despite preventive measures, some patients will still experience nausea in the recovery room. The NEA anesthesiologist will order additional medication in the recovery room in an attempt to treat this sometimes refractory problem.
Vital signs and recovery room stay
Patients are discharged from the recovery room when they meet strict criteria. An NEA anesthesiologist will review your recovery course and sign permission for you to be transferred either to a hospital floor for inpatients or to a same day surgery unit for ambulatory patients. The usual stay in the recovery room is at least one hour. Before patients can be discharged they must achieve their baseline mental status, have stable vital signs, have a normal temperature and have a pain scale less than 4. Patients who’ve had a spinal or epidural must be able to raise their hips for more than five seconds. The recovery time for patients who’ve had a general anesthetic compared to a spinal/epidural anesthetic is similar. For patients who’ve had minimal sedation and/or a regional block in the operating room, it is possible to bypass the recovery room and go directly to the same day surgery unit.
Same day surgery unit stay
In the same day surgery unit, each patient is placed in a recumbent chair. Nurses from this unit will continue to monitor the patient’s vital signs. Patients can be discharged from same day surgery after tolerating fluids and being able to void. Additional pain pills and anti-nausea medicine is given when needed. NEA nurses will go over any specific post-operative instructions and prescriptions given by the surgeon. All patients who’ve been given anesthesia must be accompanied home by an escort. Northeastern Anesthesia has an overarching goal, which is to make your surgical experience safe, uncomplicated and marked by a rapid return to daily life.
Please contact Northeastern Anesthesia Services for any questions about anesthesia or pain management for surgery.
Geriatric AnesthesiaMany patients and their families express concern regarding the safety of administering an anesthetic to the geriatric patient. Elderly patients have a higher postoperative complication rate when compared to younger patients but age alone does not preclude the administration of a safe anesthetic for surgery.