Hypertension is the most common avoidable medical indication for postponing anaesthesia and surgery and although care guidelines exist for the medical patient with hypertension, there are no accepted guidelines for pre-operative evaluation and perioperative care of patients with hypertension who undergo non-cardiac surgery. Therefore management of hypertensive surgical patients remains unclear, whether blood pressure (BP) level or BP-related target organ damage at the time of surgery predicts perioperative cardiovascular complications in patients undergoing major surgery, and thus whether deferring surgery in order to improve BP control will lead to a reduction in perioperative cardiac risk. The literature review critically evaluates the current literature on the topics of hypertension and the surgical patient, white coat hypertension and hypertension and obesity. The literature review supports the uncertainty of patient's management prior to non-cardiac elective surgery as there are no published national guidelines as a direct association between pre-operative hypertension and the perioperative cardiac complications are unclear. Although there appears to be a general agreement that patients with mild-to-moderate hypertension can proceed with surgery because such hypertension poses little additional risk of perioperative cardiovascular complications. Severe hypertension and the presence of hypertension-induced end organ damage should be postponed until better BP control is obtained.

As health care providers our philosophy is to deliver the very highest quality of care to our patients. However within many hospitals there are not firm policies to allow family members to see their loved ones in the immediate postoperative period. Thus parents are routinely not being encouraged to comfort and support their children within the Post Anaesthetic Care Unit. The evolution of ‘family centred’ care should result in parents being encouraged to be with and care for their children during hospitalisation. This has been found to be beneficial to all parties. Whilst parental presence in the anaesthetic room has become more accepted practice the same cannot be said of Post Anaesthetic Care Units despite the recommendations made by the Department of Health [1991] and ‘The Patients’ Charter [1996]. Why does this situation exist? Is it due to preconceived attitudes of the staff involved, parental ignorance or historical reasons? This article will examine available research and attempt to identify possible reasons why such situations exist within many Post Anaesthetic Care Units and suggest possible solutions.

There are a number of factors that prolong patients’ stay in the recovery room (RR), which are related to system or clinical issues. However, less has been discovered from the RR nurses about reasons for prolonged patient stay and recommendations to solve this issue. Prolonged patient stay of more than 2 hours in the RR interferes with the primary role of the RR nurse, which is to provide care to immediate postanaesthesia patients. Consequently, this could affect the operating room schedule, normal flow of patients to the RR and discharge to the nursing units.

The International Federation of Nurse Anesthetists (IFNA) has been striving to promote quality education and practice standards since it began in 1989. Many organisations throughout the world have recognised these efforts including the International Council of Nurses. This article summarises IFNA's achievements and introduces IFNA's new initiative to enhance the quality of anaesthesia care worldwide through an approval process for education programmes.

The number of devices available to monitor the haemodynamic status of patients is increasing. Practitioners need to be aware of the non-invasive and invasive methods available in order to care for their patients safely and effectively. This article reviews a number of noninvasive measurements of haemodynamic function, in addition to invasive methods such as arterial blood pressure, central venous pressure and pulmonary artery pressure monitoring. It is argued that using these methods in combination provides a comprehensive haemodynamic assessment.

Maintaining the patient's airway in the post anaesthetic stage of the patient's care is a skilful endeavour and all practitioners working in a recovery unit must be familiar with all types of obstruction, the causes and how to treat them. Awareness must also be demonstrated of the airway adjuncts available to maintain a patient's airway.

Ageing is a normal process and much diversity exists in the physical, psychosocial and spiritual needs of older individuals. While many older people remain independent active and well, there is a rise in the prevalence of dementia. Developments in surgical techniques and improved patient outcomes have resulted in larger numbers of older people now undergoing surgery. However, age-related risks and complexities persist including the existence of cognitive impairment and dementia. Perioperative care of older patients with dementia provides additional challenges for nurses and other healthcare professionals. This paper discusses the unique care needs of older people with dementia and the role of perioperative nurses in meeting these needs.

Britains older population is on the increase. Anecdotal evidence suggests that the perioperative care of older patients does not take into consideration the physiological changes that come with ageing and their implications for care. Active consideration of physiological changes can contribute to the reduction in morbid events and achieves a better outcome for the older surgical patient.

IN debating the issue of whether or not nursing care should be perceived within a framework of cultural competence, this paper briefly describes the background of this approach to nursing, and as an exemplar, discusses how culture can impact on the practice of anaesthetics and peri–anaesthetic care. This is illustrated through drawing on my own transcultural experiences while employed for nearly five years as a non–physician anaesthetist in Saudi Arabia and may therefore be of interest to those practitioners involved in the delivery of anaesthetics and peri–anaesthetic care.

Post operative nausea and vomiting remains one of the most common complications following surgery. Its high incidence, despite better anti-emetic medication, requires a better understanding of its mechanism and management in order to improve the patient experience. This article reports on a recent audit carried out in a dedicated post anaesthetic orthopaedic unit to assess the level of the problem.