Developments in surgery have enabled more ambitious operations to be attempted than ever before, while similar advances in anaesthesia and monitoring have meant that many patients who were previously considered unfit now undergo surgery. It is essential that standards of patient care during surgery are continued post-operatively until the depressant effects of anaesthesia have worn off and it is safe for patients to return to the wards or to their homes. The importance of adequate supervision by well-trained nurs­ ing staff in properly equipped surroundings has been recognised by the introduction of recovery rooms in most hospitals. Despite this, many patients still emerge from anaesthesia in wards or departments where they are supervised by inexperienced nursing staff in unfamiliar surroundings. Recovery from anaesthesia may be accompanied by a variety of dangerous and potentially fatal complications, many of which can be avoided by the detection of early warning signs and the institution of appropriate therapy before an irreversible situation is allowed to develop. This book describes the major complications liable to be encountered and suggests how they may be avoided by careful monitoring, vigilant nursing and sound organisation. The patient's behaviour at recovery is influenced by his pre-operative condition, by drug therapy pre- and intra-operatively and by the nature of the surgery, and sections have been devoted to these aspects since a basic understanding of them is essential in anticipating events in the recovery room.

Springer Book Archives

1. Organisation.- Role of the Recovery Room.- Site.- Design.- Equipment.- Safety.- Staffing.- Policies of a Recovery Unit.- Further Reading.- 2. Normal Recovery.- Physiology of the Elimination of Anaesthetic Gases.- Progress of Normal Recovery.- Care Plan Nursing.- Reception of the Patient.- Basic Nursing Position and Safety.- Routine Observations.- Assessment of Colour.- Assessment of Respiratory Function.- Assessment of Cardiovascular Function.- Assessment of Level of Consciousness.- Recognition of Blood Loss.- Maintenance of the Airway.- Insertion of Oropharyngeal Airway.- Insertion of Nasopharyngeal Airway.- Suction of Upper Airway.- Care of the Intubated Patient.- The Ventilated Patient.- Oxygen Therapy.- Administration of Oxygen.- Maintenance of Fluid Balance.- Intravenous Infusion Drip Rates.- Intravenous Fluid Therapy.- Intravenous Infusions.- Intravenous Injections.- Blood Transfusion.- Drainage Systems.- Record Keeping and Charting.- Criteria for Discharge.- Transfer of Patient to Ward Staff.- Further Reading.- 3. Pain Relief and Local Anaesthesia.- Methods of Pain Relief.- Local Anaesthetic Techniques.- Specific Local Anaesthetic Blocks.- Patient Management in the Recovery Unit.- Further Reading.- 4. Complications.- Respiratory Complications.- Upper Airway Obstruction.- Inadequate Ventilation (Hypoventilation).- Hypoxaemia.- Bronchospasm.- Aspiration of Gastric Contents.- Pneumothorax and Haemothorax.- Tension Pneumothorax.- Cardiovascular Complications.- Hypotension.- Hypertension.- Bradycardia.- Tachycardia.- Dysrhythmias.- Cardiac Arrest.- Miscellaneous Complications.- Delayed Return of Consciousness.- Restlessness, Excitement and Delirium.- Nausea and Vomiting.- Shivering.- Convulsions.- Hypothermia.- Hyperthermia.- Blood transfusion Reactions.- ProblemsAssociated with Massive Blood Transfusion.- Failure of Coagulation.- Oliguria.- Further Reading.- 5. Recovery in Different Branches of Surgery.- Emergency Surgery.- Gastroenterology.- Orthopaedic Surgery.- Obstetrics and Gynaecology.- Ear, Nose and Throat Surgery.- Thyroid Surgery.- Dental and Faciomaxillary Surgery.- Ophthalmic Surgery.- Neurosurgery.- Thoracic Surgery.- Vascular Surgery.- Genito-urinary Surgery.- Paediatric Surgery.- Further Reading.- 6. Pre-existing Factors Affecting Recovery.- Premedication.- Anaesthetic Technique.- Pre-operative Drug Therapy.- Respiratory Disease.- Cardiovascular Disease.- Neuromuscular Disease.- Liver Disease.- Renal Disease.- Endocrine Disorders.- Thyroid Disease.- Haematological Disease.- Musculoskeletal Disease.- Geriatric Patients.- Pregnancy.- Malnourishment.- Obesity.- Further Reading.- 7. Recovery and Day Surgery.- Patient Selection.- Procedures Suitable for Day Surgery.- Documentation.- Anaesthetic Techniques.- Recovery from Anaesthesia.- Discharge from the Day Unit.- Post-anaesthetic Complications.- Further Reading.- 8. Monitoring.- ASA Classification.- Routine Monitoring.- Respiratory System.- Cardiovascular System.- Metabolic Systems.- Neurological System.- Specific Monitors.- Further Reading.- Appendix A. Drugs Commonly Used in a Recovery Room.- Appendix B. Translations of Standard Recovery Phrases.