Responding to a Respiratory Complication in the Recovery Room: A Simulation Case for Anesthesiology Students

Postoperative respiratory complications have multiple etiologies, are commonly occurring, and are potentially life-threatening complications of anesthesia. Adverse outcomes associated with respiratory complications are a leading cause of injury-related malpractice claims in anesthesiology. Appropriate response to respiratory complications in the postanesthesia care unit (PACU) involves early intervention, development of a differential diagnosis, and an organized approach to respiratory support and patient disposition.

This simulation is designed for medical students, student nurse anesthetists, and junior resident physicians rotating clinically in anesthesiology. It is designed as a 1-hour, small-group, simulation-based learning activity centered upon a single patient encounter. It focuses on a postoperative encounter occurring shortly after a patient arrives in the PACU. The patient is recovering from a prolonged emergent upper abdominal surgery using an anesthetic associated with increased risk of respiratory complications, and has multiple risk factors for postoperative respiratory complications. This scenario is easily reproduced on modern simulation mannequins without specialized programming. The patient's vital signs are displayed and remain within normal limits, with the exception of the oxygen saturation and heart rate, which must be adjusted during the exercise.

Learners provided evaluations of their experience with this simulation, and these appraisals and comments have been unanimously positive.

We employed this exercise using an anesthesiology resident physician to proctor and debrief, a simulation technician to program and run the model, and a faculty anesthesiologist to mentor each session. We used this simulation case as an educational opportunity for medical students rotating clinically in our department.