AS6.1-3 | Post-anaesthesia Recovery — Glossary

A validated 10-point scoring system (Modified Aldrete Post-Anaesthetic Recovery Score) assessing activity, respiration, circulation, consciousness, and oxygen saturation; a score of ≥9 is required for safe PACU discharge.

Resuscitation trolley containing all equipment and drugs required for emergency management in the PACU; must be checked at every shift change using a documented checklist and sealed with a tamper-evident numbered seal.

Failure to regain consciousness within 30–60 minutes of cessation of anaesthesia; requires structured assessment for opioid overdose (naloxone), benzodiazepine overdose (flumazenil), hypothermia, hypoglycaemia, hypoxia/hypercarbia, or stroke.

A state of disorientation, combativeness, and purposeless movement during recovery from anaesthesia, most common with sevoflurane in young males; must be distinguished from agitation due to hypoxia (check SpO₂ first before attributing to behaviour).

Application of firm bilateral digital pressure in the laryngospasm notch (depression between the mastoid process and angle of the mandible) to break laryngospasm via painful stimulus that relaxes the vocal cord reflex.

Sustained reflex closure of the vocal cords triggered by laryngeal stimulation during emergence; presents with inspiratory stridor (partial) or silent chest with respiratory effort (complete); managed with CPAP, Larson manoeuvre, and if necessary suxamethonium.

Competitive opioid receptor antagonist used to reverse opioid-induced respiratory depression; given in titrated IV increments of 0.1–0.2 mg (not 0.4 mg bolus) to avoid abrupt reversal with catecholamine surge and pulmonary oedema; watch for re-narcotisation as naloxone half-life (30–60 min) is shorter than most surgical opioids.

Anticholinesterase agent that reverses non-depolarising neuromuscular block by inhibiting acetylcholinesterase; always co-administered with glycopyrrolate to prevent muscarinic side effects (bradycardia, excess secretions); not effective for deep block (train-of-four count <2).

5-HT₃ antagonist antiemetic used as first-line treatment for PONV in the PACU; given as 4 mg IV; prolongs QT interval at high doses — use with caution in patients with known QT prolongation.

A dedicated monitored clinical area staffed by trained nurses where patients recover from anaesthesia before return to the general ward; provides bridge monitoring during the highest-risk period of emergence.

Nausea and vomiting in the first 24 hours after surgery, occurring in 20–30% of patients; risk factors include female sex, non-smoking status, history of PONV or motion sickness, opioid use, and longer procedures; treated with ondansetron, metoclopramide, or dexamethasone.

Return of opioid-mediated respiratory depression after initial naloxone reversal, occurring because naloxone's half-life (30–60 minutes) is shorter than most intraoperative opioids; requires continued PACU vigilance and repeat naloxone dosing.

Modified gamma-cyclodextrin that encapsulates and inactivates rocuronium and vecuronium; capable of reversing deep neuromuscular block when neostigmine is ineffective; preferred for rapid or complete reversal.

A depolarising neuromuscular blocking agent used for rapid-sequence intubation (1–1.5 mg/kg IV) and in small 'lytic' doses (0.1–0.5 mg/kg IV) to break laryngospasm; triggers hyperkalaemia, malignant hyperthermia in susceptible patients, and raises IOP and ICP.

A numbered disposable seal on the crash cart drawers that must be intact and logged in the shift checklist; a broken or absent seal indicates the cart has been opened and must be restocked and resealed before the next patient arrives.

Minimum clinical conditions required before a patient is moved from the operating theatre to the PACU: patent airway with spontaneous ventilation and SpO₂ ≥95%, cardiovascular stability within 20% of baseline, returning laryngeal reflexes, responsiveness to verbal commands, and documented pharmacological reversal of residual neuromuscular block.