Give me a 10 marks answer about discharge criteria from PACU from standard anaesthesia textbooks for AIIMS md anaesthesia exams

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Discharge Criteria from PACU

Introduction

The Post-Anaesthesia Care Unit (PACU) is a specialized unit where patients recover from anaesthesia under close monitoring before being transferred to a ward, ICU, or home. Discharge from the PACU requires systematic assessment to ensure patient safety. Criteria are established by the department of anaesthesiology in accordance with hospital medical staff and applicable guidelines (ASA Task Force on Postanesthetic Care, 2013).

(Miller's Anesthesia 10e; Morgan & Mikhail's Clinical Anesthesiology 7e)

General Principles

A mandatory minimum stay in the PACU is not required.
Patients must be observed until they are no longer at risk for ventilatory depression and their mental status is clear or has returned to baseline.
Criteria vary depending on the destination: ICU, regular ward, Phase II (step-down) recovery, or home.
The supervising anesthesiologist retains responsibility for discharge, even if a PACU nurse makes the bedside determination using hospital-sanctioned criteria.

(Miller's Anesthesia 10e, p. 11632)

Clinical Discharge Criteria (PACU to Ward)

1. Neurological / Consciousness

Easy arousability - responds appropriately to voice or mild stimulation
Full orientation - to person, place, and time
Ability to protect the airway (intact gag/cough reflex)
Ability to call for help if necessary

2. Respiratory

Able to take a deep breath and cough freely
Respiratory rate within acceptable limits (no apnea or severe hypoventilation)
SpO₂ >92% on room air (or >90% with supplemental O₂ at minimum)
Patients should be observed for at least 20-30 minutes after the last parenteral opioid dose to detect respiratory depression
SpO₂ monitored for at least 15 minutes after discontinuation of supplemental oxygen

3. Cardiovascular / Hemodynamic

Stable vital signs for at least 15-30 minutes
Blood pressure and heart rate within ±20 mmHg of preoperative baseline
Assessment of peripheral perfusion
No significant arrhythmia

4. Temperature

Normothermia should be re-established prior to discharge
Resolution of shivering (shivering is not an absolute contraindication but must be addressed, as it markedly raises O₂ consumption)
Achieving strict normal temperature is not an absolute requirement, but shivering should have resolved

5. Pain

Acceptable analgesia achieved
Oral analgesics sufficient for ongoing pain management

6. Nausea and Vomiting (PONV)

PONV adequately controlled before discharge
Minimal or manageable with oral medications

7. Surgical Considerations

No obvious surgical complications - active bleeding excluded
Surgical site assessment (drainage, dressings checked)

8. After Regional Anaesthesia

Regression of both sensory and motor blockade should be documented
Failure of a spinal/epidural block to resolve >6 hours after the last local anaesthetic dose warrants urgent neurological evaluation to exclude spinal haematoma

(Morgan & Mikhail 7e, p. 2436-2437; Miller's 10e, p. 11632; Barash 9e, p. 4573)

Postanaesthesia Scoring Systems

Scoring systems are widely used to objectively document fitness for discharge and standardize PACU care.

1. Aldrete Score (Original and Modified)

Developed in 1970 by Aldrete and Kroulik; modified in 1995 to replace visual colour assessment with pulse oximetry.

Parameter	Score
Oxygenation: SpO₂ >92% on room air / >90% on O₂ / <90% on O₂	2 / 1 / 0
Respiration: Deep breath + free cough / Shallow dyspnoeic / Apnea	2 / 1 / 0
Circulation: BP ±20 mmHg preop / ±20-50 mmHg / >±50 mmHg	2 / 1 / 0
Consciousness: Fully awake / Arousable on calling / Not responsive	2 / 1 / 0
Activity: Moves all 4 limbs / Moves 2 limbs / No movement	2 / 1 / 0

Total: 10 points. Score ≥9 required for PACU discharge.

(Morgan & Mikhail 7e, Table 56-2)

2. Post-Anaesthesia Discharge Scoring System (PADSS)

Used for ambulatory / day-surgery patients being discharged home. Assesses five parameters:

Parameter	Score 2	Score 1	Score 0
Vital signs	Within 20% of preop	Within 20-40% of preop	>40% of preop
Activity	Steady gait, no dizziness	Requires assistance	Unable to ambulate
Nausea/Vomiting	Minimal/oral meds	Moderate/IV meds	Severe/refractory
Pain	Controlled with oral analgesics	-	-
Surgical bleeding	Minimal/no change	Moderate	Severe

Score ≥9 = fit for home discharge.

