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Student Education

Anaesthesia Postoperative care

BMJ 2007; 334 doi: (Published 01 April 2007) Cite this as: BMJ 2007;334:0704138
  1. Jonathan M Behar, final year medical student1,
  2. Petrut Gogalniceanu, final year medical student1,
  3. Lesley Bromley, consultant anaesthetist and director of postgraduate medical education2
  1. 1Royal Free and University College Medical School, London NW7 3SL
  2. 2University College London Hospitals NHS Foundation Trust, London W1P 9LL

“All patients who have had an operation under either regional or general anaesthesia are in a potentially unstable cardiorespiratory state.” Jonathan M Behar and colleagues explain this statement from the Royal College of Anaesthetists

The anaesthetist's care of the patient doesn't end when the patient's eyes open-it is a continuous process starting some 24 hours before surgery and continuing into the early recovery period, when most complications occur and when adequate analgesia is of utmost importance.

The recovery room is a warm, well lit area close to the operating theatres, where patients are calmly reoriented and monitored after emergence from anaesthesia. Nursing staff monitor vital signs, such as heart rate and rhythm, blood pressure, respiratory rate, oxygen saturations, temperature, and level of consciousness. They also assess the patient's pain. Once the anaesthetist is happy that the patient is safe, using the criteria in box 1 as a guide, plans are made for discharge to the ward.

Box 1: Criteria that a patient should meet before transfer to the ward

A-Independently maintains a secure airway with intact airway reflexes

B-Spontaneously breathing with adequate oxygen saturations

C-Haemodynamically stable (a term used to describe a patient whose cardiac output is not compromised)

Other-Awake, normothermic, and pain free (or at least has sufficient analgesia prescribed and administered)


As many as a fifth of patients experience postoperative adversities, and it is widely accepted that recovery rooms are essential in improving their outcome. Although most problems are minor (nausea and vomiting in 40% of cases), airway difficulty and breathing problems are also common (about 30% of cases) and require immediate control.

Respiratory complications

Airways obstruction-Can be caused by many factors, including laryngospasm, soft tissue swelling around the pharynx (often in children), foreign bodies (loose teeth), hypotonia of pharyngeal muscles from the remaining anaesthetic, and viscous fluids (blood, especially from maxillofacial surgery). The signs of an obstruction …

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