The Importance of Tools in Specific Nursing Care in the Post-Anesthesia Care Unit (PACU)

I am Said Pasban-Noghabi. I was graduated from Department of Nursing, Tarbiat Modares University, Tehran, Iran. I’m M.Sc. Student in nursing education of Pediatric. I work as a nurse in a general hospital and deal with clinical practices every day. We found the following points as a researcher in the post anesthesia nursing care (PACU). This unit is located next to the operation room (OR) and it is considered to be one of the most dangerous stages of anesthesia [1]. The goal of PACU is to provide the patients under general anesthesia or Local anesthesia with necessary cares. Monitoring of the level of consciousness, reflexes of airway and controlling the vital signs are some of the nursing cares in PACU [2]. Frouliti believes that the nature of PACU is actually providing nursing care. PACU is a place where the patients are in a critical state and require intensive care [3]. One of the standard cares in PACU is checking the level of consciousness of the patients. This level is checked every 15 min with nurse [4]. The study conducted by Rafieian et al. showed that caring standards were not followed during nursing care in PACU [5]. The patients are to remain in PACU until they feel no danger of respiratory depression and they are in a clear mental status [6]. The conscious is defined as being awake and aware of their surrounding and identity [7]. One of the methods for monitoring the patients in PACU is Aldrete scoring system. This system includes activity, breathing, Circulation, consciousness and skin colour of the patient. This tool is used to dismiss the patient from PACU. Scores of 0 to 10 are given to 5 criteria. It is necessary to get 9 out of 10 so that one can be discharge [6]. However, no particular tool is introduced to assess the consciousness of patients by nurses during the recovery in PACU. Some texts point to utilizing Glasgow Coma Scale (GCS). GCS is a tool used to provide a rapid reproducible quantification of depth of unconsciousness [7]. Others have recommended using AVPU team in PACU to measure the level of consciousness. This tool includes Alert, Responds to Voice, Responds to Pain, Unconscious. Of course, except for neurosurgery patients [8]. Based on the studies conducted, there is no other tool to measure the level of consciousness in PACU and this issue has not been clarified appropriately in the standards. Thus other tools like Aldrete, GCS and AVPU have been introduced. It is better to choose a tool compatible with the condition of patients in order to study their level of consciousness during nursing cares in PACU.