(Barash 9e, Table 54-2; Miller's Anesthesia 10e)

ASA Task Force Recommendations (Box 76.10 - Miller's)

The ASA Task Force on Postanesthetic Care (2013) summarizes discharge requirements:

Periodic assessment of airway patency, respiratory rate, and SpO₂ during emergence and recovery
Heart rate, blood pressure, pain, temperature, mental status, PONV, and neuromuscular blockade recovery - all periodically assessed and stable before discharge
Assessment of drainage and bleeding
Requirement to urinate or drink fluids before discharge should NOT be part of a routine protocol (may be appropriate case-by-case)
Discharge after predefined criteria are met; scoring systems assist documentation
No mandatory minimum stay required
Outpatients discharged to a responsible adult escort
Written discharge instructions - diet, medications, activities, emergency contact

Fast-Track Recovery / PACU Bypass

With the widespread use of short-acting agents (propofol, desflurane, remifentanil), many patients may already fulfill discharge criteria before or upon PACU arrival. In these cases, admission to the PACU only delays inevitable discharge and wastes resources. Modified discharge criteria (e.g., Modified Aldrete Score applied in the OR) allow selected patients to bypass Phase I PACU and go directly to Phase II (step-down) or home.

(Miller's Anesthesia 10e, p. 11634)

Special Circumstances

Situation	Comment
Transfer to ICU	Full PACU discharge criteria need not all be met
Regional anaesthesia	Ensure regression of block documented; motor function assessed
Neuraxial block	Failure to resolve >6 h - rule out spinal haematoma urgently
OSA patients	Extended observation recommended; SpO₂ monitoring off supplemental O₂
Outpatients	Must have responsible adult escort; written instructions mandatory

Summary

Discharge from PACU requires the patient to be:

Conscious and oriented with intact protective reflexes
Haemodynamically stable for ≥15-30 min
Respiratory function adequate with acceptable SpO₂
Pain and PONV controlled
Normothermic (shivering resolved)
Bleeding/surgical site stable
A Modified Aldrete Score ≥9/10 (or PADSS ≥9 for ambulatory cases) should be documented

No mandatory minimum time is required, but individualized assessment by the responsible anesthesiologist remains the gold standard.

References (Standard Textbooks):

Miller's Anesthesia, 10th Edition - Chapter 76 (Post-Anaesthesia Care Unit)
Morgan & Mikhail's Clinical Anesthesiology, 7th Edition - Chapter 56 (PACU Discharge Criteria)
Barash, Cullen & Stoelting's Clinical Anesthesia, 9th Edition - Chapter 54 (Preparation for Discharge)
ASA Task Force on Postanesthetic Care: Anesthesiology 2013;118:291-307

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DISCHARGE CRITERIA FROM PACU

(Post-Anaesthesia Care Unit)

AIIMS MD Anaesthesia - Long Answer (10 Marks)

1. INTRODUCTION

The Post-Anaesthesia Care Unit (PACU) provides close monitoring and care during emergence from anaesthesia and the immediate postoperative period. Safe discharge from the PACU requires systematic assessment across multiple physiological domains to ensure the patient can be safely cared for at a lower level of monitoring. Discharge criteria are established by the department of anaesthesiology in accordance with hospital medical staff policies and the ASA Standards of Post-Anaesthesia Care (Standard V, 2013).

"Although specific PACU discharge criteria may vary, certain general principles are universally applicable. A mandatory minimum stay in the PACU is not required. Patients must be observed until they are no longer at risk for ventilatory depression and their mental status is clear or has returned to baseline."

