Complications of Surgery Flashcards
Consider post-op pain in tibial or supracondylar fractures - what might you be concerned about? How would you manage?
Compartment syndrome - check PCA in situ, having analgesia etc.
Examine neurovascular status and check passive stretch of compartment.
Senior review, keep NBM in meantime and consider bivalving cast
Consider either intracompartmental pressure measurement or proceed straight to fasciotomy
When measuring intracompartmental pressure in ?compartment syndrome, what pressures would be abnormal and what would be diagnostic?
over 20 abnormal, over 40 diagnostic
What are 4 complications of compartment syndrome?
Muscle ischaemia and necrosis - debride and consider amputating
Incomplete decompression of deeper muscles due to incisions being too small
Ischaemic contractures
Renal failure secondary to rhabdomyolysis
Why is rhabdomyolysis a problem? What medication can you consider alongside hydration?
Creates circulating pool of myoglobin, which can form casts and obstruct nephron to cause ATN
Consider loop diuretic
3 categories of stoma complication?
Local early, local late and systemic
What are 4 local early complications of stoma?
Ischaemia/necrosis, retraction, obstruction and separation
What are 4 local late complications of stoma?
Prolapse, stenosis, parastomal hernia and skin changes
Systemic complications of stoma?
High output causing electrolyte derangement, arrhythmias and renal dysfunction
Give some abdominal incisions?
What is abdominal compartment syndrome?
Sustained increase in intra-abdominal pressure over 20mmHg resulting in tissue hypoperfusion and end-organ dysfunction
What is normal intra-abdominal pressure, what may be associated with hypoperfusion and what is definitive for abdominal compartment syndrome?
Normal 5-7mmHg
High is 15 - may have microvascular hypoperfsuion
Over 20 is definitely abnormal
3 main risk factors for abdominal compartment syndrome?
Long complex abdominal surgeries with extensive tissue handling
Tissue hypoxia and subsequent reperfusion
Complex abdominal wall closure e.g. with incisional hernias - reduced functional size of abdominal cavity
How do you diagnose abdominal compartment syndrome?
Insert transurethral catheter intravesicularly with pressure transducer to measure pressure
Sustained pressure over 20mmHg with evidence of end organ dysfunction suggestive of abdominal compartment syndrome
Management of abdominal compartment syndrome?
If stable - insert NG tube, urinary catheter
Perform CT for ?collections that may be drainable percutaneously
Improve abdo wall compliance e.g. with muscle relaxants, sedation
If unstable or conservative measures unsuccessful - theatre for laparotomy and laparostomy with bogota bag or vac system, for later relooks and delayed closure
What is the most common cause of surgical site infection?
S aureus
6 factors minimising risk of surgical site infections?
Not shaving wound - or using disposable clipper if needed
Good PPE, hand hygiene etc.
Peri-operative prophylactic antibiotics where indicated
Chlorhexidine to clean skin and approriate use
Use of iodophor impregnated drapes rather than incise
Avoid tissue hypoxia/excessive bipolar
3 general example of where prophyalctic antibiotics are recommended peri-opeartively?
Prosthesis
Clean-contaminated surgeries
Contaminated surgeries
What are the 3 phases of the WHO safety checklist?
Prior to induction of anaesthetic (sign in - brief)
Prior to incision (time out)
End of procedure (sign out - debrief)
What is the WHO checklist?
Series of safety checks introduced by WHO to minimise chance of patient harm during surgery, consisting of 3 domains of cross-checks to identifal potential hazards during surgery and minimise risks of these
WHO checklist - prior to anaesthetic induction?
Check identity and confirm surgical site
Confirm consent signed
Check site marked
Confirm anaesthetic equipment working
Significant blood loss anticipated?
Airway issues?
Check allergies
WHO checklist - prior to incision?
Introduce team by name and role
Reconfirm patient details, procedure, site and position incl site markings
Highlight procedure specific equipment, investigations
Any anticcipated critical incidents and key steps
Intraoperative imaging required?
Sterility of instruments
ASA
Antibiotics
Sugar control
Hair removal
Warming
Diathermy
VTE prophylaxis
WHO checklist - end of procedure?
Name of procedure
Instrument, swab and sharp counts complete and correct
Specimens labelled and packaged correctly
Equipmetn issues
Any post-op concerns
4 complications of splenectomy?
Haemorrhage - due to short gastrics or splenic hilar vessels
Pancreatic fistula due to damage to pancreatic tail
Thrombocytosis -give aspirin
Encapsulated bacterial infection e.g. s pneumoniae, h influenzae, n meningitidis
