Postoperative Monitoring and Recovery
Core concepts
Postoperative recovery in children demands vigilant, systematic monitoring. The PACU nurse assesses airway patency, respiratory effort, oxygenation, circulation, temperature, level of consciousness, pain, and the surgical site. Airway complications are the leading early risk: laryngospasm, obstruction from a large tongue or secretions, and hypoventilation from residual anesthetic. Monitor for emergence delirium, which presents as agitation, thrashing, and inconsolability, distinct from pain; it is common in young children after certain anesthetics. Postoperative nausea and vomiting is frequent and treatable. Hypothermia should be prevented and corrected with warming measures. Recognize signs of bleeding and hypovolemia: tachycardia, delayed capillary refill, narrowing pulse pressure, and decreased urine output. Children compensate well until they crash, so subtle changes matter. Use age-appropriate pain and sedation scales. Discharge criteria include stable vitals, adequate pain control, ability to drink, and no respiratory compromise; teach parents warning signs before discharge.
Traps in questions
A frequent trap mistakes emergence delirium for inadequate pain control. Another trap relies on a normal blood pressure to exclude hypovolemia, since children maintain pressure until late. Do not ignore delayed capillary refill.
Rule of thumb
Treat the child, not the number: a rising heart rate with cool extremities and delayed refill suggests early shock even if blood pressure looks normal.