Novice Guide

Published: 15/08/2019

Recovery and the postoperative visit

As an anaesthetist, your responsibility for the patient does not end when the anaesthetic is turned off. Your role in transferring the patient to the recovery area, handing over to the recovery staff and reviewing them in the immediate postoperative period is integral to reducing risks associated with surgery.

There are 4 phases:

  • transfer to the recovery room
  • handover of the anaesthetic and perioperative events to recovery staff
  • communicating a clear plan for airway management, analgesia, fluid and oxygen therapy
  • the postoperative visit.

Transfer to the recovery room

It is the responsibility of the anaesthetist to make sure that the patient is safe to transfer. As patients wake up from an anaesthetic they can develop airway complications, so need to be closely observed.

Before leaving theatre, you must make sure that:                             

  • the patient is physiologically stable and breathing adequately
  • the patient is positioned appropriately
  • appropriate monitoring is applied according to departmental guidelines
  • you have all the drugs and equipment you need
  • oxygen is administered.

Once you leave theatre you must be vigilant for any signs of airway obstruction.

Arriving in recovery

On arrival in recovery your first priority is to:

  • ensure oxygen is attached to the wall supply
  • apply the required monitoring – Pulse oximeter, NIBP +/- ECG
  • reassess airway, breathing and circulation using the ABC approach to ensure the patient is stable.

Associated e-Learning resources:

Handover

When the patient is stable, you should perform a clear and succinct handover to the recovery nurse. It should include:

  • Patient details:
    • name and age
    • relevant comorbidities
    • drug history and allergies
  • Surgical details:
    • type of operation with the estimated blood loss (EBL)
    • antibiotics given
    • any complications or problems associated with the procedure
  • Anaesthetic details:
    • the basic technique used
    • the analgesia and anti-emetics administered
    • fluids and blood products administered during the operation.

Plan for recovery and on going ward care

You should make a clear management plan for the immediate post-operative period. You should highlight any concerns you have and document who to contact in case of any problems.

The plan should include:                                                             

  • oxygen and monitoring requirements
  • analgesia, anti-emetics and fluids regimes
  • acceptable physiological parameters (e.g. blood pressure).

Before you leave recovery, you must:

  • document your plan clearly
  • ensure that you have completed your anaesthetic record and drug chart.

Check your patient is stable and your recovery nurse is happy before leaving the recovery room.

Associated e-Learning resources:

Pain management

This is an important subject and a speciality in its own right. Most hospitals have their own dedicated pain service. They will advise you about local protocols and managing difficult patients.

Ensure that you are familiar with the WHO analgesia ladder.

Associated e-Learning resources:

An example of a typical handover.

Mr Smith is a 48yr old man who has undergone an uneventful appendicectomy. He is a well controlled type 1 diabetic and is on an insulin sliding scale. He has no allergies.

He had a Rapid Sequence Induction and received 1g paracetamol and 10mg morphine during the operation. The surgeon infiltrated 10ml of 0.5% bupivacaine into the wound at the end of the operation. He also had 50mg of cyclizine and 2 litres of Hartmann’s. His intra-operative blood glucose was 6.2.

The surgery entailed an estimated blood loss of 200mls. He received 1.5mg of cefuroxime and 500mg of metronidazole as antibiotic prophylaxis.

He needs standard monitoring and oxygen to keep his saturations above 97%. I have prescribed a litre of Hartmann’s to be infused over 4-6 hours and intravenous morphine for recovery. I have prescribed paracetamol, ibuprofen and omeprazole regularly and oral morphine as required .

Please can you repeat his blood glucose and let me know what it is. I will then come and review him before he goes to the ward. I will be in Theatre 3.

Postoperative visit                                                                                               

You should try and see your patient on the ward after surgery. It is an excellent opportunity to review the outcome of the anaesthetic plan. In addition to this you should:

  • ensure they remain physiologically stable
  • inform them of any issues related to the anaesthetic e.g. difficulties with intubation
  • get feedback about your anaesthetic and analgesic plan.

Associated e-Learning resources: