Adverse drug reactions in the recovery room
Aug 28, 2025
Staying one step ahead - adverse drug reactions in recovery 💊
Adverse drug reactions (ADRs) are always an important consideration in the recovery room for any adverse event occurring, as patients are exposed to a variety of medications during anaesthesia, surgery, and immediate postoperative care. Early recognition and timely management are essential to prevent deterioration and ensure patient safety.
What to look out for:
ADRs can present in a number of ways and should always be a consideration to rule out. Common reactions include:
- Respiratory depression 🫁 (often from opioids or sedatives): decreased respiratory rate, hypoxia, or rising CO₂ levels
- Cardiovascular effects ❤️ (often from anaesthetic or vasoactive agents): hypotension, arrhythmias, or brady/tachycardia
- Neurological changes 🧠: agitation, confusion, excessive sedation, or seizure activity
- Allergic reactions 💉: rash, urticaria, bronchospasm, or, in severe cases, anaphylaxis with airway compromise and hypotension
- Gastrointestinal symptoms 🤢: nausea and vomiting, often from opioids or volatile anaesthetics
Escalation:
Recovery nurses play a vital role in early detection. Any sudden change in your primary assessment should be treated as potentially drug related until ruled out. These events should be escalated quickly to the treating anaesthetist or the anaesthetist in charge, and in some instances an emergency response may need to be initiated. As always, clear communication and handover of the important elements pertaining to the event is a critical role for the primary nurse.
Immediate management of a suspected ADR can include:
- For respiratory depression 🫁, provide airway support and oxygen. Treatment may include reversal agents such as naloxone
- For hypotension or arrhythmias ❤️, ensure continuous monitoring, position patient accordingly to promote return venous flow, treatment may include supporting circulation with fluids or medications
- For allergic reactions 💉, cease the suspected agent, administer oxygen. Treatment prescribed by anaesthetics may include antihistamines, corticosteroids, or adrenaline in suspected anaphylaxis
- For nausea/vomiting 🤢, administer antiemetics as prescribed, optimise positioning to enhance patient comfort, provide reassurance
Vigilance, continuous monitoring and assessment in the recovery room ensures early recognition and rapid escalation of potential ADRs, helping prevent minor reactions from life-threatening emergencies.
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References:
Khalil, H., Huang, C. Adverse drug reactions in primary care: a scoping review. BMC Health Serv Res 20, 5 (2020). https://doi.org/10.1186/s12913-019-4651-7
Struys, Michel M. R. F, and Philip M. Hopkins, 'Adverse drug reactions in anaesthesia', in Jonathan G Hardman, Philip M Hopkins, and Michel M.R.F Struys (eds), Oxford Textbook of Anaesthesia, Oxford Textbook (Oxford, 2017; online edn, Oxford Academic, 1 Apr. 2017), https://doi.org/10.1093/med/9780199642045.003.0022,
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