Sedatives and reversal agents in PACU
Feb 12, 2026
Recovery in the post-anaesthesia care unit (PACU) is the transition from anaesthesia or procedural sedation to safe consciousness and physiological stability. Sedative agents, whether used intra-operatively or for procedural sedation, influence how patients emerge, and the PACU team must be familiar with their effects and how to reverse unintended over-sedation. According to ANZCA standards, PACU care focuses on structured observation until discharge criteria are met with safely managed consciousness levels.
Sedative agents such as dexmedetomidine may be used to promote a calm emergence and reduce common recovery challenges like agitation, cough, pain, postoperative nausea and vomiting. Trials show that while dexmedetomidine does not necessarily prolong PACU length of stay, it can improve the quality of recovery by reducing certain undesirable symptoms.
Reversal agents are specific medications given to counteract drug effects if oversedation or respiratory compromise occurs. For example, sugammadex speeds reversal of neuromuscular blockade compared with neostigmine and may shorten PACU time, though findings vary between studies. Short-acting antagonists such as flumazenil for benzodiazepines and naloxone for opioids are key tools in reversing excessive sedation or respiratory depression, with careful monitoring due to the potential for re-sedation.
Key points
- PACU care is guided by clear recovery criteria and vigilant monitoring for excessive sedation.
• Dexmedetomidine, while not lengthening stay, improves several recovery symptoms.
• Sugammadex often provides faster neuromuscular recovery vs neostigmine.
• Flumazenil reverses benzodiazepines, naloxone reverses opioids (watch for re-sedation).
Practical implications
PACU nurses must assess sedation depth, airway protection, and physiological stability post-anaesthesia. Understanding both sedative profiles and when reversal is appropriate supports safe handovers and early recognition of adverse effects.
Clinical insight
Confidence in identifying oversedation and using reversal agents appropriately comes from knowledge of drug mechanisms and vigilant monitoring. These skills help maintain patient safety and flow through recovery.
Build Knowledge ✅
Improve Safety ✅
Stay connected with news and updates!
Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.
We hate SPAM. We will never sell your information, for any reason.