The Post-Anesthesia Care Unit (PACU) rotation is based in the University Hospital, is no less than two contiguous weeks, and may extend to one month. During the PACU rotation, residents learn to evaluate and manage patients in the immediate postoperative setting across the broad range of conditions that occur in PACU, using their clinical skills and the skills of the perioperative nursing team. Clinical responsibility extends to all patients admitted to and discharged from the University Hospital PACU during the normal workday.

Residents learn valuable medical team skills including communication, indications and techniques for invasive monitoring, CPR team responsibilities, discharge readiness and criteria and patient resource management skills. Residents also learn techniques for advanced airway management skills including fiberoptic intubation and basic diagnostic and therapeutic bronchoscopy during their rotation in PACU by being involved with care of patients in the LLUMC OR in whom the responsible attending anesthesiologist chooses these techniques.

Upon completion of the PACU rotation, our residents:
  • Evaluate postoperative patients independently.
  • Recognize common postoperative complications independently and institute therapy in consultation with the attending anesthesiologist.
  • Recognize complex perioperative conditions that require the patient receive a higher level of care than proposed (admission vs. outpatient, ICU vs. basic unit, intubated vs. extubated, etc.) and arrange for care in the system using the consultative and administrative resources available including the attending anesthesiologist covering PACU.
  • Understand and apply discharge criteria in the system independently.
  • Recognize indications for invasive monitoring independently and achieve a degree of proficiency in placement of arterial and central venous catheters under the supervision of the attending anesthesiologist.
  • Respond to CPR calls, and manage the airway of patients undergoing CPR independently, with understanding of ACLS.
  • Understand nursing responsibilities toward postoperative patients, and facilitate the flow of patients through the perioperative process independently.
  • Know and apply the ASA Difficult Airway Algorithm, and apply advanced airway techniques including fiberoptic intubation under the supervision of the attending anesthesiologist.
  • Recognize patients likely to have difficult airway anatomy, and prepare the patient and the care team for appropriate airway management.
  • Recognize the anatomy of the upper airway, trachea and major bronchi when using fiberoptic bronchoscopy, and apply the bronchoscope as indicated for placement of double lumen ETT or bronchial blockers, awake intubation and therapeutic bronchoscopy under the supervision of the attending anesthesiologist.

Mathew Malkin, MD directs this rotation.