Common Pediatric PACU Problems

Abstract

Perioperative care of neonates, infants, and children significantly differs from that in adults. It was estimated that about 1.5 million to 2 million children under 3 years of age undergo anesthesia annually in the United States. Although the exact incidence of pediatric postoperative problems and complications are not quantified, it is known that both minor and major morbidity most commonly occurs in infants and children under 3 years of age, especially those with severe comorbidities. In the ever-growing field of pediatric same-day surgery, safe and efficient flow through the perioperative and postoperative periods necessitates in-depth knowledge of managing potential PACU complications. In this chapter, we provide an overview of specific and most common pediatric complications such as airway complications, postoperative nausea and vomiting, and emergence agitation. Although not novel, availability of an immediate response team (designated postoperative anesthesia staff) and availability of PACU standing orders avoids delays in physician evaluation, treatment, and length of pediatric patients’ distress. We also lay out criteria for discharge, as well as implementation of Postanesthesia Recovery Score system evaluations. This review contains 3 figures, 11 tables, and 52 references. Keywords aspiration, bronchospasm, discharge criteria, emergence agitation, emergence delirium, laryngospasm, negative pressure pulmonary edema, PONV, postintubation croup, vomiting