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

This simulation presents a postoperative patient in the Post-Anesthesia Care Unit (PACU) who develops progressive respiratory compromise approximately 20 minutes after arrival following a prolonged emergent upper abdominal surgery. The patient is a 68-year-old obese male with multiple comorbidities including poorly controlled diabetes mellitus, hypertension, chronic opioid use, and an extensive smoking history.

Learners are expected to recognize early signs of respiratory insufficiency including somnolence, tachypnea, poor air movement, and upper airway obstruction in the absence of stridor. The case progresses from mild hypoventilation to worsening respiratory acidosis, supported by arterial blood gas findings (pH 7.19, PaCO₂ 80 mmHg), requiring escalation of airway management strategies.

Participants must implement appropriate non-invasive airway maneuvers, optimize oxygenation and ventilation using adjuncts such as oral or nasal airways and bag-valve-mask ventilation, and initiate further evaluation to identify reversible causes of postoperative hypoventilation such as opioid-induced respiratory depression and carbon dioxide narcosis. The scenario emphasizes early recognition, airway management, teamwork, and clinical decision-making in the management of postoperative respiratory failure.

Target Learners 

• Anesthesiology residents 

• Surgery residents 

• Emergency medicine residents 

• PACU nurses 

• Certified Registered Nurse Anesthetists (CRNAs) 

• Medical students in clinical training 

• Interprofessional perioperative care teams 

Equipment Needed 

• High-fidelity adult patient simulator 

• Standard PACU monitoring equipment: 

• • Cardiac monitor 

• • Pulse oximeter 

• • Non-invasive blood pressure cuff 

• • Capnography (if available) 

• Oxygen delivery devices: 

• • Nasal cannula 

• • Simple face mask 

• • Non-rebreather mask 

• Airway adjuncts: 

• • Oral airway 

• • Nasal airway 

• Bag-valve-mask device with oxygen source 

• Suction apparatus 

• ABG laboratory results 

• Portable chest X-ray results 

• Anesthesia record 

• Medication administration supplies 

Estimated Time to Complete the Activity