Post-Anesthesia Care for DIEP Flap Patients

Initial Assessment and Monitoring

Patients recovering from DIEP flap breast reconstruction require intensive one-to-one nursing observation in the PACU with continuous monitoring of flap perfusion, hemodynamic stability, and aggressive multimodal pain management until they achieve full consciousness, airway control, and cardiovascular stability 1, 2
Continuous pulse oximetry, non-invasive blood pressure, ECG, and capnography (if airway device in place) must be maintained until full recovery from anesthesia 3, 4
Monitor and document at minimum: level of consciousness, airway patency, respiratory rate and adequacy, oxygen saturation, blood pressure, heart rate and rhythm, core temperature 5, 6
Record pain intensity on an agreed scale, nausea/vomiting status, IV infusions, drugs administered, and surgical drainage volume 5, 2

One-to-one observation by a registered PACU practitioner or trained staff member is mandatory until the patient regains airway control, respiratory and cardiovascular stability, and can communicate 1, 4, 2
An anaesthetist must be immediately available for PACU patients at all times 3, 8
If patient arrives with laryngeal mask airway or supraglottic device, the PACU nurse must be specifically trained in its management and removal 5, 6
Tracheal tube removal is the anaesthetist's responsibility but may be delegated to appropriately trained PACU staff who accept this responsibility 5, 6

No patient should be discharged from PACU until pain control is satisfactory 5, 6
PACU nurses must be specifically trained in managing patients with PCA, epidurals, spinals, and peripheral nerve blocks 5, 2
Postoperative nausea and vomiting must be satisfactorily controlled before ward discharge 5, 6
Administer antiemetics per protocol as these patients often have prolonged operative times increasing PONV risk 6

Patients must meet ALL of the following minimum criteria before discharge: fully conscious, able to maintain clear airway with protective reflexes intact, breathing and oxygenation satisfactory, cardiovascular system stable, pulse and blood pressure approximate normal preoperative values or within acceptable parameters, peripheral perfusion adequate, pain and postoperative nausea/vomiting adequately controlled, core temperature acceptable 5, 2