CASE 1

Following major debulking laparotomy under GA with an epidural, the patient was admitted to Recovery displaying signs of haemodynamic instability and without an immediately available management plan. A second anaesthetist arranged transfer to HDU but the reasons for this were not explained to the patient and transfer was delayed due to bed availability issues.

CASE 2

A patient with a complex medical history underwent renal transplantation. They were haemodynamically stable intraoperatively, on extubation, and at the time when the monitoring was disconnected prior to leaving theatre. Transfer monitors were unavailable in the hospital. On arrival in recovery the patient had unrecordable oxygen saturations, blood pressure or heart rate. CPR was commenced.

Commentary

These cases highlight the need for effective planning for post-anaesthetic care during complex surgery, ensuring the plan is clearly communicated to Recovery staff.  In the first case, the patient has undergone complex surgery with invasive monitoring and epidural analgesia.  The requirement for ITU/HDU care post-op should have been arranged prior to surgery, with a clear management plan agreed before the patient was transferred to recovery, to avoid any subsequent delays. 

The second case illustrates why it is essential to ensure that minimum standards of monitoring are in place for safe transfer, even when this is only a short distance from the operating theatre to recovery.^{1, 2, 3}

1. Klein AA, Meek T, Allcock E, et al. Recommendations for standards of monitoring during anaesthesia and recovery: Guideline from the Association of Anaesthetists. Anaes 2021; 76(9): 1212-23
2. Royal College of Anaesthetists. Guidelines for the Provision of Anaesthesia Services for the Perioperative Care of Elective and Urgent Care Patients, 2025
3. Royal College of Anaesthetists Standard 1.3.1.5. ACSA Standards, 2025