CHAPTER 42 Postanesthesia Care Unit

Introduction (AS6.1)

Emergency critical care has become a growing area of concern in the present century, with particular concern for postoperative morbidity and mortality among high-risk patients; with the advent of the postanesthesia care unit (PACU), the quality of patient care along with postoperative morbidity has significantly improved.

The National Confidential Enquiry into patient outcome and death reported that a system was needed to be devised for patients with a high risk of perioperative complications, including postoperative care, hence emphasizing the need for PACU.

PACU or recovery room is specifically struc­tured and staffed to monitor and manage patients recovering from the effects of anesthesia and surgery, thereby serving as a bridge from one-to-one monitoring in the operation theater (OT) to less focused monitoring in the ward.


Recovery room/PACU is usually built close to the OT complex and has a specified number of beds, depending upon the number of OTs and OT turnover. The facility should be open to allow each recovery bay to be observed at all times. The beds are to be spaced out to allow unobstructed access to trolleys, X-ray equipment, and resuscitation carts. The basic structure consists of the following:

  • Beds (Fowlers’s cot with side rails).

  • Multipara monitors.

  • Oxygen port and various devices for oxygen therapy.

  • Suction port.

  • Crash cart (with all emergency drugs and equipment).

Crash Cart (AS6.2)

It is a term used to describe a self-contained mobile unit that virtually contains all of the materials, drugs, and devices necessary to perform a code. It is placed in an easily accessible location and can be moved on wheels when needed. It is a tall, five-drawer cart, with each drawer having a separate set of contents with a list attached to it.

External Contents

This is placed on top of the crash cart and has the following:

  • Biphasic defibrillator with paddles/pads.

  • Ambu bag with a face mask of different sizes.

  • Oxygen tube connector.

Internal Contents

It is divided and placed in five different drawers, depending on the use and requirement.

a. First drawer:

The first drawer comprises four rows with specific constituents (Table 42.1).

Table 42.1 First drawer contents

Table 42.1 First drawer contents




Medications used in a cardiac arrest (epinephrine, amiodarone, sodium bicarbonate, and calcium)


RSI medications needed for intubation and medications for bradycardia


Medications predominantly used in tachyarrhythmias


Medications needed for hypotensive emergencies and patients with low CO. Hydrocortisone is included for its use in refractory hypotension and suspected adrenal crisis

Abbreviations: CO, cardiac output; RSI, rapid sequence induction.

b. Second drawer:

The second drawer has also four rows with specific contents (Table 42.2).

Table 42.2 Second drawer contents

Table 42.2 Second drawer contents




Medications for hypertensive emergencies and decreased mental status due to hypoglycemia and opioid overdose


IV and inhaled medications for acute exacerbations of respiratory diseases (asthma, chronic obstructive pulmonary disease, and upper airway edema) and medications for allergic reactions


Antiepileptics, diuretics



Abbreviation: IV, intravenous.

c. Third drawer:

The third drawer is reserved mainly for materials to establish peripheral intravenous (PIV) access and contains some other miscellaneous items. The drawer contains:

  • Angiocatheters (14, 16, 18, 20, 22, 24 G) for emergent decompression of tension pneumothorax.

  • For PIV access, contents include needles (16, 18, 21, 25 G), alcohol wipes, syringes (1, 3, 5, 10, 20, 30 mL).

  • Long spinal needles (peds: 20, 22 G; adults: 18 G) for emergency pericardiocentesis, scalpel blades (10, 11, 15).

  • Sutures (nylon 2.0, 3.0, 4.0; prolene 2.0), radial and femoral arterial line catheters (peds: 22, 24 G; adults: 20 G).

  • Nasal packs and balloons (unilateral and bilateral) for severe nose bleeding and a magnet to reset malfunctioning pacemakers/defibrillators.

d. Fourth drawer:

The fourth drawer is designed to store respiratory equipment and supplies for both adults and pediatric patients. The front half of the drawer can be divided into two detachable compart­ments (pediatric and adult), one of which can be removed and placed at the head of the bed during resuscitation, depending on the patient’s age group. The back half will contain the rest of the supplies: compact surgical airway set (cricothyroidotomy), batteries and light bulbs for the laryngoscope, tape, endotracheal tube holders, CO2 detector, and xylocaine spray.

e. Fifth drawer:

The fifth drawer is reserved for larger instruments and supplies needed for special procedures. The contents of this drawer include central venous catheters (3–7 Fr/single and triple lumen); intra­osseous kit; cut-down tray; umbilical catheterization set (3.5 and 5 F); chest tubes (sizes 10–42); thoracostomy kit; thoracotomy kit; suture set; delivery set; trauma tourniquets; pericardiocentesis kit; sterile stapler; and burr hole manual drill kit.

The crash cart needs to be checked and restocked regularly to detect any equipment malfunction or removal and replacement of expired drugs.

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Dec 11, 2022 | Posted by in ANESTHESIA | Comments Off on CHAPTER 42 Postanesthesia Care Unit

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