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Rotation: Post-Anesthesia Care

Definition References

Curriculum Objectives

Clinical Duties Evaluation

1. Definition – The Post-Anesthesia Care experience is a two-week rotation for the CA-1 or 2 resident which will provide training and learning in the care of the patient in the post-operative period. 
2. Curriculum – This rotation is spent in the PACU at University Hospital.  Although the majority of the experience is focused on the immediate post-operative period, the resident will also care for patients spending extended time in the PACU, including but not limited to critical care patients and patients awaiting hospital beds.  The resident will be exposed to patients of all ages, from all surgical services.  The day begins at 7:00am with turnover of patient care from the on-call team. Teaching rounds will be made with the Medical Director of the PACU or his designee on a daily basis.  The resident will be present for all admissions, interventions, and discharges.  A one-month block in the yearly didactic schedule is dedicated to Critical Care and PACU.
3. Clinical Duties with Learning Pathways
   1. The resident will rotate through the PACU for two contiguous weeks of focused post anesthesia care experience.  Management of the patient during the post anesthesia period is continuous throughout the training period and the educational experience is therefore not limited to this two- week period.  Teaching, supervision, and evaluation are provided by entire attending staff on a case-by-case basis, coordinated by the Medical Director of the PACU.
   2. The resident will manage the postoperative airway of all patients entering the PACU, as demonstrated by the immediate recognition and management of the compromised patient.  This includes appropriate and timely intubation versus mask ventilation assistance; the diagnosis and treatment of recurarization; and the management of impending respiratory failure.  The attending anesthesiologist for each patient will be the primary team leader however in the case of urgent airway management the resident will be assisted and evaluated by the Medical Director of the PACU and/or the Anesthesia Administrator.
   3. Ventilation and hemodynamic monitoring treatment are addressed in the Critical Care Curriculum and Objectives.  Special attention to the perioperative period is the focus of the skills in the PACU.
   4. The scope of practice in the PACU dictates that the resident will diagnose and treat acute and chronic medical conditions that may or may not be limited to the post operative patient.  Included are conditions of the Respiratory, Cardiovascular, and Central Nervous Systems; fluid balance abnormalities; electrolyte imbalance; and Endocrine abnormalities.  Residents will demonstrate the appropriate use of consultative services in the management of complex medical and surgical problems, and will integrate and coordinate the information and treatment options gleaned from these services.
   5. Residents will be cognizant of the importance of impaired temperature regulation in the perioperative period, beginning in the operating room and demonstrated by the delivery of a normothermic patient to the PACU. The recognition and treatment of hypo- and hyperthermia are the responsibility of the PACU resident.
   6. Treatment of post-operative nausea and vomiting will be recognized by the resident as a continuum of the perioperative care of the patient, evaluation therefore beginning with the preoperative evaluation of the patient, through the discharge of the patient.  The PACU resident will diagnose and treat nausea and vomiting in the recovery period.
   7. Pain management begins preemptively in the preoperative period and continues through the operative period and PACU stay.  The resident will formulate a perioperative pain management plan in collaboration with the Acute Pain Management Service, including but not limited to PCA, PCEA, Regional Anesthesia, and intraoperative analgesics.  The resident will evaluate all PACU patients’ comfort levels utilizing in part the Visual Analog Scale.  The resident will utilize the above plan, adjusting it as necessary to meet the patients’ needs.
   8. The Aldrete score is utilized by the PACU nursing staff in the evaluation of the patient’s readiness for discharge.  The resident will demonstrate an understanding of the discharge criteria in their final evaluation and discharge of the patient from the PACU. 
4. References – Residents are expected to read and study the chapters devoted to post-anesthesia care in the major textbooks (e.g. Miller and/or Barash).  In addition, selected journal articles and cases for discussion will be provided.  They include but are not limited to:

• Aldrete JA, Kroulik D. A Post-Anesthesia Recovery Score. Anesthesia and Analgesia 1970; 49:924-933.
• Leslie J. How can we best treat postoperative nausea and vomiting? Current Opinion in Anesthesiology 2001; 14(6):623-627.

5. Objectives - attached
6. Evaluation – All learning objectives will be evaluated as stated in section V.  Each resident will receive at the beginning of the rotation a topic card for discussion with the Medical Director of the PACU or his designee.  When the resident has prepared and presented this information to the satisfaction of the MDPACU or the supervising attending, the card must be signed by the attending.  It is the resident’s responsibility to fulfill these responsibilities as well as to turn in the card to the Resident Education Committee (in the person of Ms. Venino).