AH2 ‐ Common Periop Complications - General Complications After surgery - Dr Aramovic

Question 1

This is very examinable topic!

Answer 1

Question 2

What are the learning objectives form this lecture?

Answer 2

Question 3

What are definitions you need to know (complications - define in terms of this setting)

E.g technical vs avoidable vs non techncal complications

Answer 3

Question 4

How else can we define post-opertive surgical complications?

Answer 4

Question 5

What is the Clavien-Dindo classification of post-opertive complications

Answer 5

Question 6

What is the general time frame of complications (as per timing post op)

Answer 6

Wind, Water,

Question 7

How can we prevent surgical complications as junior doctors? (need to know this for exams)

Answer 7

Question 8

What are respiratory complications associated with surgery? (atelectasis)

• Most common with painful thoracic and upper abdominal operations: (why is this important) - Pain is major inhibitory factor in upper GI?resp surgery

Answer 8

Question 9

Respiratory complication:

How can aspiration be caused????? (accidentally)

Answer 9

Question 10

How can we prevent asipration as risk post-operatively

Answer 10

Question 11

What complications are associated with aspiration - How can we identitfy and treat these patients

Answer 11

Question 12

How do we prevent and recognise DVT/PE risk in patients? What management do we need to provide?

Answer 12

1. Adequate fluid
2. adequate pain relief so important
3. Mechanical and chemical prophylaxis
4. Early mobilastion post surgically

Suspect if there is unilateral, leg pain, or swelling, low grade fever, hypoxaemia, air hunger, pleuritic chest pain or haemoptysis

Question 13

How do we prevent endocarditis?

Answer 13

1. PROVIDE antibiotic prophylaxis as there is a risk of nosocomial infection ie, an intravenous devices (heart prosthetics)

Question 14

What are important coagulation disorders to look out for in surgical patients? How do we manage these patients optimally?

Answer 14

1. Medical anticoagulation most common cause of disruption these days

Question 15

What are the 4 major medical anticoagulants? (need to cease and monitor in surgical patients)

Answer 15

Question 16

What questions should ask yourself when stopping anticoagulation post-opertively?

1) is it safe to stop?
2) Is bridging anticoagulation required
3) Is it safe to operative without stopping anticoagulation

Answer 16

Question 17

When should

Answer 17

Question 18

When is bridging anticoagulation needed!

Answer 18

Question 19

What are important surgical complications with patients with Diabetes? What medications should start and stop?

Whose in charge?

NEED to have diabetes well controlled pre-op!

If needing insulin- halving normal insulin dose is normally enough.

Non-insuling dependent - omit oral hypoglycaemics whilst fasting pre-op, and if necessary insulin sliding scale post op until tolerating a diet

Answer 19

Question 20

Most important part of talk!

How do we recognise non-technical complications?

1. Abnormal observations (VS U/O, Weight)
2. changing observations- changing over time
3. Unexpected symptoms

Answer 20

1. Abnormal observations (VS U/O, Weight)
2. changing observations- changing over time
3. Unexpected symptoms

Question 21

How do we define a fever in post-op patient?

How do we manage a post op fever?

(The type of fever and time after surgery may suggest the cause)

Answer 21

Question 22

How do we define post opertive tachycardia?

What do we need to do to manage this? (need to work out cause)

What can be causing this (3 marks)

Answer 22

Question 23

Case 1: identify 5 things that could lead to complications

Answer 23

1. Risk of aspiration -
2. Risk of atelectasis- distended
3. AKI
4. Haemorrhage (apixaban) - 36 hours increased
5. Euglcaemic ketoacidosis
6. HTN - may present as haemorrhage
7. Post-op
8. Atrial Tachycardia
9. Endocarditis
10. Diabetes needs to be optimized

Question 24

True or false

Answer 24

1. False cannot be reversed
2. True - NGT
3. True
4. False
5. True
6. (for patient with anaemia needs to be given pre-op) - thus false

Question 25

What are the possible explanations for this observation chart day 1-3 post op?

What other information do you need/

Answer 25

Atelectasis- leading to pneumonia

Question 26

POssible causes of fever, tahcycardia, poor oxygentation (due to rigors) , High RR, ?????

Answer 26

Day 4- think IV cannula causing bactraemia

Question 27

What is occuring here?

Question 28

What occurs day 9 post operativey with such detirioation?

Question 29

What are important medico-legal aspects of complications?

Consent?Rapport? Communication, compassion, professional proficiency are vital

Dont avoid or abandon the patient!

Do say sorry for the way things turn out?

Answer 29