A review of respiratory deterioration after surgery starts with a timeline. The relevant information may be spread across the anesthesia record, recovery-room chart, medication record, ward observations, and emergency response documentation. Looking at these records together helps clarify what was observed, what was communicated, and what occurred next.

ASA's postanesthesia standards address assessment during recovery, transfer of information, and monitoring of oxygenation, ventilation, and consciousness. These are useful areas to examine when organizing the record. The standards also recognize that monitoring should reflect the patient's condition. ASA Standards for Postanesthesia Care, amended 2024

Records to assemble

  • Preoperative assessment, relevant cardiopulmonary history, sleep-apnea screening, and home medication list.
  • Complete anesthesia and airway records, with medications, doses, routes, and administration times.
  • Recovery-room observations, sedation assessments, oxygen therapy, handoff notes, and discharge or transfer criteria.
  • Ward observations and medication administration records, including patient-controlled analgesia orders and available pump logs.
  • Available monitor trends, alarm records, respiratory therapy notes, and contemporaneous nursing assessments.
  • Rapid-response or resuscitation records, subsequent investigations, intensive-care documentation, and relevant facility policies in effect at the time.

Questions that organize the review

When was the first documented change in breathing, oxygenation, or alertness? What medication had actually been given before that change? What was the patient receiving during transfer and afterward? How did the care team respond to observations or alarms? Does the sequence in the chart agree with available device timestamps?

The medication route matters. ASA's 2016 guidance on respiratory depression specifically addresses neuraxial opioids. Its recommendations should not be applied indiscriminately to every postoperative medication regimen. It highlights assessment of ventilation, oxygenation, and consciousness, with attention to patient risk and other sedating medications. ASA neuraxial opioid guideline

An adverse outcome, an isolated vital sign, or a missing chart entry does not independently establish the mechanism or adequacy of care. A case-specific review separates the documented facts, competing explanations, and unanswered questions, using references appropriate to the date of treatment.