It is the responsibility of the anesthetist or
anesthesiologist to determine which plane
is optimal for the procedure. The deter-
mination is made according to specific
tissue sensitivity of the individual and the
surgical site. Each successive plane is
achieved by increasing the concentration
of the anesthetic agent in the tissue (fig.
Stage 4 is called the toxic or danger stage.
Obviously, this is never a desired stage of
anesthesia. At this point, cardiopulmonary
failure and death can occur. Once surgical
anesthesia has been obtained, the health
provider must exercise care to control the
level of anesthesia. Plane 4 of stage 3 is
demonstrated by cardiovascular impair-
ment that results from diaphragmatic
paralysis. If this plane is not corrected im-
mediately, stage 4 quickly ensues (fig 5-3).
For purposes of this discussion, the recovery
phase consists of the period that begins at the
completion of the operation and extends until the
patient has recovered from anesthesia. The re-
covery phase generally takes place in a specialized
area called the recovery room. This unit is usually
located near the operating room and has access
to the following:
. Surgeons and anesthesiologists or
. Nurses and Hospital Corps personnel who
are specially prepared to care for im-
mediate postoperative patients
. Special equipment, supplies, medication,
and replacement fluids
From the time of admission to the point of
discharge, routine care in the recovery room con-
sists of the following:
Measuring temperature and vital signs
. Take immediately upon admission and
as ordered by the physician thereafter.
Maintaining airway patency
l Patients having an artificial airway in
place will automatically expel it as they
. Have a mechanical suction apparatus
available to remove excessive excretions
from the patients airway.
. Ensuring the integrity of dressings, tubes,
catheters, and casts
Locate the presence of any of the
Make notations regarding all drainage
including color, type, and amount.
Immediately report the presence of
copious amounts of drainage to the
nurse or physician.
. Monitoring intravenous therapy (including
blood and blood components)
. Make notations including type of in-
fusion, rate of flow, and condition of
the infusion site.
. Observe patients receiving blood or
blood components closely for un-
. Monitoring skin color changes
. Check dressings and casts frequently to
ensure they are not interfering with
normal blood circulation to the area.
. Notify the physician or nurse of general
skin color changes that may indicate
airway obstruction, hemorrhage, or
. Assessing level of responsiveness
. For general anesthetics, check for
orientation to the environment each
time vital signs are taken.
. For regional anesthetics, check for
return of sensory perception and volun-
tary movement each time vital signs are
. Observing for side effects of the anesthetic
agent. Each agent has the potential for
causing specific side effects. Some com-
mon major side effects that may occur fol-
lowing the administration of both spinal