In the postoperative period, the safety of patients with obesity may be improved by the use of supplemental oxygen, non-invasive ventilation (continuous positive airway pressure), monitoring of sedation, and ideally continuous pulse oximetry.263
Patients with obstructive sleep apnoea have a higher incidence of postoperative complications including hypoxia, renal failure, unplanned critical care stay, and delayed discharge. Therefore, consideration should be given to monitoring such patients in a critical care environment postoperatively.264
Critically ill patients should only be held in the recovery area because of a lack of availability of appropriate facilities elsewhere if recovery staff are appropriately trained, and the recovery unit is appropriately equipped to enable monitoring and treatment to the standard of a level 3 intensive care unit (ICU). In some circumstances, such as a viral pandemic or a...
Where postoperative care is delivered outside of a main ICU (e.g. a level 2 high dependency unit (HDU) or specifically developed PACU), nurse-led, protocol driven care of frequently occurring problems for high risk surgical patients (such as pain, fluid imbalance, nutrition and mild cardiorespiratory compromise) can ensure good patient outcomes.250 Protocols and policies should be agreed between nursing staff...
Where the postoperative destination is not a main ICU (e.g. a level 2 HDU or specifically developed PACU), the patient should remain in PACU until they are stable and are no longer likely to require immediate support from an anaesthetist. This is of particular importance when transferring patients from recovery to level 2 critical care units that are not staffed...
All hospitals should have a clear policy describing the safe triage of surgical patients considered to require postoperative critical care, with guidance on which patients should be admitted immediately to ICU, and which can wait in a standard recovery area for a short period while an ICU bed becomes available. Staff in critical care and recovery units should develop procedures...
Hospitals should have written policies on the management of surgery that is sufficiently urgent that it proceeds when postoperative critical care is desirable but not available; this situation should be considered exceptional.
Preoperative assessment, optimisation, manipulation of patients’ normal drugs and shared decision making in patients with diabetes requires a cross-specialty approach based on national guidance involving anaesthetists, surgeons, diabetes physicians, diabetes inpatient specialist nurses and pharmacists. The development of such teams requires time and resources. This should be recognised and provided.269,270
Patients with diabetes are at increased risk of adverse postoperative outcomes. Pathways of care providing proactive preoperative interventions to promote day of surgery admission and day surgery should be developed.269
Patients with diabetes are at increased risk of concurrent morbidity. These conditions should be identified and optimised where and when possible.269
