When the reflexes return, the patient usually spits out the airway. Position the
unconscious patient with his head to the side and slightly down. This position keeps the
tongue forward, preventing it from blocking the throat and allows mucus or vomitus to drain
out of the mouth rather than down the respiratory tree. Do not place a pillow under the
head during the immediate postanesthetic stage. Patients who have had spinal
anesthetics usually lie flat for 8 to 12 hours. The return of reflexes indicates that
anesthesia is ending. Call the patient by name in a normal tone of voice and tell him
repeatedly that the surgery is over and that he is in the recovery room.
(2) To relieve the patient's discomfort. Pain is usually greatest for 12 to 36
hours after surgery, decreasing on the second and third post-op day. Analgesics are
usually administered every 4 hours the first day. Tension increases pain perception and
responses, thus analgesics are most effective if given before the patient's pain becomes
severe. Analgesics may be administered in patient controlled infusions.
(3) Early detection of complications. Most people recover from surgery
without incident. Complications or problems are relatively rare, but the recovery room
nurse must be aware of the possibility and clinical signs of complications.
(4) Prevention of complications. Complications that should be prevented in
the recovery room are respiratory distress and hypovolemic shock.
b. The difference between the recovery room and surgical intensive care are:
(1) The recovery room staff supports patients for a few hours until they have
recovered from anesthesia.
(2) The surgical intensive care staff supports patients for a prolonged stay,
which may last 24 hours or longer.
8-11. RESPIRATORY DISTRESS
a. Respiratory distress is the most common recovery room emergency. It may be
caused by laryngospasm, aspiration of vomitus, or depressed respirations resulting from
(1) A laryngospasm is a sudden, violent contraction of the vocal cords; a
complication, which may happen after the patient's endotracheal tube, is removed. During
the surgical procedure with general anesthesia, an endotracheal tube is inserted to
maintain patent air passages. The endotracheal tube may be connected to a mechanical
ventilator. Upon completion of the operation, the endotracheal tube is removed by the
anesthesiologist or anesthetist and replaced by an oropharyngeal airway (figure 8-4).