CASE 1

A patient had a persistently low systolic BP in Recovery despite fluid resuscitation. The patient required oxygen and eventually was transferred overnight to HDU.  The Recovery nurse felt their concerns about the patient, expressed to several anaesthetists, had not been adequately responded to.  

CASE 2

The patient arrived in Recovery from Theatre with a metaraminol infusion at a rate that exceeded the locally prescribed maximum.

Approximately an hour later, the patient deteriorated, with an unrecordable blood pressure and hypoxia. An anaesthetist reviewed the patient, increased the metaraminol infusion and gave a bolus of adrenaline. 2 units red cells were transfused. After further reviews, a CVP line was inserted, and noradrenaline infusion started. The Recovery staff felt that if a CVP line had been sited and noradrenaline started earlier the collapse in Recovery could have been avoided.

Commentary:

Collapse in Recovery cannot always be anticipated or prevented. Recovery-trained nurses are experienced in care of post-operative patients, and their concerns should be taken seriously. The rationale for management decisions should be explained in detail. In the second case local guidelines had been breached and arguably care of the patient should not have been handed over until the need for vasopressor support had reduced.