Miller's Anesthesia, 10th Edition

2. PHASES OF POSTANAESTHESIA RECOVERY

┌─────────────────────────────────────────────────────────────────────┐
│                    PHASES OF PACU RECOVERY                          │
├───────────────────┬─────────────────────┬───────────────────────────┤
│   PHASE I         │   PHASE II          │   PHASE III               │
│   (PACU / ICU)    │   (Step-down /      │   (Home Recovery)         │
│                   │    Day Surgery)      │                           │
├───────────────────┼─────────────────────┼───────────────────────────┤
│ - Intensive 1:1   │ - Less intensive    │ - Patient at home         │
│   nursing         │   monitoring        │ - Responsible adult       │
│ - Airway, haemo-  │ - Ambulation        │ - Written instructions    │
│   dynamic         │ - Oral intake       │ - 24 hr contact no.       │
│   monitoring      │ - Discharge prep    │                           │
│ - Emergence from  │                     │                           │
│   anaesthesia     │                     │                           │
├───────────────────┼─────────────────────┼───────────────────────────┤
│ Aldrete Score ≥9  │ PADSS Score ≥9      │ Written instructions      │
│ required for      │ required for        │ Responsible escort        │
│ discharge         │ home discharge      │                           │
└───────────────────┴─────────────────────┴───────────────────────────┘

3. GENERAL PRINCIPLES OF PACU DISCHARGE

Principle	Detail
No mandatory minimum stay	No fixed duration; discharge when criteria met
Physician responsibility	Supervising anaesthesiologist responsible for discharge decision
Nurse-led discharge	Permitted if all hospital-sanctioned criteria are met
Destination-dependent criteria	ICU < Ward < Phase II < Home (progressively stricter)
Scoring system use	Documents fitness for discharge; does not replace clinical judgement
Individualised assessment	Scoring thresholds must be used alongside disease severity and operative course

(Morgan & Mikhail 7e; Barash 9e)

4. CLINICAL DISCHARGE CRITERIA (PACU → WARD)

4.1 Neurological / Consciousness

Criterion	Details
Level of consciousness	Fully awake OR easily arousable on calling
Orientation	Oriented to person, place, time
Airway protection	Intact cough and gag reflex
Ability to call for help	Can summon assistance if needed
Motor function	Can move all four limbs voluntarily

4.2 Respiratory

Criterion	Threshold
Respiratory rate	Normal range, no apnea
Depth	Can take deep breath and cough freely
SpO₂ (room air)	≥92%
SpO₂ (on O₂)	≥90% at minimum
Post-opioid observation	Minimum 20-30 minutes after last parenteral opioid
Post-O₂ discontinuation	SpO₂ monitored ≥15 min after stopping supplemental O₂
Capnography	Increasingly used after deep sedation / GA

4.3 Cardiovascular / Haemodynamic

Criterion	Threshold
Blood pressure	Within ±20 mmHg of preoperative baseline
Heart rate	Within acceptable limits, no significant arrhythmia
Stability duration	Stable for at least 15-30 minutes
Peripheral perfusion	Assessed clinically (capillary refill, skin colour)
ECG	Any new abnormality investigated before discharge

4.4 Temperature

Criterion	Details
Normothermia	Should be re-established prior to discharge
Shivering	Must have resolved (shivering raises O₂ consumption precipitously)
Treatment	Forced-air warming device; IV meperidine 10-25 mg for refractory shivering

Note: Strict normothermia is not an absolute requirement, but shivering must have resolved. (Morgan & Mikhail 7e)

4.5 Pain

Criterion	Details
Pain score	Acceptable to patient; controlled with oral analgesics
PACU observation	At least 15 min after last IV opioid/sedative
Postoperative pain	Most common cause of delayed discharge in ambulatory surgery
High-risk predictors	Increasing BMI, longer anaesthesia duration, orthopaedic/urological procedures

4.6 Nausea and Vomiting (PONV)

Criterion	Details
PONV control	Minimal, or managed with oral medications before discharge
Parenteral antiemetics	If required - patient not discharged until settled
Fluids	Oral fluids requirement is NOT mandatory unless clinically indicated

4.7 Surgical Considerations

Criterion	Details
Active bleeding	None - wound checked before discharge
Surgical drainage	Documented and acceptable
Dressings	Checked and intact
Urination	NOT routinely required before discharge (may be appropriate case-by-case, e.g., after neuraxial block)

(ASA Task Force, Box 76.10, Miller's Anesthesia 10e)

5. POSTANAESTHESIA SCORING SYSTEMS

5.1 Original Aldrete Score (1970) vs Modified Aldrete Score (1995)

Developed by Aldrete and Kroulik (1970); modified to replace color assessment with pulse oximetry in 1995 (Aldrete).

