Everything you wanted (or didn’t want) to know about having surgery-part 4,the Post-op Phase

I haven’t worked in the PACU (post anesthesia care unit) since it was called the Recovery Room, so this post won’t be quite as detailed as the others. While I like the adage, “If you can’t impress em with intelligence, baffle them with bullshit”, I think I will refrain from baffling you until I post about non-medical bullshit.

Your post-op phase starts as the surgeon is finishing. While he is closing (sewing you up), putting on dressings, cleaning prep/blood/tape/cracker crumbs (just checking to see if you are paying attention) off your skin, a good anesthetist is slowly waking you up, reversing any paralytics, titrating narcotics so that you can maintain your own airway by the time we are ready to move you out of the OR.  We actually wake you up in the OR (you won’t remember) and ask you to lift your head, squeeze our hands, cough-anything that tells us you are with us and able to not choke on your own spit. The tube and monitors are DC’d (discontinued or removed) and we get you packaged up to roll out. Many things are happening at this point; anesthesia is assessing and responding to your pain; the surgeon is (probably) dictating; the scrub is starting to strip the room; the nurse is helping all of the above AND taking care of you (not saying that nurses are perfect..but…). Hearing is the first sense to return when emerging from anesthesia, so if you remember anything, it will be how loud everything sounds.

Some patients wake up crazy-flailing, hitting, yelling-I find this is usually the young, muscular men. Not sure why, but they tend to kick our asses when they wake up. Do what you can to control your emotions when you wake up, especially physical expressions of your emotions. Nothing like having to put a patient right back to sleep because they popped a stitch and are now bleeding again. Or worse, you are showing your bare ass to the whole OR because you are flopping around, kicking your blankets off.

We move you (or assist you to move yourself) to a gurney or hospital bed. A nice nurse will obtain a bed over a gurney if you are staying in the hospital more than a day. You are rolled into the PACU where a nurse reapplies the monitors while getting a report from one of the team taking care of you. The PACU nurse will take your temp, look at your wound/drains, assess your pain level and your level of consciousness.

At this point it is very likely you have the mother of all hangovers, but still high. Your throat is scratchy and, trust me, your breath smells like a neglected litter box. You may be nauseous.You are going to be hurting where you had surgery and possibly other places, depending on how you were positioned. While there are fabulous drugs for the aforementioned, the PACU nurse has the delicate job of balancing your pain/nausea control against respiratory arrest. Now is the time to delve into your bag of meditation tricks to help ease your pain. Pain is exacerbated (made worse) from muscle tension around the wound. Try to relax. The more pain medication you require, the longer you have to lay in a room full of other people who just had surgery too.

Patients average 60-90 minutes in the PACU. You are here to be monitored for any immediate complications of anesthesia and surgery. Potential issues: respiratory arrest, laryngospasm (throat closes, preventing air passage) aspiration (of blood or vomit) into your lungs, bleeding and hypothermia. Just to name a few.

There are various scoring systems used to determine if you are ready to leave the PACU. Basically, they are checking to see if you are metabolizing the anesthetic and are not currently or at risk for bleeding. Consciousness, airway maintenance, muscle tone, color, temperature, pulse & respiration rate and blood pressure all indicate if you are clearing the anesthesia agents from your system.

If you are going home straight from the PACU, they will bring you some fluids and possibly crackers to nibble. This is to make sure you can keep it down. Once that is demonstrated (along with stable vital signs), they get you dressed, call your ride, explain discharge instructions and give you the boot! If you are checking in, you will have to wait until you get to the floor for your test snack.

Whew….that’s it, in a very big nutshell.  You may not always get a “nice” nurse or have things go exactly as I have outlined, but I think this series of articles can generally be applied to anyone having a planned, non-emergent surgery. If you have specific questions, please post and I will do my best to honestly answer based on my experience or research. Thanks for reading.


About Bossy Mae

Hi everyone, a little about me: I’ve been an operating room nurse for 18 years. I was one of the lucky ones who procured a job in the OR right out of nursing school. And except for a short stint in Labor & Delivery, surgery has been the main (only) focus of my career. I have worked in small rinky dink hospitals and large teaching institutions and everything in between. I’ve worked as a full time/part time/perdiem and as a traveler. I’ve held staff nurse positions as well as charge nurse positions. Once I was even a manager (never again). I currently hold a bachelors in nursing (recently achieved) and am in the planning (read: saving) stage of getting my masters. All of the above statements will be addressed in later posts, as I have strong feelings about each of those subjects (as well as a variety of other non-nursing subjects, you will learn). I believe that knowledge is power, and I’m not talking about “book lernin”. I mean that the more you know about what you are experiencing, the more control you feel you have resulting in less anxiety about the experience (whether positive or negative). So, I don’t tend to sugar coat answers to direct questions. I think normal (??) adult humans respond best to honesty. Which means many of my posts will be discussing the surgery experience (sticking to what I know!) for the patient; what happens leading up to, during and immediately after having surgery. Disclaimer: everything I say here is based on MY experience, and does not tacitly represent any institution for whom I currently, or have ever worked. Not that I am gonna name names anyway. But just in case. I’m just sayin.-Bossy Mae, BSN, RN, CNOR