The recovery period from general anesthesia refers to the time from discontinuation of anesthetic agents until the patient achieves stable vital signs or regains consciousness. Complications during this phase can be categorized into neuropsychiatric, respiratory, circulatory, and other related complications. Their occurrence is associated with multiple factors including surgery, anesthesia, blood transfusion/fluid infusion, and the surgical environment [1].

The recovery period is a high-risk phase for anesthesia-related complications. While mild complications may increase patient discomfort, severe ones can be life-threatening. Most of these complications are predictable and preventable. Proactive treatment and nursing care can minimize their incidence, significantly enhancing the safety of anesthesia. This article briefly discusses the types of complications during recovery from general anesthesia and corresponding nursing strategies.

1. Shivering

Shivering is the most common complication during recovery from general anesthesia and is related to thermoregulation following core body heat loss [2]. Shivering can occur at any stage during anesthesia or surgery but most frequently appears during recovery.

Nursing Focus: Reduce factors contributing to further heat loss and temperature drop.

Strategies:

(1) Ensure warmth: Cover the patient thoroughly immediately after surgery, including exposed areas like limbs, shoulders, and neck.

(2) Increase room temperature (e.g., turn off air conditioning or activate heating).

(3) Administer low-dose Tramadol or similar medications, which can be effective [3].

2. Hypothermia

Most patients experience some degree of temperature drop in the later stages of general anesthesia, with severe cases leading to hypothermia. Although body temperature gradually rises as anesthetic effects wear off and the patient awakens during recovery, the incidence of hypothermia remains high, reaching up to 78.4% [4], especially after major surgeries.

Consequences: Can induce shivering, circulatory impairment, arrhythmias, and delayed awakening.

Causes: Any factor causing heat loss, including:

(1) Low operating room temperature

(2) Cold skin disinfectants

(3) Hemorrhage

(4) Loss of large volumes of body cavity fluids (e.g., ascites)

(5) Infusion of cold stored blood or IV fluids

(6) Surgical and anesthetic factors.

Prevention Strategies: 

(1) Actively warm the patient.

(2) Use warmed IV fluids and blood products.

(3) Counteract the effects of anesthetic drugs.

(4) Promote prompt awakening.

3. Nausea, Vomiting, and Aspiration

Factors causing nausea and vomiting in patients recovering from general anesthesia include:

(1) Anesthetic Agents: Morphine, Pethidine (Meperidine), Ketamine, and volatile inhalational anesthetics increase the risk.

(2) Irritation: Oropharyngeal secretions, blood, airway suctioning, or nasogastric tubes.

(3) Hypoxia: Hypotension and hypoxemia leading to central nervous system hypoxia can trigger nausea/vomiting.

Principle: Reduce precipitating factors and stimuli to prevent aspiration.

Strategies:

(1) Ensure suction equipment is readily available and functional until the patient leaves the OR.

(2) Position patients with poor consciousness in a head-down, lateral position to facilitate postural drainage.

(3) Administer oxygen and correct hypotension.

(4) Administer antiemetics for severe cases.

4. Agitation and Injury

Agitation during anesthesia recovery is relatively common. It leads to increased metabolic demand and can cause related injuries such as wound dehiscence, falls, restraint-related fractures, or eye injury from masks.

Causes: Postoperative pain, irritating stimuli (e.g., tracheal/oropharyngeal suctioning), hypoxia, uncomfortable positioning, urinary retention. Agitation is also related to anesthetic technique, being more pronounced after inhalational anesthesia [5-6].

Nursing Focus: Address underlying causes and prevent secondary complications/injury.

Strategies:

(1) Early extubation when appropriate.

(2) Minimize frequent/stimulating suctioning.

(3) Provide proactive postoperative analgesia.

(4) Optimize patient positioning for comfort.

(5) Administer oxygen to rapidly correct hypoxemia.

(6) Assess for and relieve urinary retention.

Prevent Injury: Maintain patient safety until fully awake using appropriate restraints (e.g., secure limb fixation, protective padding, side rails) to prevent falls. Exercise caution to avoid restraint injuries. Monitor closely.

Psychological Support：

Patients often experience significant anxiety and fear due to sensations like dyspnea, shivering, vomiting, and pain/discomfort.

Nursing Strategies:

(1) Reassure patients that these sensations are common and temporary.

(2) Demonstrate genuine care and compassion.

(3) Encourage patients to breathe calmly and steadily.

(4) Motivate patients to cooperate with treatment.

(5) Alleviate fear to help reduce associated complications.

Summary

Common complications during recovery from general anesthesia include shivering, hypothermia, hypotension, agitation, nausea, and vomiting. These complications can occur simultaneously and are often interrelated (e.g., hypothermia and hypoxia can exacerbate or trigger shivering, agitation, nausea/vomiting, hypertension, and arrhythmias).

Nursing Principles: Proactively eliminate harmful factors and manage symptoms.

Key Strategies Summarized:

(1) Implement active patient warming.

(2) Avoid or minimize irritating stimuli (e.g., reduce unnecessary suctioning, aim for early extubation).

(3) Vigilantly monitor for and prevent secondary complications (e.g., injury from agitation, aspiration from vomiting).

(4) Provide proactive, multi-modal treatment for underlying causes (e.g., effective analgesia).

(5) Deliver supportive psychological care to reduce anxiety and fear.

In conclusion, proactive nursing interventions are crucial for effectively reducing and preventing various complications, thereby significantly enhancing patient safety during the recovery period from general anesthesia.

References:

[1] SUN Dajin, HANG Yannan (Eds.). Shiyong Linchuang Mazuixue [Practical Clinical Anesthesiology] [in Chinese]. Beijing: China Science and Technology Press; 2001: 451, 1224.

[2] Buggy DJ, Crossley AW. Thermoregulation, mild perioperative hypothermia and postanaesthetic shivering. Br J Anaesth. 2000; 84(5): 615–628.

[3] TAO Mingzhe, LI Shaojun, BAI Zhiping, et al. Qumaduo Yizhi Quanma Huifuqi Zaodong Fanying ji Qi Liangxiao he Shixiaoying de Yanjiu [Study on tramadol inhibiting agitation during recovery from general anesthesia and its dose-effect and time-effect relationships] [in Chinese]. Zhongguo Linchuang Yaolixue yu Zhiliaoxue Zazhi [Chinese Journal of Clinical Pharmacology and Therapeutics]. 2003;8(3):299–302.

[4] Sari S, Aksoy SM, But A. The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors. Int J Clin Pract. 2021;75(6):e14103.

[5] TAO Mingzhe, REN Yonggong, SHI Biming, et al. Bingbofen Xugei Jigao Ti Gao Quanma Su Xing Zhi Liang de Tantao [Exploration of propofol sequential administration for improving recovery quality after general anesthesia] [in Chinese]. Zhongguo Wuzhenxue Zazhi [Chinese Journal of Misdiagnostics]. 2003;3(5):653–655.

[6] Ozkose Z, Ercan B, Unal Y, et al. Inhalation versus total intravenous anesthesia for lumbar disc herniation: comparison of hemodynamic effects, recovery characteristics and cost. J Neurosurg Anesthesiol. 2001;13(4):296–302.

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