Post Op Care

Question 1

Various definitions available in the literature

Answer 1

Respiratory complications that occur within 48–72 h following surgery

2. Conditions affecting the respiratory tract that can adversely influence clinical
   course of the patient after surgery
3. Any pulmonary abnormality occurring in the post‑operative period that
   produces identifiable disease or dysfunction that is clinically significant and
   adversely affects the clinical course

Question 2

Wide spectrum

Answer 2

Atelectasis-resulting in post-operative hypoxaemia (commonest complication)
Pneumonia, bronchitis
Bronchospasm
Exacerbation of previous lung disease
Pulmonary collapse due to mucus plugging of the airways
Respiratory failure with ventilatory support >48 h
Acute lung injury (ALI)
Pulmonary embolism

Question 3

Incidence

Answer 3

Major surgery- pulmonary complications more common than cardiac complication

5–10% of patients undergoing non‑thoracic surgery

22% of high-risk patients

1–2% of minor surgeries

Question 4

Impact

Answer 4

one in four deaths occurring within a week of surgery is related to pulmonary complications

Increased length of stay

Increased health care cost

Question 5

Pre‑operative risk factors> patients related

Answer 5

Age >65 years
Positive cough test
Smoking
COPD
Bronchial asthma
Obesity
General health
Obstructive sleep apnoea

Question 6

Procedure‑related risk factors>

Answer 6

Duration of surgery
Type of anaesthesia
Site of surgery
Type of surgery
Blood transfusion> independent risk predictor TRALI
NGT
Mechanical ventilation >48 h

Question 7

Laboratory

Answer 7

Urea > 7,5 mmol/l
Increased creatinine
Abnormal liver function tests
Low albumin
Preoperative anaemia (< 7 g/ml)
Predicted maximal oxygen uptake
FEV1: FVC < 0,7 and FEV1 < 80% of predicted

Question 8

Pathophysiology

Answer 8

Intraoperative changes to the respiratory system

reduction of FRC of 15–20%

altered ventilation perfusion (V/Q) relationships» mismatch

Question 9

Atelectasis

Answer 9

Compressive atelectasis
Airway ( FRC < closing volume)
Absorption atelectasis
Greater the FiO2
after induction, faster the collapse
Mx : manage post op pain (analgesia)
encourage to cough and take deep breaths
counter pressure on abdominal incision
chest physiotherapy

Question 10

Post operative hypoexemia

Answer 10

Hypoxemia is a below-normal level of oxygen in your blood

CAUSES
Airway obstruction
Residual anaesthetic and opioid effect
Hypercapnia
Residual effects of NMBDs

Question 11

Airway obstruction

Answer 11

Impaired activity of genioglossus- increased resistance
Abnormal co-ordination of pharyngeal and upper esophageal muscles- increased risk of aspiration
Sputum retention- impairment of mucociliary transport

Question 12

Pneumonia

Answer 12

Develops usually after 2 – 5 days post op.
Health care related problem
High grade fever
Thick sputum

Mx : IV antibiotics
Encourage to cough, take deep breaths, Chest physiotherapy

Question 13

Aspiration pnemonitis

Answer 13

Aspiration pneumonitis is described as an acute lung injury that results from the inhalation of regurgitated gastric contents

Usually occurs in:
General anaesthesia
GERD
Altered level of consciousness
Critically ill/Old age patients
Bowel obstruction
Emergency surgeries, trauma patients

Question 14

Characterized by

Answer 14

Dyspnea Post op
Progressive Wheezing
Infiltrate on CXR
May be silent
Prevention :
Reduced gastric contents

Question 15

Mx

Answer 15

Mx:
Place the pt on Oxygen (face mask)
Confirm diagnosis by CXR (diffuse interstitial infiltrates)
Enquire about previous resp problems
If SpO2 is not maintained and RR is increases then intubate the pt and do suctioning
Give IV antibiotics directed against Gram negative organisms

Question 16

Pulmonary Edema, Acute Lung Injury and ARDS

Answer 16

Pulmonary oedema: Collection of fluid in the alveoli
Acute lung injury(ALI) Acute respiratory distress syndrome(ARDS)
Acute onset respiratory symptoms

Chest radiograph with bilateral infiltrates
Pulmonary artery wedge pressure of less than 18 MMHg
ALI: PaO2/FIO2 ratio < 300 mmHg
ARDS: PaO2/FIO2 ratio < 200 mmHg

Question 17

Pulmonary embolism

Answer 17

Pulmonary embolism occurs when a blood clot lodges in the lungs. It can damage part of the lung due to restricted blood flow, decreased oxygen levels in the blood, and affect other organs as well. Large or multiple blood clots can be fatal.
The blockage can be life-threatening
signs and symptoms include Dyspnoea, chest pain, haemoptysis , syncope, CVS collapse
PE Should be considered in any unexplained hypoxia, tachycardia, or dysrhythmia

Investigations: Oxygen saturation, CXR, ECG, CT Chest
V/Q scan (scan for exclusion)
Pulmonary Angiography

Question 18

Pulmonary embolism

Answer 18

Management:
Supplemental O2
Maintain vitals
Anticoagulants
Embolectomy

Question 19

Conclusion

Answer 19

non‑cardio thoracic surgery ranging from hypoxemia in the post‑operative period which can be treated with simple oxygen therapy to severe complications such as ALI which may prove fatal
risk factors are identified preoperatively, proper anesthetic planning can reduce the incidence of complications
Limiting the duration of surgery to <3 h, using a minimally invasive surgery and using regional techniques can decrease the incidence
proper analgesia, selective use of NGT, protective ventilatory technique