📌 Quick-Tip: PACU Discharge Criteria: Safe Transfer from Recovery to Ward

2025年10月30日2025年10月31日

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Your patient opens their eyes after general anesthesia. The vital signs look stable—so, is it time to transfer them to the floor? 🤔
Not so fast✋.
Premature discharge from the Post-Anesthesia Care Unit (PACU) can lead to serious postoperative complications. Safe transfer depends on a structured, multi-domain assessment using standardized scoring tools such as the Aldrete Score, with a typical minimum threshold of ≥9 out of 10.

🔍 Essential Vitals for Discharge Stability

When deciding whether your patient is ready for discharge, objective stability in vital signs is non-negotiable. Transfer should be delayed if any values deviate more than ±20% from the preoperative baseline.

🫁 Respiratory Target:

Keep your patient’s SpO₂ ≥95% with supplemental oxygen, or at least 92–93% on room air. Respiratory rate should stay between 8–25 breaths per minute, with stable spontaneous breathing and no airway obstruction. 💡

🫀 Circulatory Target:

Aim to keep both heart rate and systolic blood pressure within ±20% of their preoperative values. Remember—absolute numbers can be misleading. Always interpret vitals in the context of each patient’s individual baseline.

🌡️ Temperature Target:

Body temperature should be ≥36.0°C, measured either centrally or peripherally according to your institution’s protocol. Shivering should be absent or well controlled before discharge.

💡 Consciousness, Airway, and Pain Management

Before transfer, make sure your patient is awake enough to respond to verbal cues and follow simple commands—for example, “open your eyes” or “squeeze my hand.”

🔹 Consciousness / Airway:

A patent airway and stable spontaneous breathing are essential. This domain carries heavy weight in the Aldrete Score, so pay close attention here. 💡

🔹 Pain and PONV:

Pain should be well managed, ideally NRS ≤5, or at a level that doesn’t require immediate opioid redosing. Nausea and vomiting should be minimal or absent.

🔹 Other Considerations:

Check surgical sites and drains—bleeding and output should be minimal and stable (for most procedures, <100 mL/hr, though this varies). Dressings should not require frequent reinforcement or changes.

💡 Additional Safety Layer: Neuromuscular Monitoring Before Discharge

If neuromuscular blocking agents were used during anesthesia, confirm that the Train-of-Four ratio (TOFR) is ≥0.9 before discharge from the PACU. This ensures complete recovery from neuromuscular blockade and helps prevent residual paralysis and related complications such as hypoventilation or airway obstruction.

This step represents an important safety check increasingly emphasized in international guidelines, even though it’s not formally included in every version of the Aldrete Score. Whenever possible, verify full reversal with objective monitoring before approving discharge.

🎯 Regional Anesthesia: Special Clearance Rules

Patients who received neuraxial or peripheral nerve blocks need extra observation time. These cases shouldn’t be rushed. ⚠️

⏰ Observation Time:

Observe the patient for at least 30 minutes after block placement or the last formal assessment. Some facilities require even longer observation depending on the block type and institutional protocol.

⬇️ Effect Regression:

Confirm that motor and sensory block levels are stable or regressed enough to allow safe transfer. For neuraxial blocks, this includes checking the ability to flex knees or move feet.

🔹 Monitoring:

Stay alert for possible complications such as hematoma formation before discharge.

🇯🇵 Japan-Specific Information:
Some Japanese hospitals require 60 minutes or more of observation, especially for neuraxial anesthesia. Always follow your institution’s local rules.

🌐 International Comparison:
Fast-track pathways in some Western centers allow earlier discharge for carefully selected patients, particularly after peripheral nerve blocks. Still, practices vary widely worldwide—many institutions maintain conservative observation times to prioritize safety.

📋 Standardized Scoring Tools: Aldrete and MPADSS

Standardized scoring systems bring consistency and objectivity to PACU discharge decisions. They reduce subjectivity and support clear documentation.

📝 Aldrete Score:

The most commonly used tool, assessing five areas—activity, respiration, circulation, consciousness, and SpO₂. A total score of ≥9/10 generally indicates readiness for discharge.

📝 MPADSS (Modified Post-Anesthetic Discharge Scoring System):

Used mainly for outpatient cases, this system focuses on home readiness, adding criteria such as nausea control, oral intake, pain management, and the ability to ambulate.

🇯🇵 Japan-Specific Information:
In Japan, the Aldrete Score is widely recognized, but many hospitals adapt it into their own local criteria depending on available resources. The MPADSS, however, is less commonly used than in Western practice.

📝 Take-Home Messages

In short, safe PACU discharge depends on a structured, objective, and multi-domain evaluation—most often via the Aldrete Score (≥9/10).

🔑 Key Points

Use the Aldrete Score systematically (≥9/10) for objective discharge decisions.
Heart rate and systolic BP should stay within ±20% of preoperative values.
SpO₂ ≥95% on oxygen or ≥92–93% on room air; respiratory rate 8–25/min.
Maintain body temperature ≥36.0°C with no shivering.
Ensure responsiveness to verbal commands.
Aim for pain NRS ≤5 with minimal nausea or vomiting.
After regional anesthesia, observe for ≥30 minutes.
If neuromuscular blockers were used, confirm TOFR ≥0.9 before discharge.