الفهرس 
Postanesthetic Care UnitOnly 14 pages are availabe for public view
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Abstract
Recovery of patients after procedures performed in post-anesthetic care unit (PACU), ASA standards for PACU care stated five standards for PACU, PACU requires special equipment’s e.g. fully equipped trolley, equipment’s for maintaining air way and hemodynamic monitoring equipment’s . Patient transferal from the operating room to the PACU occurs through several steps which includes transferal, status reporting and information reports. Discharging from PACU is an important step in post-operative care process, discharging a patient is carried out through several scoring systems to insure that the patient is in the optimum condition for discharging, scoring system such as Aldret scoring system, The Post-Anesthetic Discharge Scoring System (PADSS) and fast tracking scoring system.
Nervous system problems in PACU is one of the most series complications that may face the patient. Problems such as delirium, which carry a remarkable incidence and of several types as mixed hypoactive and hyperactive. Several risk factors precipitate for post-operative delirium preoperative, intraoperative and post-operative factors. Delirium symptoms and signs must be will known to PACU stuff. Delirium assessment scores help in early detection of the condition, scores as NEECHAM Confusion Scale and Delirium Rating Scale. Delayed awakening is another neurological complication caused by several factors includes prolonged pharmacological effects of opioids, volatile anesthetic agents, neuromuscular blocking agents and local anesthetics. Metabolic abnormalities, electrolytes imbalance and hypothermia are another possible causes for delayed awakening.
Post-operative stroke is one of the devastating post-operative neurological complication early diagnoses and management is essential to improve outcome after stroke. However, diagnosis may be difficult because symptoms such as somnolence, slurred speech, visual changes, agitation, confusion, numbness, and muscular weakness or paralysis may overlap with the effects of residual anesthetics. In addition to nerve injuries this may occur due to improper positioning intraoperatively e.g. Brachial plexus injury and radial nerve injury.
Management of these neurological crises includes management of delirium through ruling out physiological causes, supportive treatment and pharmacological treatment which includes haloperidol and physostigmine with taking care of their adverse effects. Delayed awaking is managed according to the cause, opoids and other seditves are managed by naloxone and flumazenil, neuromuscular agents by anticholinesterase and sugammadex. Other causes are managed according e.g. hypothermia by warming blankets, electrolytes disturbances by correction. Treatment of stroke includes intravenous thrombolysis, intra-arterial and interventional therapy and combined intravenous/intra-arterial thrombolysis. Peripheral nerve injury is avoided by proper positioning intraopertively.