Anaes · Extubation & recovery
Recovery and the post-anaesthesia care unit
Also known as Post-anaesthesia care unit · PACU · Recovery room · Postoperative recovery · Aldrete score · Phase I recovery
Exam-pass PACU hub: structured SBAR handover, continuous monitoring, airway obstruction and hypoxaemia, emergence hypertension/hypotension, Apfel PONV prophylaxis, shivering, OSA-safe recovery, emergence delirium, and Aldrete/PADSS discharge criteria for ANZCA Final and equivalents.
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Red flags
- Airway obstruction and hypoxaemia dominate early PACU crises — jaw thrust, oxygen, reverse residual NMB/opioid, do not leave until SpO2 and consciousness are stable.
- Treat the cause of emergence BP swings (pain, full bladder, bleeding, residual block) before reflexive antihypertensives or pure pressors.
- OSA + residual paralysis + opioid = classic ward respiratory arrest. Full quantitative reversal, sit up, restart CPAP, monitored bed.
- Emergence delirium: protect the patient, reverse hypoxia/pain/retention first — sedate only if still dangerous.
- PONV prophylaxis fails if you ignore Apfel risk and stack same-class antiemetics.
- Shivering multiplies oxygen consumption — active warm first, then treat pharmacologically if needed.
Meet the patient
A 62-year-old obese man with obstructive sleep apnoea arrives in PACU after a laparoscopic cholecystectomy. He was given rocuronium and morphine in theatre. The nurse calls you two minutes after you walk away: his saturation has dropped to 88 percent, his respiratory rate is six, and a train-of-four was never documented. The airway is obstructed, the opioid is working too well, and the residual block is unmeasured — and you have minutes to untangle all three before bradycardia arrests him.[1]
The question every PACU stem turns on is the same: what is the first thing you do, and what must you NOT leave the bay without confirming? The answer is always airway, oxygenation, and a stable first set of observations — in that order, every time.[1]
References4ShowHide
- [1]Aldrete JA The post-anesthesia recovery score revisited J Clin Anesth, 1995.PMID 7772368
- [2]Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers Anesthesiology, 1999.PMID 10485781
- [3]Cook TM, Armstrong RA, Oglesby F NAP7: high mortality risk in neonates and very low risk in children Br J Anaesth, 2025.PMID 39645515
- [4]Kim JW, et al. Comparative effectiveness of dexmedetomidine and meperidine for the treatment of postanesthetic shivering: a propensity score-matched retrospective cohort study BMC Anesthesiol, 2026.PMID 42363066