Postprocedure Recovery and Complication Management
Phase I versus Phase II
Phase I is immediate recovery: airway reflexes returning, close monitoring, vital signs at least every 15 minutes, and readiness assessed with a scoring system (Aldrete: activity, respiration, circulation, consciousness, oxygen saturation - each 0-2; usually ≥9 needed to move on). Phase II is ambulatory readiness: the patient is awake, oriented, tolerating oral fluids as policy allows, pain and nausea controlled, and able to be discharged with an escort.
Complications to recognize early
- Airway obstruction: snoring, paradoxical chest movement, falling saturation - reposition, jaw thrust, oral/nasal airway, suction.
- Laryngospasm: stridor, then silence; treat with jaw thrust, 100% oxygen, positive pressure, and small propofol dose if needed.
- Respiratory depression: opioids or residual anesthetic; increasing sedation plus slow respiratory rate; consider naloxone with careful titration.
- PONV: Apfel risk factors - female sex, nonsmoker, history of PONV/motion sickness, postoperative opioids.
- Malignant hyperthermia: rising ETCO2, rigidity, tachycardia, hyperthermia; dantrolene 2.5 mg/kg IV.
- Hypothermia, hypotension, bleeding, delayed awakening, emergence delirium, anaphylaxis.
Traps
Discharging a patient with an Aldrete of 8; treating a quiet patient with a rising PaCO2 as stable; missing bleeding under drapes because only vital signs are checked; assuming a normal oxygen saturation excludes hypoventilation; forgetting to consider obstructive sleep apnea when a patient is sleepy.
Rule of thumb
Any patient who is sleepier than expected gets the same first three checks: airway, ventilation (capnography/rate), and circulation - before considering reversal agents.