Post-surgery patients are kept in recovery area till they recover
from the effect of Anaesthesia and become fit to be transferred to intermediate
care (ward/room). In recovery area, the patient is under observation of
Anaesthesiologist and his/her physiological parameters are being monitored.
While transferring the patient out of recovery, it is critical to ascertain
that the patient is in a right physiological condition and it is safe to shift
him/her to ward/room. To ascertain this, appropriate criteria must be applied to
assess the patient’s condition.
The criteria that can be used for this purpose are described
below. Aldrete method can be used to score these criteria and base the decision
on total score.
1.
Consciousness
level – Ability of patient to respond to verbal instructions and answer the
questions. Patient should be oriented to their surroundings. They should be
able to cough, when asked.
2.
Activity –
The patient should be able to move all limbs on instructions. All possible
movements should be achieved (except the limitations due to bandages, or
surgical interventions).
3.
Respiration
– The patient should have 10-20 breathes per minutes (in adults), with no extra
effort. Higher rate of breathing is required in children (up-to 40, depending
upon the age). The SpO2 level must be more than 95%. The gas exchange must be
adequate as assessed clinically or in some patients through a arterial line
blood gas sampling
4.
Circulation
– Adequate perfusion of all the organs, measured through BP level, urine
output, heart rate and clinical examination of skin, hands and feet. The BP
should be within 10-20% of his/her pre-operative baseline BP level. Heart rate
should be 60-90 beats per minute and urine output at 0.5-1.0ml per kilogram of
bodyweight per hour.
5.
Pain –
Pain should be in control and up-to the level that doesn’t affects patient’s
comfort. A simple pain assessment scale must be used for this purpose. The
patients must be able to take a deep breath or cough without any pain in chest
region
6.
Surgical
bleeding – The bleeding from surgical site should be within expected limit
and change of dressing should not be required. Continuous bleeding may lead to
fluid imbalance.
7.
Nausea
and Vomiting – Patient should not have any retching or vomiting or feeling
of nausea.
How to use this criteria:
As a matter of policy these criteria must be used for all
patients who has undergone surgery under general anaesthesia or major regional
anaesthesia, to determine if the patient is fit enough for shifting out of controlled
recovery areas. The criteria must be applied through a qualified
anaesthesiologist. Scoring of these criteria can be done as per Aldrete post anaesthesia
recovery score method. A total score of 9 or higher must be achieved to shift
patient out of recovery area. If the patient is not adequately meeting the
criteria, the patient should be continued in recovery area and treatment must
be given. If required, patient can be shifted to ICU for further care. Necessary
instructions (such as for pain control, bleeding management etc.) must be sent to
the receiving unit where the patient is being transferred.
