Portal de Periódicos da CAPES

Postoperative Care

2012; Elsevier BV; Volume: 30; Issue: 3 Linguagem: Inglês

10.1016/j.anclin.2012.07.013

2210-3538

Scott A. Falk,

Cardiac, Anesthesia and Surgical Outcomes

In the early days of anesthesia and surgery the postoperative or postanesthesia care unit (PACU) was a location in which patients would continue to recover from the lingering effects of anesthesia. As anesthetic care has advanced, this recovery period has evolved to what is essentially a transitional area in which patients receive varying intensity of care as they either begin their recovery and healing process or are triaged to higher level units. The PACU has different meanings and plays widely varying roles depending on the needs of a particular patient or the population served. At the Hospital of the University of Pennsylvania PACU, we essentially conducted an experiment by assessing daily the most pressing patient needs encountered in the unit. These findings led to the creation of the articles included in this issue. The first article is a detailed look at the interdisciplinary rounding process in the ICU and the ways in which interdisciplinary rounding have been utilized to improve outcomes in ICU environments. Implementing this “rounding” paradigm is important as PACUs become more than transitional spaces. It implies that they are evolving to become important care areas where healing begins. The next 2 articles give a detailed look at multimodal pain control as well as neuraxial analgesia in the PACU. Pain control is vital in the perioperative period not only for organic medical reasons, ie., reducing surgical stress responses, but also is a tremendous value-added outcome measure by patients. Early pain control undoubtedly leads to better longer term pain management and patient emotional well-being during the healing process. Common complications of neuraxial analgesia that should be diagnosed in the early postoperative period are addressed. We found that other common patient-centered problems in the PACU included anxiety and postoperative nausea and vomiting. The articles on these subjects do an excellent job reviewing the current standards of care as well as addressing possible advances that we will see in the near future. Of particular interest were the complementary medicine treatments available for anxiolysis in the perioperative period. Advanced pharmacologic strategies for treatment of refractory postoperative nausea and vomiting are delineated. Commonly occurring and vitally important medical problems are addressed in detail. Perioperative hemodynamic dysregulation, treatment, and monitoring modalities are described. Common scenarios with appropriate actions are addressed. Oliguria and perioperative renal injury and dysfunction are addressed. Diagnostic and treatment options for this devastating complication are characterized. The importance of perioperative glycemic control is conveyed. This detailed view of this physiologic derangement gives insight into both causes and treatments of glycemic dysregulation and its importance to healing and well-being. The modality of postoperative noninvasive ventilation is also described. As our population moves toward one with increasing incidence of obesity and obstructive sleep apnea, this will become more essential. As anesthesiologists take care of patients with increasing morbidities, a deep understanding of these medical issues and their implications in the perioperative care period will become essential. We end this issue by addressing postoperative quality assurance and improvement. Health care, in general, and perioperative services, in particular, are becoming more resource intense and expensive. Ensuring high levels of perioperative quality will be essential in the future as we strive to continue to provide better care more efficiently to our patient population. I am delighted with the work the authors have contributed to this issue. It is my hope that the future of perioperative care continues to evolve into the essential time of healing. I would also like to thank Pamela Hetherington for all of her time and patience. I am especially grateful to my family for their love and support. They make it all worthwhile.