Mod 10c: complications in anaesthesia Flashcards
How do you avoid complications
thorough assessment
adequate planning
appropriate referral if complications suspected
What are 5 minor complications of anaesthesia
Sore throat
damage to teeth
corneal damage
muscular pain(sux)
PONV
What are some risk factors for PONV?
Patient: young, female, hx of PONV/motion sickness
Anaesthetic: opiods, etomidate, N2O
Surgical: strabismus, laparoscopy, ear, orchidopexy, gynae
Postop:pain, opiates, hypotension
What is the prophylaxis of PONV?
Avoid risk factors
Pharmacological: odansetron, droperidol, dexamethosone
Non-pharma: good hydration
What are 3 more serious complications?
Nerve damage
Central venous line complications
Hypothermia
What can cause nerve damage?
positioning( arms in non-supine positions)
Neuraxial and regional blockade(neuropraxias vs long term damage)
Hypoperfusion of spinal cord
What are the early complications of central venous lines?
- Pneumothorax
- Haemothorax
- Nerve damage
- Arrhythmia
- Air embolism
What are the late complications of central venous lines
- Sepsis
- Endocarditis
- Thrombosis
- Tamponade
What is hypothermia and what precipitates it?
core temp<35 C
Precipitating factors:
- cold environment, IV fluids, gases
- Vasodilatation due to anaesthesic agents
How long should you monitor the temp of any anaesthetic
> 15 min
How do you prevent hypothermia
Warm theatre environment
Passive warming of patient
* Forced air warmer
Warm IV Fluids, Blood, Gases (HMEF)
Active warming
What is the pathophysiology of hypothermia
Platelet dysfunction and bleeding risk
Delayed metabolism of drugs
Delayed emergence from anaesthesia
Arrhythmias
Post-op shivering
*Increased oxygen consumption
What are 6 major categories of complications?
Death
Airway complications
Equipment failure
Awareness
Cardiac complications
Drug related
What are the patient risk factors for complications?
*Comorbidities
*ASA status
*Surgical condition
*Age
What are the anaesthestic risk factors for complications
*Intubation
*Equipment failure
*Aspiration risk
*Anaphylaxis
*Drug choices
*Pharmacogenetic
disease
*Respiratory
depression
*Awareness
What are the surgical risk factors for complications
*Type and extent of
surgery
*Emergency or
elective
*Skill and knowledge
surgeon
*Mishaps
How do you manage a difficult airway
recognise->management plan
Unrecognised-> failed intubation drill
How do you manage a failed intubation?
*Call for help!
*100% oxygen
*Reposition
*Difficult airway trolley
*Ventilate between
attempts
*BACKUP AIRWAY →
LMA
What are causes of rising airway pressures
Obstructed ETT
Kinked ETT
Circuit blockage
Bronchospasm
Mucus plug in airway
PNEUMOTHORAX
What are some causes of sudden leak in circuit
dislodged ETT
Disconnection at any point
Vaporisers, sodalime not connected
What are 2 warning signs of sudden leak in circuit
ventilator alarms
ventilator bellows keeps collapsing
What are the 3 things that can fail under equipment failure
machine failure
hypoxic gas mixture
ventilator disconnection
How can you prevent drug errors?
Important to label drugs
Draw drugs up yourself
Use colour coding system of
labels
DILUTE DRUGS
APPROPRIATELY!
What are patient risk factors for MI/arrest?
*IHD
*CCF
*valvular disease
*arrhythmia,
*Peripheral Vascular
Disease
*hypovolaemia
What are the anaesthetic risk factors for MI/arrest
- hypo/hypertension
- tachycardia
*hypoxia
What surgical procedures are a risk for MI/arrest
*Major intrathoracic
*Major abdominal
*Major vascular
*Emergency surgery
What are the common causes of anaphylaxis?
antibiotics(commonest)
muscle relaxants
latex
What is the triad of symptoms in anaphylaxis?
cvs collapse
bronchospasm
skin changes
How do you manage anaphylaxis
ABC’s
Adrenaline(0.5mgIMI/boluses of 10-15ug IVI)
Addtional measures: hydrocortisone, antihistamines
Which underlying diseases put you at risk for postoperative respiratory failure?
- Pulmonary
disease - Myasthenia
gravis - Neurological
- Muscular
- Morbid obesity
Which metabolic disease put you at risk for post op resp failure?
- Hypokalaemia
- Hypoglycaemia
Which complication in surgery put you at risk for post operative resp failure
- Aspiration
- Pulmonary
embolism
Which drugs put you at risk of postoperative resp failure
- Opioids
- Muscle relaxants
- Magnesium
Which groups are at high risk for awareness under anaesthesia
obstetric GA
trauma
previous awareness
How do you prevent awareness under anaesthesia
vigilance and angent analyzer
What monitoring should be included to prevent awareness under anaesthesia
clinical judgement of depth
processed EEG
