PeriAnesthesia nursing is the professional nursing specialty of patient care prior to and following surgery or other therapeutic intervention requiring all types of anesthesia.

PreAnesthetic nursing involves the assessment of, and the plan of care for the preoperative patient using a nursing history and identifying individual needs of each patient. The preanesthetic nurse incorporates the type of anesthetic to be administered and extent of surgical intervention into this assessment. Based on the findings, and using knowledge, skill and judgment, the nurse determines the need for further consultations and/or treatments by other healthcare professionals. The patient is taught preoperative preparation and postoperative recovery including pain management and surgical wound care. The patient's preexisting comorbidities and physical and mental states are factored into the information.

PostAnesthetic nursing is the professional nursing specialty of patient care following surgery or other therapeutic intervention requiring all types of anesthesia. Postanesthetic nursing care varies according to the phase of recovery in which the care is provided. Postanesthetic Recovery is divided into 3 recognized phases of recovery:

PeriAnesthesia Nursing during the 20th Century

During World War II, hospital and health care workers were scarce.  Surgical patients were returned to the inpatient bed on many different units in the hospital directly from the operating room (theatre).  This was soon recognized to be very time consuming for the nurse caring for this patient and unsafe.  There could be postoperative complications that occurred out of sight of the nurse with a larger patient load.  It was because of this and financial factors that a centralized unit was opened.  Nurses, scarce equipment and resources in one location seemed to be the efficient solution. This unit was not necessarily near to the operating room, however.  Nurses were assigned to monitor patients immediately postoperatively including observations of respirations, pulse and surgical site hemorrhage.  In case of complication, the anesthetist or surgeon could be summoned from the operating room but in many cases they were too far away from the patient to affect a positive outcome.

Progress in the 1950's

By the end of the 1960's, most hospitals had constructed a Recovery Room in close proximity to the Operating Rooms.  The numbers of Operating Rooms expanded as anesthetics improved, surgery refined and surgical intervention became a positive choice for care of ailments.  The numbers of surgical procedures required the postanesthetic nurse to continue to learn and be able to recognize postoperative complications related specifically to each one.  Education consisted of the surgeon explaining the surgical technique. Patients were better prepared for surgery, often being admitted the night before surgery for lab tests and x-rays, intravenous hydration and preoperative sedation for anxiety.

The demand for more invasive and accurate monitoring of the postoperative patient grew.  Respirators became more sophisticated and used more frequently.  They were able to deliver more than one volume of air, now with oxygen, and more than one mode of ventilation offered for various pulmonary conditions.  Monitoring of vital signs too became mechanized.  New cardiac monitors could monitor cardiac rhythms on a screen and count the rate.  There were even some monitors that could connect to the patient arterial system to monitor blood pressures.  Surgical procedures became more of a life and limb saving nature, and less devastating to the patient.  Postanesthetic nurses learned new surgery and technology at an alarming speed.  The numbers of postanesthetic beds grew and more nurses trained in this specialized area as the length of stay for the postoperative patient increased.  Patients were being transferred from the operating rooms now with special breathing tubes (endotracheal tubes) in place, many attached to respirators for prolonged periods because of the anesthetics and new paralytic medications used for better surgical performance.  With the more accurate and invasive monitoring equipment, it was easy to see that patients were suffering from unstable heart rates, rhythms and blood pressures.

Into the 1980's came the first use of computers in a few of the more progressive hospitals.  Lab data could be acquired at the bedside.  Patient comfort was directly related to postoperative morbidity and better analgesics were incorporated as an integral part of postoperative nursing care.  Close monitoring with better technology included cardiac monitoring in more than one lead, improved pharmacological agents to manage the fluctuations in blood pressures and newer ventilators ("respirators") that could minimally assist the drowsy patient or fully rest the more unstable patient.  The new ventilator now had multiple modes for a variety of respiratory supports and delivered volumes of oxygen at a variety of concentrations.  Many patients now had more than one invasive pressure line inserted at the outset of surgery, requiring more intensive postoperative understanding and education for the postanesthetic nurse.  Patient safety was now the focus of care, as more information regarding the "hidden" hemodynamics was available through better technology. By the late 1980's patients were being viewed as two distinct categories for management pre- and postoperatively.  Healthy patients undergoing more minor procedures could be given a new, lighter anesthetic and be well enough to be discharged home later on the same day.  Postoperative outcomes were measured and it was soon realized that these patients could also arrive at hospital on the morning of surgery to produce significant cost savings to the hospitals.  At first, these new day surgery patients were frequently cancelled due to unknown comorbidities or inadequate preoperative preparation discovered on the morning of surgery and a solution had to be formulated.  This lead to the opening of PreAdmission units, where the patient was assessed and given adequate information to prepare for surgery and postoperative management.  This innovation reduced the numbers of preoperative cancellations on the morning of surgery. The Ontario PeriAnesthesia Nurses Association was formed in 1985 in order for postanesthetic nurses to find a meeting ground to share information and new ideas.  By 1989, day surgery nurses were invited to join the association, and by the 1990's PreAdmission nurses were included.

By the mid-1990's most hospitals had adopted the process of "preadmitting" surgery patients and were now offering multidiscipline professional consultations for holistic management of preoperative management and postoperative planning.  More and more, patients were able to be discharged home with the new lighter anesthetics producing a much easier recovery.  Better pain modalities included oral as well as adjunct intravenous medication given as studies showed that each analgesic affected pain sensation at a different location.  Surgical procedures became more extensive, including transplantation of organs.  Again, the perianesthesia nurse had much new information to learn.

Currently in the 21st Century:

As technology and therapeutic interventions progress at an alarming rate, it is rare that the preoperative or postoperative nurse does not require further education or information.  Patient safety and safer healthcare are the focus of each nurse's daily routine.  Incorporating families as partners in care has its own challenges while respecting the privacy of patients is expected and even mandated.   

What is in store for the future? It is difficult to predict what the future holds for all perianesthesia nurses as the demand for patient inclusion in decision-making often conflicts with the need for best practices in care.  As technology progresses and surgical techniques become less invasive, perianesthesia nursing care will be ever evolving.