Respiratory problems in the post-anesthesia care unit (PACU)
- Edward A Bittner, MD, PhD, FCCP, FCCM
Edward A Bittner, MD, PhD, FCCP, FCCM
- Assistant Professor of Anaesthesia
- Harvard Medical School
- Edward George, MD, PhD
Edward George, MD, PhD
- Assistant Professor of Anesthesiology
- Harvard Medical School
- Section Editor
- Natalie F Holt, MD, MPH
Natalie F Holt, MD, MPH
- Section Editor — Preoperative and Postoperative Evaluation and Management
- Assistant Professor of Anesthesiology
- Yale School of Medicine
- Deputy Editors
- Nancy A Nussmeier, MD, FAHA
Nancy A Nussmeier, MD, FAHA
- Deputy Editor — Anesthesiology
- Department of Anesthesia, Critical Care, and Pain Medicine
- Massachusetts General Hospital
- Geraldine Finlay, MD
Geraldine Finlay, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor
- Tufts University School of Medicine
Respiratory complications are the second most common problem requiring treatment in the immediate postoperative period, after nausea and vomiting [1,2]. Etiologies are varied and can be due to abnormalities in the upper airway, lower airway, or lung parenchyma, as well as abnormalities of peripheral nerves and muscles that control breathing. Appropriate monitoring, early diagnosis, and timely management are critical since even potentially fatal respiratory compromise is usually reversible.
This topic will review monitoring, assessment, and management of respiratory problems in adults admitted to the post-anesthesia care unit (PACU). Evaluation of preoperative pulmonary risk, strategies to reduce postoperative pulmonary complications, and management of these complications after PACU discharge are presented separately.
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- RESPIRATORY MONITORING AND RISK ASSESSMENT
- INITIAL APPROACH TO RESPIRATORY INSUFFICIENCY
- Signs and symptoms
- Initial assessment
- - Supplemental oxygen
- - Ventilatory support
- - Secretion clearance
- UPPER AIRWAY OBSTRUCTION
- Pharyngeal muscular weakness
- Airway edema
- Foreign body
- Vocal cord paralysis
- Cervical hematoma
- Obstructive sleep apnea
- LOWER AIRWAY AND PULMONARY COMPLICATIONS
- Pulmonary edema
- Aspiration pneumonitis
- Tension pneumothorax
- Pulmonary embolus
- Preexisting pneumonia
- CENTRAL AND PERIPHERAL NERVOUS SYSTEM ABNORMALITIES
- Opioids and anesthetic agents
- Neuromuscular blocking agents
- DISCHARGE FROM THE POST-ANESTHESIA CARE UNIT: RESPIRATORY CONSIDERATIONS
- SUMMARY AND RECOMMENDATIONS