Immediate postanaesthetic recovery

I have just read ‘Immediate Postanaesthetic Recovery’[1. Unfortunately it fails to recognise the role recovery areas can and do play in the care of critically ill postoperative patients. ‘Comprehensive Critical Care’[2] recognised that each trust would have to review its provision of post anaesthesia care to ensure that critically ill patients in recovery areas are cared for appropriately within a comprehensive critical care service. It recognised that recovery areas will need to have the necessary skills and personnel available to care for such patients. Depending on local circumstances, this may involve the patient remaining in the recovery area for a period of monitoring. This is particularly so for the Level 1 or 2 patient, who does not require ventilatory support. Occasionally, this may mean a Level 1 or 2 patient staying overnight in a ‘24-h recovery’. In other units, this may mean caring for a patient ventilated for a short period of time after major elective surgery. Whilst the Critical Care Unit Consultant should be involved in the care of such patients, in most of these situations the operative team should have the necessary skills to enable them to retain primary responsibility for the patient. Unfortunately, this role of recovery does not appear to have been appreciated by the working party that wrote ‘Immediate Postanaesthetic Recovery’. It fails to recognise that a recovery area has an important role in the efficient running of a critical care service. For example, it may enable elective operations to be undertaken which may otherwise have to be cancelled due to a lack of intensive care unit beds. It is not just about ‘maintaining the flow of surgical lists’. One of the key aims of the Royal College of Anaesthetists is to ensure that all anaesthetists in training have the necessary skills to enable them to safely stabilise all critically ill patients having acquired intermediate training in Intensive Care or its equivalent. It is surprising therefore that the impression given by this document is that the operative team does not possess the necessary skills to care for a critically ill patient post operatively and is dependent on the critical care team to provide immediate postoperative care.