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1.   INTRODUCTION

The purpose of this document is to state the general principles and outline important specific responsibilities of the anaesthetist following sedation or anaesthesia

1.1   Following sedation or anaesthesia, the patient is particularly at risk of adverse events related to the airway, ventilation and the circulation.

1.2   The system for care of the patient in this important period is designed to prevent harm to the patient.

1.3   The anaesthetist has a major responsibility for the management of the patient recovering from surgery and anaesthesia, particularly while the patient is in the post-anaesthesia care unit.

2.   PRINCIPLES

2.1   The anaesthetist has responsibility for ensuring that the patient recovers safely from surgery and anaesthesia in an area appropriate for that purpose as specified in College Professional Document PS4 Recommendations for the Post-Anaesthesia Recovery Room.

2.2   Care of and responsibility for the patient following sedation or anaesthesia is shared with nursing staff and with the practitioner performing the procedure. There must be effective communication between those sharing care of the patient.

2.3   The anaesthetist is responsible for recognition, management and documentation of any adverse effects that may be related to sedation or anaesthesia. This includes a responsibility to inform patients and/or caregivers of any future health care matters relevant to the conduct of sedation or anaesthesia.

2.4   When a patient is to be discharged from medical care on the same day that sedation or anaesthesia has been administered, the anaesthetist must ensure that the patient and caregivers understand the principles of post-anaesthesia care. See College Professional Document PS15 Recommendations for the Peri-operative Care of Patients Selected for Day Care Surgery.

2.5   The anaesthetist has a responsibility to audit outcomes of anaesthesia care and include these in quality assurance or peer review processes. See College Professional Document TE9 Guidelines on Quality Assurance

3.   SPECIFIC RESPONSIBILITIES

3.1   The anaesthetist is responsible for safe transport of the patient from the operating theatre or procedure room to the post-anaesthesia care unit, high dependency unit or intensive care unit.

3.1.1   Safe transport requires administration of supplemental oxygen in most cases

3.1.2   The anaesthetist is responsible for selection and use of appropriate monitoring equipment for use during transport.

3.2   The anaesthetist will provide a formal handover of responsibility to suitably trained staff in the post-anaesthesia care unit or intensive care unit, with appropriate briefing on relevant aspects of the surgery, and anaesthesia or sedation.

3.2.1   Handover of care should only occur when the anaesthetist considers that the patient's condition is stable, particularly with regard to cardio-respiratory status.

3.2.2   Handover should include instructions relating to specific relevant issues such as airways, throat packs, intravenous and intra-arterial devices, epidurals or drug infusions.

3.3   The anaesthetist will provide specific advice regarding

3.3.1   Clinical observations and monitoring

3.3.2   Pain relief

3.3.3   Management of complications, particularly post-operative nausea and vomiting

3.3.4   Fluid therapy

3.3.5   Respiratory therapy

3.3.6   discharge from the post-anaesthesia care unit

3.3.7   On-going care related to anaesthesia matters

3.4   The anaesthetist must be readily available to deal with any unexpected problems or alternatively ensure that another nominated anaesthetist or other consultant is available and has access to necessary information about the patient.

3.5   Other responsibilities are:

3.5.1   To ensure that the patient remains in the recovery facility until safe for discharge to a ward or home.

3.5.2   To ensure there are plans for adequate post-operative care of the patient after discharge from the post-anaesthesia care unit.

3.5.3   To provide advice to the primary care team after discharge of the patient from the post-anaesthesia care unit.

RELATED DOCUMENTS

TE6 Guidelines on the Duties of an Anaesthetist

TE9 Guidelines on Quality Assurance

PS4 Recommendations for the Post-Anaesthesia Recovery Room

PS15 Recommendations for the Perioperative Care of Patients Selected for Day Care Surgery

COLLEGE PROFESSIONAL DOCUMENTS

College Professional Documents are progressively being coded as follows:

TE Training and Educational

EX Examinations

PS Professional Standards

T Technical

POLICY - defined as 'a course of action adopted and pursued by the College'. These are matters coming within the authority and control of the College.

RECOMMENDATIONS - defined as 'advisable courses of action'.

GUIDELINES - defined as 'a document offering advice'. These may be clinical (in which case they will eventually be evidence-based), or non-clinical.

STATEMENTS - defined as 'a communication setting out information'.

This document is intended to apply wherever anaesthesia is administered.

This document has been prepared having regard to general circumstances, and it is the responsibility of the practitioner to have express regard to the particular circumstances of each case, and the application of this document in each case.

Professional documents are reviewed from time to time, and it is the responsibility of the practitioner to ensure that the practitioner has obtained the current version. Professional documents have been prepared having regard to the information available at the time of their preparation, and the practitioner should therefore have regard to any information, research or material which may have been published or become available subsequently.

Whilst the College endeavours to ensure that professional documents are as current as possible at the time of their preparation, it takes no responsibility for matters arising from changed circumstances or information or material which may have become available subsequently.

Promulgated: 1990

Reviewed: 1996

Date of current document: Dec 2006

© This document is copyright and cannot be reproduced in whole or in part without prior permission.

College Website: http://www.anzca.edu.au/