Post-Anesthesia Care / PACU

The first 60 minutes after anesthesia are when airway loss, hemodynamic instability, and emergence delirium strike — PACU priorities differ sharply from general postop care.

PACU care begins with a structured handoff from the OR nurse and anesthesia provider covering anesthesia type, airway management, estimated blood loss, fluids given, medications administered, and intraoperative events. The immediate priority is airway patency — the patient arrives lateral or with head tilted to prevent tongue obstruction and aspiration. Assessment follows the ABC framework at 5- to 15-minute intervals: airway and oxygen saturation, breathing depth and rate, circulation (BP, HR, ECG), level of consciousness, temperature, pain, and surgical site. Hypothermia is common because the OR is cold and anesthesia impairs thermoregulation; forced-air warming blankets are first-line treatment. Emergence delirium — agitation, confusion, thrashing — can occur as anesthesia wears off, requiring safety measures and reorientation, not restraints as a first response. Discharge readiness is scored using a standardized tool such as the Aldrete score, which rates activity, respiration, circulation, consciousness, and oxygen saturation on a 0-2 scale (total 0-10). A score of ≥9 typically meets discharge criteria, though some facilities accept ≥8. The PACU nurse is the gatekeeper: no patient transfers until scoring criteria are met and the anesthesia provider gives authorization.

Key Distinctions

Don't confuse PACU priorities (airway, emergence complications, Aldrete scoring) with general postop nursing (wound care, ambulation, discharge teaching) — PACU is a distinct recovery phase. Students often think shivering post-anesthesia is just discomfort, but hypothermia increases oxygen demand, bleeding risk, and cardiac irritability. Emergence delirium is not the same as postop delirium — it's transient, occurs during anesthesia emergence, and resolves within minutes to an hour.

Clinical Pearl

Aldrete scores five categories — Activity, Respiration, Circulation, Consciousness, O2 saturation — each 0-2. Think: "Can the patient move, breathe, maintain BP, wake up, and keep sats up?" Below 9, the patient stays.