Parameter	Original Criteria	Modified Criteria	Score
Color / Oxygenation	Pink	SpO₂ >92% on room air	2
	Pale or dusky	SpO₂ >90% on supplemental O₂	1
	Cyanotic	SpO₂ <90% on O₂	0
Respiration	Deep breath + free cough	Deep breath + free cough	2
	Shallow but adequate	Dyspnoeic / shallow / limited	1
	Apnoeic / obstructed	Apnoeic	0
Circulation	BP within 20% of preop	BP ±20 mmHg preop	2
	BP within 20-50%	BP ±20-50 mmHg	1
	BP deviating >50%	BP >±50 mmHg	0
Consciousness	Awake, alert, oriented	Fully awake	2
	Arousable, drifts back	Arousable on calling	1
	No response	Not responsive	0
Activity	Moves all 4 extremities	Moves all 4 extremities	2
	Moves 2 extremities	Moves 2 extremities	1
	No movement	No movement	0

Total = 10 points. Score ≥9 required for PACU (Phase I) discharge. (Morgan & Mikhail 7e, Table 56-2; Miller's 10e, Table 68.5)

5.2 Post-Anaesthesia Discharge Scoring System (PADSS)

For Ambulatory / Day-Surgery Home Discharge (Phase II → Home)

Developed by Chung et al. for patients being discharged directly home. Score ≥9/10 = fit for home.

Parameter	Score 2	Score 1	Score 0
Vital signs (BP + pulse)	Within 20% of preop baseline	Within 20-40% of preop	>40% deviation from preop
Activity level	Steady gait, no dizziness; OR meets preop level	Requires assistance	Unable to ambulate
Nausea/Vomiting	Minimal / treated with oral medication	Moderate / treated with parenteral medication	Severe / continues despite treatment
Pain	Controlled with oral analgesics, acceptable to patient	-	-
Surgical bleeding	Minimal / no dressing change needed	Moderate / up to 2 dressing changes	Severe / >3 dressing changes needed

Note: Requirement to void and retain oral fluids was removed from current PADSS versions as these unnecessarily prolong stay without improving safety. (Miller's 10e; Barash 9e Table 54-2)

5.3 White's Fast-Track Recovery Score

For PACU Bypass (OR → Phase II direct)

White and Song added pain and PONV to the Modified Aldrete Score to assess PACU-bypass eligibility. A score ≥12/14 qualifies for fast-track (direct Phase II).

Parameter	Score 2	Score 1	Score 0
Activity	Moves all 4 limbs	Moves 2 limbs	No movement
Respiration	Deep breath + cough	Dyspnoeic	Apnoeic
Circulation	BP ±15% preop	BP ±15-30%	BP >30% deviation
Consciousness	Fully awake	Arousable	Unresponsive
Oxygenation	SpO₂ >92% room air	Needs O₂ for SpO₂ >90%	SpO₂ <90% on O₂
Pain	None / mild, acceptable	Moderate, treated with IV analgesic	Severe, uncontrolled
PONV	None / mild, no treatment	Moderate vomiting, 1 antiemetic	Persistent, multiple antiemetics

Score ≥12/14 = eligible for PACU bypass (fast-track to Phase II) (Miller's Anesthesia 10e)

6. DISCHARGE CRITERIA AFTER REGIONAL ANAESTHESIA

Type of Block	Special Criteria
Peripheral nerve block	Motor and sensory regression documented; block extent known
Spinal/epidural	Sensory regression to at least S1-S2 dermatome; motor power partially returning
Continuous perineural catheter	May be discharged with catheter in situ for postoperative analgesia; patient educated
Failure to resolve	Neuraxial block not resolving >6 hours after last dose - exclude spinal subdural/epidural haematoma by urgent neurological review + MRI/CT
Vasopressor dependency	No ongoing vasopressor requirement for sympathetic blockade

(Morgan & Mikhail 7e, p. 2437)

7. FAST-TRACK RECOVERY AND PACU BYPASS

                    ┌──────────────────────┐
                    │  END OF SURGERY (OR) │
                    └──────────┬───────────┘
                               │
                    ┌──────────▼───────────┐
                    │  Apply White's Fast- │
                    │  Track Score         │
                    └──────────┬───────────┘
                               │
            ┌──────────────────┼────────────────────┐
            │                  │                    │
        Score <12          Score ≥12           Directly to
            │           (Fast-Track)              ICU
            ▼               ▼
     PHASE I PACU      PHASE II (Step-down)
     (Full monitoring) (Bypass PACU)
            │               │
    Aldrete ≥9         PADSS ≥9
            │               │
            ▼               ▼
       PHASE II         DISCHARGE HOME
    (Step-down)        (with responsible
            │           adult escort +
    PADSS ≥9            written instructions)
            │
            ▼
    DISCHARGE HOME

"With the increased use of short-acting drugs and techniques, many patients will have already met the discharge criteria before, or by the time, they reach the PACU. Instead, these patients may bypass phase 1 recovery and go directly to the phase 2 unit; this is known as fast-track recovery."

