Post-Anesthesia Care and Recovery Management Flashcards

A patient in the PACU following IV sedation with propofol and fentanyl develops a respiratory rate of 6 breaths/min, SpO₂ of 88% on 4L/min O₂, and remains unresponsive to verbal stimuli 45 minutes post-procedure. Which intervention is the MOST appropriate next step?

Answer: Perform jaw thrust, increase O₂ to 10L/min via non-rebreather mask, and prepare naloxone while calling for emergency assistance

The patient shows signs of opioid-induced respiratory depression (low RR, hypoxemia, unresponsiveness). The priority is airway support (jaw thrust) and oxygenation while simultaneously preparing naloxone for reversal. Flumazenil reverses benzodiazepines, not propofol or opioids. Calling for emergency assistance is critical given the severity. Naloxone alone without airway management first is incorrect sequencing.

During Phase I recovery, a 68-year-old ASA III patient who received midazolam 3 mg and fentanyl 100 mcg for a 90-minute oral surgical procedure becomes suddenly agitated, disoriented, and combative 30 minutes post-sedation. Vital signs are BP 162/94, HR 110, SpO₂ 96%. Which condition should be ruled out FIRST before attributing this to emergence delirium?

Answer: Hypoglycemia and hypoxia

In an elderly ASA III patient, acute agitation and disorientation must first prompt exclusion of physiologic causes — hypoxia and hypoglycemia are life-threatening, easily correctable, and common mimics of emergence delirium. Paradoxical benzodiazepine reaction is a valid consideration but is a diagnosis of exclusion. Flumazenil was not administered. Ketamine was not part of this drug regimen.

A patient who received deep IV sedation with dexmedetomidine develops a sustained heart rate of 38 bpm and blood pressure of 78/50 mmHg in the PACU. The patient is lethargic but rousable. Which pharmacologic intervention is MOST appropriate?

Answer: Atropine 0.5 mg IV push

Dexmedetomidine (an alpha-2 agonist) commonly causes bradycardia and hypotension through sympatholysis. Atropine 0.5 mg IV is the first-line treatment for symptomatic bradycardia per ACLS. Glycopyrrolate is an alternative but atropine is faster-acting and preferred for acute symptomatic bradycardia. Epinephrine is reserved for cardiac arrest. Flumazenil reverses benzodiazepines and has no effect on dexmedetomidine.

A 34-year-old patient with a documented latex allergy is in phase II recovery after sedation. She reports generalized pruritus, urticaria on her trunk, and mild throat tightness. Her BP is 104/68 (baseline 118/76), HR 98, SpO₂ 97%. Which of the following describes the CORRECT sequence of management?

Answer: Epinephrine 0.3 mg IM (anterolateral thigh), supplemental O₂, place supine, activate EMS

This presentation—urticaria, throat tightness (early angioedema/laryngospasm warning), and hypotension—meets criteria for anaphylaxis. Epinephrine IM into the anterolateral thigh is the first-line treatment, not antihistamines or corticosteroids, which are adjuncts. IV epinephrine push risks fatal arrhythmias and is reserved for cardiac arrest or anaphylactic shock refractory to IM dosing. EMS activation is mandatory. Antihistamines alone do not prevent circulatory collapse.

Following monitored anesthesia care with ketamine 0.5 mg/kg IV for a pediatric patient, the recovery nurse notes nystagmus, hypersalivation, and purposeless movements 20 minutes post-procedure with SpO₂ 99% and HR 115. The patient does not respond meaningfully to parents. What is the MOST accurate interpretation of this clinical picture?

Answer: These are expected dissociative recovery phenomena from ketamine and require supportive care in a calm, low-stimulation environment

Nystagmus, hypersalivation, and purposeless movements are classic and expected emergence phenomena following ketamine dissociative anesthesia. With normal SpO₂ and hemodynamics, these do not represent seizures or neurologic injury. Management focuses on minimizing external stimuli (quiet, dim recovery environment), reassuring parents, and monitoring. Hypersalivation from ketamine is managed with glycopyrrolate if severe, not succinylcholine. Benzodiazepines are only indicated if emergence phenomena are severe or prolonged.

A patient is being evaluated for Phase II discharge using the Modified Post-Anesthetic Discharge Scoring System (PADSS). She scores: activity 2, vital signs 2, nausea/vomiting 1, pain 2, surgical bleeding 2 — for a total of 9/10. Her escort reports he drove alone on a motorcycle. Under PADSS criteria and safe discharge standards, what is the CORRECT course of action?

Answer: Discharge must be withheld and a responsible adult must be arranged for safe escort, regardless of PADSS score

PADSS scoring assesses physiologic readiness but does not constitute the sole criterion for discharge after sedation. A responsible adult escort capable of accompanying the patient (not operating a vehicle the patient rides on) is a mandatory discharge criterion after IV sedation, regardless of numerical score. A motorcycle escort cannot adequately monitor a post-sedation patient. A taxi alone (unaccompanied) also fails this requirement. Discharge cannot occur under these conditions; an appropriate escort must be arranged.