Transcript Post operative complications Classification

Post operative complications
Classification
1.
Specific to operation
2.
General ( Immediate early late)
E.G
Complication of a Bowel Resection for colon
ca
Specific
Intraoperative
Haemorrhage
-
Wound infection
-Anastomotic leak
-Intra-abd.abscess
Adhesion
-Stricture
- hernia
General to anaeshesia
-
MI
-Anaphylactic Reaction
-
Pumonary collapse
-DVT
-Cannula phlebitis
- UTI
- PE
Common clinical presentation
1.
Low urine output (oligo-anuria)
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Urine output is a reflection of GFR which is a
reflection of RBF hence hydration
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Surgery produces the stress response. Which
leads to decreased urine volume.
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Other factors can affect GFR not just RBF
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Min. acceptable urine output is 0.5ml/kg
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Important to act on urine output to avoid
tubular damage and necrosis hence acute renal
failure
Patient has oligo-anuria
Catheterize
If catheter
? retention
flush
If real oligo - anuria
Check for low
Cardiac output
Assess for signs
of hypovolaemia
Treat causes of
Low cardiac output
(e.g arrhythmias)
trial of fluid Challenge
bolus up to 5ml/kg
Consider icu support
if failed consider
further challenge
monitored by cvp
Advanced therapies
1.
Furosemide
2.
Dopamine
water
3.
Renal support – indication
k+
urea (to toxic bwels)
failure to regulate acid-base
2- Confusion (D.A.M HYPOS)
Drugs
- Anaesthetic agents

- Analgesics (opiates)
- Normal drugs being given
- Normal drugs not being given
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Acute systemic infection
- Wound infection
- Anastomotic leak
- Chest infection
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Metabolic disturbance
-
Hypokalaemia / hyper
-
Na+ Na+
-
Sugar / sugar
-
Fluid overload
- Alcohol withdrawal
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Hypotension
- Occult haemorrhage
-
Inadequate fluid infusion
-
Low cardiac output (MI arrhythmias, PE)
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HYPOXIA
-
PYREXIA
HYPOXIA

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Common especially in thoracic + abdominal
surgery cause may be multifactorial
Have a low index of suspicion – mild
confusion mild hypotension and slight
tachycardia may be the only signs -
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Basic physiology. Adequate analgesia, proper
patient positioning, humidified oxygen and
physiotherapy
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Most post-op respiratory problems are not due
to classical pneumonia. Provided the collapse
and hypoventilation that underlies many
problems is treated, any infectious element
usually settles spontaneously.
Common or important problems
1.
Anastomotic leak
-
Between days 4 – 14 postoperatively
manefist as
Peritonitis
Intra – abdominal abscess
Enteric fistula. (path or least resistance i.e
through wound or drain site)
a)
b)
c)
2- Wound complication
a)
Wound infection
b)
Wound dehiscence.
c)
Wound hernia
3- Cannula related sepsis
4- UTI
5- Intestinal obstruction
a)
b)
Mechanical – uncommon as early
complication following surgery – late due to
adhesion.
Paralytic
6- Fluid and electrolyte imbalance
May occur as a result of.
a)
Inappropriate administration of fluid replacement
therapy by the medical staff.
b)
Excessive losses e.g due to NG tubes. High
intestinal stoma output , intestinal fistulae, diuretics
etc.
Intrinisic renal disease exacerbated by surgery or
drugs
c)
7- Thromboembolic disease.
-
Upto 20% of patients that stay longer than 7
days can develop DVT
-
Highest in women on ocp + pelvic surgery
-
Majority will not be clinically apparent .
8- Adhesions
-
Fibrnonos – usually resolve 6-9 weeks
Can become fibrosed
dense fibrotic adhesion. In
abdomen these bands of tissue may form between or
over loops of small bowel in particular. may lead to
“kinking” or compression of small bowel loops,
causing obstruction and even infarction of the blood
supply. Such complication may occur shortly after
the adhesions form. Within months of surgery, or
many years after.
Factors that cause adhesion include:
a)
Genetic
b)
Infection/inflammation at time of surgery
c)
Use of powdered (starch) surgical gloves)
d)
Use of biological suture material
e)
Cooling of intestinal loop.
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