Miller's Anesthesia 10e

Eligible for Fast-Track / PACU Bypass:

Short ambulatory procedures
Local infiltration / minor peripheral blocks
Healthy patients (ASA I-II) after minor procedures
Patients using short-acting agents (propofol TIVA, desflurane, remifentanil)
BIS-guided anaesthesia

8. ASA TASK FORCE RECOMMENDATIONS (Box 76.10, Miller's 10e)

The ASA Task Force on Postanesthetic Care (2013) issued the following summary for discharge:

#	Recommendation
1	Periodic assessment of airway patency, respiratory rate, and SpO₂ during emergence and recovery
2	HR, BP, pain, temperature, mental status, PONV, and neuromuscular blockade recovery - all periodically assessed and stable before discharge
3	Assessment of surgical drainage and bleeding
4	Requirement to void or retain oral fluids should NOT be part of routine discharge protocol (case-by-case basis)
5	Discharge only after predefined criteria are met; scoring systems assist documentation
6	No mandatory minimum PACU stay required
7	Outpatients must be discharged to a responsible adult escort
8	Outpatients receive written instructions - diet, medications, activities, emergency contact number

9. SPECIAL SITUATIONS AND THEIR MANAGEMENT

┌───────────────────────────────────────────────────────────────────────────┐
│              SPECIAL CIRCUMSTANCES MODIFYING DISCHARGE CRITERIA           │
├─────────────────────┬─────────────────────────────────────────────────────┤
│  SITUATION          │  MODIFICATION                                       │
├─────────────────────┼─────────────────────────────────────────────────────┤
│ Transfer to ICU     │ Full PACU criteria need NOT all be met;             │
│                     │ proper handoff report essential                     │
├─────────────────────┼─────────────────────────────────────────────────────┤
│ Obstructive Sleep   │ Extended PACU observation; SpO₂ monitored           │
│ Apnoea (OSA)        │ off supplemental O₂ before discharge                │
├─────────────────────┼─────────────────────────────────────────────────────┤
│ Residual opioid     │ Observe ≥20-30 min; naloxone 40 mcg q2min up       │
│ effect              │ to 200 mcg if needed; ensure not re-sedated         │
├─────────────────────┼─────────────────────────────────────────────────────┤
│ Residual neuro-     │ Monitor with neuromuscular transmission monitor;    │
│ muscular blockade   │ Reverse with neostigmine/glycopyrrolate or          │
│                     │ sugammadex before discharge                         │
├─────────────────────┼─────────────────────────────────────────────────────┤
│ Hypothermia         │ Active rewarming with forced-air warming device;    │
│                     │ must resolve shivering before discharge             │
├─────────────────────┼─────────────────────────────────────────────────────┤
│ Neuraxial block     │ Block must show regression; void required; failure  │
│ (spinal/epidural)   │ to regress >6 h → urgent haematoma exclusion        │
├─────────────────────┼─────────────────────────────────────────────────────┤
│ Paediatric patients │ Emergence delirium common; parent/guardian          │
│                     │ accompaniment for Phase II; strict PONV control     │
├─────────────────────┼─────────────────────────────────────────────────────┤
│ Elderly / frail     │ Conservative discharge; assess baseline cognition;  │
│                     │ risk of delayed sedation and falls                  │
├─────────────────────┼─────────────────────────────────────────────────────┤
│ Delayed emergence   │ Investigate: residual drugs (opioid, BZD, NMB),    │
│ (>90 min)           │ metabolic (hypo/hyperglycaemia, electrolytes,       │
│                     │ hypothermia), neurological (stroke, seizure, ↑ICP)  │
└─────────────────────┴─────────────────────────────────────────────────────┘

