Post-anesthesia care unit

And we've talked about GI stuff, the reflux and how obesity relates to that.

So you referenced talking about how our loved ones respond to the anesthetics and thereby perhaps are there different anesthetic medications that we would employ in people with Down syndrome as well as how they respond afterwards and the things we watch for in the PACU or the post-operative the recovery room space, the last part of that perioperative space, and even after they go home.

And so let me touch on those.

And it turns out there's five of those too.

That risk of emergency delirium, that risk of nausea and vomiting, that risk of heart rate issues, all of that stuff is still there, whether they're 30 or 50 or 70.

So it's reasonable to assume that the stuff about pain still applies.

So in those scenarios, and again, it's important to discuss with the anesthesia provider beforehand because they'll know what tools are or have some inkling about what tools they would like to use, and if it means communicating with the PACU staff, the nursing staff in the recovery room, about use this tool.

I know this is an adult, but use this tool and call me if this happens kind of thing.

I'm a pediatric nurse.

I'm a PACU nurse.

I am a pediatric ICU nurse.

And I'm voting for Aaron Ford for governor.

So this is identifying unmet needs from both personal and professional experiences in various clinical settings.

say, preoperative clinic immediately before surgery, intraoperatively PACU in ICU, clarifying that need and the problem with research and the data to back up those problems.

So these are all things that we can observe as residents in the operating room as we see our patients in the preoperative area, intraoperatively asking questions like, why do we do this type of monitoring? Yeah.

Our module two is all about needs screening and designing solutions for the anesthesiologist.

But if you really lock in on that solution too early, you can kind of miss the real need that's underneath it.

And so it really starts with observation.

One of the things we talk about is in anesthesia, we're in a great position for this because we see the entire perioperative journey from pre-op to the OR to PACU and the ICU and all the handoffs that happen in between all of that.

And often the best needs can be hiding in plain sight.

I mean, we're doing total joints and some of those patients are going home at the end of the day.

Same day, you know, therapy, seeing them and PACU and yeah, good to go.

And we're going to send those patients home.

I think bariatric surgery is moving in that direction.

So I'm a newly appointed assistant professor at the Boston University School of Public Health.

And I'm offered the opportunity to be part of a grant looking at handovers from the post-anesthesia care unit to the ICU or from the OR to the PACU.

And communication in healthcare context is my shtick.

The person who's offering me this opportunity is a beloved mentor and somebody who's really, really helped me with my career so far.

Precisely.

If the anesthesiologist is running wide-open IV fluids, say, empirically bolusing 1.5 or 2 liters during a short 30-minute hemorrhoidectomy, the bladder rapidly fills and over-distends while the patient is recovering in the PACU.

And then they can't pee.

The over-distended detresor muscle completely loses its mechanical advantage and cannot overcome the spastic contracted urethral sphincter.

That way, the hospitalist that's taking on the care of the patient and the house supervisor of the building can know we've got this incoming transfer that needs a bed right now.

So I need to place them over my patients waiting in the ED or my PACU patients that are coming out.

It's important to look at all people needing beds.

So sometimes we get very focused on just our emergency department because everybody needs to relieve their EDs.

Give patients discharge so patients can come in.

And then what are those barriers? It starts at the inpatient unit, at the discharge piece of an inpatient unit.

You cannot do anything with the emergency departments, the PACUs, the directed myths until you have patients discharged.

You would be amazed at the things that you learn when you start having those open conversations and bringing people into a room and saying, okay, tell us what the barriers are.