The majority of patients who have undergone surgery will be cared for initially in the Recovery Room, also known as the Post Anesthesia Care Unit (PACU.) The PACU is an ICU (intensive care unit) specially equipped to deal with patients emerging from anesthesia. The first PACUs were established over 50 years ago; their contribution to patient safety has been enormous. It is hoped that the answers to the following questions will help you understand what will happen to you during your time there.

Who will look after me in the PACU?
You will be cared for in the PACU by specially trained nurses who are skilled in the management of patients recovering from anesthesia. These nurses have the same training in the use of monitoring technology and respirators as other intensive care nursing staff. Your anesthesiologist is the physician who will be primarily responsible for treating any medical problems arising in the PACU and for overseeing your general wellbeing. Patients with pre-existing cardiac, respiratory or kidney problems may also be seen by their own specialist physicians in the PACU. Finally, your surgeon will be responsible for any problems related to your surgery.

What happens if I have pain?
Your anesthesia team will make every attempt is to ensure that you are comfortable when they arrive in the PACU. However, it is possible that as you awaken from anesthesia, you may require more pain relieving medication. Patients are asked to rate pain on a simple scale of 1-10, so that we can follow your comfort and treat you accordingly. Your nurse will typically administer narcotic pain medication through your IV. Since pain relievers can depress your breathing and decrease your level of consciousness, small doses are given at frequent intervals for your safety. Your nurse may also start a pump for those patients who have epidural catheters in place or those patients who have been prescribed PCA devices. No patient will be discharged from the PACU with inadequate pain control.

Why do patients shiver waking up from anesthesia?
When you are under anesthesia, your body loses heat and your body’s mechanisms for preventing this heat loss do not function normally. Warming devices are routinely used during surgery, but these attempts are often unable to completely prevent some drop in temperature. Shivering on emergence from anesthesia is simply the return of the body’s natural defense to heat loss. Warm blankets, warm air heating devices and intravenous medication may all be required to treat this problem.

Will I have a breathing tube in the PACU?
In most patients, if a breathing tube was used during anesthesia, it will be removed prior to the patients’ arrival in the PACU. For certain major surgeries or patients with respiratory disease, the breathing tube may be left in as you waken in the PACU. If this is likely, your anesthesiologist will inform you of this possibility during his or her preoperative visit. It is essential for your health and wellbeing that your breathing is adequate as you recover from anesthesia, since anesthetic drugs typically depress breathing and may make your respiratory muscles weak. Some patients may be more susceptible to these effects than others and may therefore require assistance with breathing for a period in the PACU or ICU. When your breathing pattern and strength have returned, the breathing tube is removed.

Can I be with my child in PACU?
Every effort is made for parents to be with their child in the PACU, since the presence of a parent often provides great comfort for a child. Once the PACU nurse determines that your child is stable, the parents will be escorted to the PACU and may remain there until the patient is discharged.
When will I be discharged from PACU?
During your stay in PACU, you will be continually assessed to ensure that you have awakened from anesthesia, your vital signs are normal, you are comfortable, and your level of activity is appropriate. For patients undergoing same day surgery, this may include walking, eating and drinking, and emptying their bladder. You will also be evaluated to make sure that there are no complications related to the surgery, such as excessive bleeding. If you are being discharged home, the PACU nurse will review the discharge instructions with you. Finally, your anesthesiologist will review your general condition and authorize your discharge. The average length of stay is 30-60 minutes.

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