Anaesthesia

12. The Post-Operative Period

12. The Post-Operative Period Post-Operative Care Patients wh o hav e bee n subjecte d t o surger y an d anaesthesi a nee d continuou s surveillance which cannot normally b e adequately provide d b y the sporadic nursin g care in a general ward. Special recovery units are set up to provide the necessary care, and usually they are of 2 types: (a) Recovery rooms ar e smal l rooms , usuall y alongsid e th e anaestheti c room , an d form an integral part of the operating suite. Patients enter the operating room via the anaestheti c roo m an d leav e via th e recovery room . Th e main advantag e o f these recovery rooms is their closeness to the operating theatre. Both the surgeon and th e anaesthetis t ca n easil y continu e thei r medica l responsibilit y t o th e patient. Thes e rooms are , however, intended mainl y fo r shor t stay , because th e facilities whic h ca n b e provide d i n suc h a smal l roo m ar e limite d b y space . A patient who needs to stay longer in the recovery room will entail congestion an d disruption of the work when the next operation is completed. Therefore, recover y rooms are better suited for smal l hospitals, for singl e theatre units or for depart ments where only occasional anaesthetic services would be required (suc h as XRay or out-patients). (b) Post-anaesthetic recovery units o r post-operativ e department s (als o know n a s recovery areas ) ar e large r area s commo n t o a numbe r o f operatin g theatres . Patients ca n remai n fo r longe r period s an d th e area s ar e mor e extensivel y equipped. A separat e nursin g an d medica l staf f ar e needed . I f th e are a serve s more tha n fou r operatin g theatres , th e workloa d ma y justify havin g nigh t staf f and twenty-four hour service. A centrally sited recovery area in a multiple theatre suite would be ideal for admission and supervision of patients. However, because it i s inside th e clea n are a o f th e operatin g theatre , acces s t o i t b y medica l an d nursing staff is inconvenient once they have left the theatre suite. The best site will therefore b e i n th e junction zon e nea r th e entranc e t o a multipl e theatr e suite , provided it is not too far from th e suites it is supposed to serve. The purpose of these departments is mainly to provide continuous, true physiological monitorin g o f th e patients , includin g informin g th e medical staf f o n dut y tha t something ha s gone wrong, recording measurements o n pape r a t suitabl e intervals , and displayin g curren t value s a s well . Th e area s t o b e monitore d ar e mainl y th e cardiovascular an d respirator y functions . Urinar y output , extensio n o f abdomina l girth (whe n applicable) , oozin g fro m wounds , etc . mus t als o b e observe d an d reported. 226 Anaesthesia Management A 'Cerebral Function Monitor' has been developed recently. As the cerebral func tion is the most reliable single indication o f a patient's well-being, this developmen t has good possibilities. A simple single channel electroencephalogram (EEG ) has also been developed. The trace appears as a solid band on a slow moving paper. When the oxygen tension i n the cerebral corte x falls, there will be a rapid reductio n i n amplitude (voltage) of the EEG and the band will narrow. An alarm is then sounded (Prior, etal, 1971) . The advantage s o f th e recover y unit s ar e tha t patient s i n thei r mos t vulnerabl e period (i.e . followin g surger y an d anaesthesia ) ca n b e scientificall y an d personall y monitored; any adverse changes can be spotted early and remedia l measures starte d without undue delay. Patients are returned t o their respective wards only...