10. COMPREHENSIVE FLOWCHART: PACU DISCHARGE DECISION

                   ┌───────────────────────────────┐
                   │   PATIENT ARRIVES IN PACU     │
                   │   (from OR / procedure room)  │
                   └───────────────┬───────────────┘
                                   │
                   ┌───────────────▼───────────────┐
                   │  Baseline Assessment:          │
                   │  Airway, Breathing, Circulation│
                   │  Temperature, Neurology        │
                   └───────────────┬───────────────┘
                                   │
          ┌────────────────────────┼────────────────────────┐
          │                        │                        │
   Complications                Stable             High acuity /
   identified              (routine recovery)    complex surgery
          │                        │                        │
          ▼                        │                        ▼
   Treat and                       │              Consider ICU
   Stabilise                       │              (bypass full
   (see Special                    │               criteria)
   Situations)                     │
          │                        │
          └────────────────────────┘
                                   │
                   ┌───────────────▼───────────────┐
                   │   Apply MODIFIED ALDRETE SCORE │
                   │   Assess all 5 domains        │
                   └───────────────┬───────────────┘
                                   │
                     ┌─────────────┴─────────────┐
                     │                           │
               Score < 9                  Score ≥ 9
                     │                           │
                     ▼                           ▼
          Continue monitoring         Verify CLINICAL criteria:
          Re-assess every             ✓ Adequate analgesia
          15-30 minutes               ✓ PONV controlled
                     │                ✓ Normothermia / no shivering
                     │                ✓ No surgical complications
                     │                ✓ Stable ≥15-30 min
                     │                ✓ ≥20-30 min post last IV opioid
                     │                ✓ Regional block assessed
                     │                           │
                     │            ┌──────────────┴──────────────┐
                     │            │                             │
                     │        Criteria               Criteria NOT
                     │          MET                    all met
                     │            │                             │
                     │            ▼                             ▼
                     │    ┌─────────────────┐        Continue PACU care
                     │    │ Destination?    │        Treat deficiencies
                     │    └────────┬────────┘
                     │             │
                ┌────┴──────┬──────┴──────┬─────────────┐
                │           │             │             │
            ICU/HDU       WARD       PHASE II       HOME
                │           │        (Day surgery)  (Ambulatory)
                │           │             │             │
            Reduce       Standard     PADSS ≥9       PADSS ≥9 +
            criteria     ward        required       Responsible
                         care                       adult escort +
                                                    Written instructions

11. SUMMARY TABLE: CRITERIA AT A GLANCE

Domain	PACU (Phase I) → Ward	Phase II → Home
Consciousness	Easily arousable, oriented	Fully awake, oriented
Airway	Protective reflexes intact	Self-maintaining
Respiration	Adequate rate + depth	Adequate; no O₂ required
SpO₂	≥92% room air (or ≥90% on O₂)	≥92% room air
BP	±20 mmHg preop, stable 15-30 min	±20% preop baseline
HR	Within acceptable limits	Within acceptable limits
Temperature	Shivering resolved	Normothermic
Pain	Controlled; oral analgesics adequate	Acceptable to patient
PONV	Controlled	Minimal; oral antiemetics sufficient
Bleeding	No active bleeding	Minimal dressing change
Scoring	Aldrete ≥9/10	PADSS ≥9/10
Opioid observation	≥20-30 min post last IV opioid	≥30 min post last IV opioid
Minimum stay	Not required	Not required
Escort	Not mandatory	Responsible adult mandatory
Instructions	Verbal	Written + verbal

12. KEY MNEMONICS FOR EXAM

"CROW" - Domains assessed in Aldrete Score:

C - Circulation
R - Respiration
O - Oxygenation
W - wakefulness (Consciousness)
A - Activity (CROWA)

"5 Cs" - Clinical discharge criteria:

Consciousness - awake and oriented
Cardiovascular - stable haemodynamics
Clear airway - reflexes intact
Comfort - pain and PONV controlled
Core temperature - normothermic, no shivering

13. REFERENCES (Standard Textbooks)

Textbook	Chapter	Content
Miller's Anesthesia, 10th Ed.	Chapter 76	Box 76.10, Aldrete Modified, PADSS, Fast-track, White's score
Morgan & Mikhail's Clinical Anesthesiology, 7th Ed.	Chapter 56	PACU discharge criteria, Aldrete Table 56-2, Regional block criteria
Barash, Cullen & Stoelting's Clinical Anesthesia, 9th Ed.	Chapter 54	Preparation for discharge, Phase I/II criteria, PADSS Table 54-2
ASA Task Force on Postanesthetic Care	2013 Guidelines	Box 76.10 recommendations; Anesthesiology 2013;118:291-307

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