Care of the unconscious patient

Emergence from anaesthesia, although usually uneventful, can be associated with major morbidity. In the immediate postoperative period, patients are at risk from respiratory and cardiovascular complications, which comprise approximately 70% and 20% of critical recovery room incidents respectively. The unconscious patient may develop upper airway obstruction or inadequate ventilation with subsequent hypoxaemia and hypercapnia, and is at increased risk of aspiration due to the absence of the protective airway reflexes. Ongoing blood loss and residual drug effects may compound cardiovascular compromise. The importance of observation and early intervention during this period has been recognised for many years. Hazards may be reduced by the provision of adequate postoperative recovery facilities along with fully trained staff, who should ideally be available at all times.

The recovery room

Recommendations for the situation and design of the recovery room and equipment required have been made by a working party of the Association of Anaesthetists of Great Britain and Ireland (2002).

Patient transfer from operating theatre

The design of trolleys should comply with the Association of Anaesthetists recommendations in that there is a need for oxygen cylinders, masks and tubing, airway support equipment, protective sides and a tilting mechanism. Portable monitoring equipment may be required. Care should be taken to avoid injury to eyes, dentition and peripheral nerves. Transfer to the recovery room should be undertaken by suitably trained staff under the supervision of the anaesthetist, who is additionally responsible for handing over information about relevant medical conditions, the anaesthetic technique, intraoperative problems and postoperative management to the recovery staff.