Problem Management in the Ambulatory Surgery Postanesthesia Care Unit

Abstract

Summary We have discussed the problems that are seen in an ambulatory surgery practice, and the different anesthetic techniques that can help to avoid specific problems. The two main problems in the PACU are the control of pain and the control of nausea and vomiting. The control of pain postoperatively in the ambulatory surgery setting can be accomplished in a number of different ways. Premedication or supplementation of anesthesia with potent intravenous opioid analgesics can significantly decrease postoperative pain and enhance recovery, as well as speed up patient discharge times. The smallest doses that are effective should be employed to minimize problems such as nausea, vomiting, and drowsiness. When possible, infiltration with local anesthetics or regional blocks can be employed either alone or in combination with potent intravenous narcotics to allow the greatest patient comfort in the postoperative setting, with the least delay in discharge. Postoperative nausea and vomiting remains an important and clinically significant problem for anesthesiologists, the PACU nurse, and patients. Management of the problem needs, first and foremost, to be centered around prevention, placing the primary responsibility on the anesthesia team. Prompt treatment in the PACU requires a cooperative effort among the anesthesiologist, the PACU nurse, and the patient, all geared toward the goal of decreasing or preventing morbidity and improving patient safety, comfort, and recovery. We now have agents that are effective in both prophylaxis and treatment of postoperative nausea and vomiting, as well as an increasing knowledge of which anesthetic techniques need to be avoided. When supplemented with rapid pain control in the PACU, and good communication between the ambulatory surgical staff and the patients and their families, we can minimize the disruption that postoperative nausea and vomiting can create in the ambulatory surgery experience.