Postoperative Care, Complications, and Professional Practice
Recovery and professional practice
Postoperative care begins with a structured handoff: procedure, anesthetic, airway, fluids, blood loss, medications, allergies, and anticipated problems. In the PACU, assess airway, breathing, circulation, consciousness, pain, nausea, temperature, and surgical site. Airway obstruction may present as snoring, paradoxical breathing, or falling saturation; treat with positioning, jaw thrust, oral airway, or reintubation. Residual neuromuscular blockade can cause weakness and hypoxemia; use train-of-four and ensure adequate reversal. Pain management is multimodal: opioids, nonsteroidal agents when appropriate, regional techniques, and adjuncts. PONV prophylaxis uses risk factors and combination therapy.
Complications include respiratory depression, aspiration, laryngospasm, negative-pressure pulmonary edema, myocardial ischemia, venous thromboembolism, surgical-site infection, nerve injury, and delayed malignant hyperthermia. Postoperative delirium and cognitive dysfunction are more common in older adults. Discharge criteria include stable vital signs, adequate oxygenation, controlled pain, no uncontrolled nausea, and ability to ambulate or return to baseline.
Professional practice includes informed consent, accurate documentation, closed-loop communication, patient safety reporting, and respect for autonomy and confidentiality. Scope of practice, supervision, and billing rules vary; follow institutional policy and legal requirements.
Traps and a rule
Trap: discharging a patient solely because the Aldrete score is high while ignoring persistent nausea, pain, or bleeding. Another is treating postoperative hypoxemia only with oxygen without assessing airway, ventilation, and opioid effect. Do not assume malignant hyperthermia cannot occur after leaving the operating room.
Rule of thumb: use a simple "ABC-S" handoff: Airway, Breathing, Circulation, and Situation with planned next steps. In the PACU, if saturation falls, first check the airway and ventilation, then oxygen, then circulation.