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Peri-op > Post-op Complications > Flashcards

Post-op Complications Flashcards

1
Q

What is the timeframe of post-op ileus according to the organ involved?

A

Small bowel (0-24hrs)

Stomach (24-48hrs)

Colon (48-72hrs) - ask pt if they have passed flatus to check for colon ileus

note: post-op ileus delayed by opiates

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2
Q

What are the most common wound contaminants in abdominal surgery?

A

Bacteroides fragilis (anaerobe)

Gram-ve bacteria:

  • E. coli
  • Pseudomonas
  • Proteus
  • Klebsiella

Staph. aureus (skin)

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3
Q

Define a surgical site infection.

A

Type of healthcare associated infection which occurs after an invasive surgical procedure.

  • 3rd most common nosocomial infection
  • majority caused by contamination of incision with patient’s microbes
  • inc. post-op resp. infections, UTIs,
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4
Q

Why are post-op respiratory infections common?

A
  • wound pain makes pt reluctant to breathe deeply/cough (tell pt to cough)
  • intubation introduces dry air —> irritation —> increased mucus production
  • opiates are anti-tussive —> mucus not coughed up
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5
Q

What are the pre-op measures taken to reduce the risk of surgical infection?

A
  • shower before surgery
  • hair removal using electric clippers (razors cause skin abrasion)
  • Abx prophylaxis indicated: prosthesis/implant surgery, clean-contaminated surgery, or contaminated surgery
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6
Q

What are the intra-op measures taken to reduce the risk of surgical infection?

A
  • skin preparation using antiseptic (povidone-iodine or chlorhexidine)
  • hand decontamination
  • sterile gowns/gloves
  • cover wounds with appropriate dressings (2-3days for skin closure; do not keep removing dressing - risk of infection; weeping wound indicates skin has not closed)
  • Abx at induction and removal of anaesthesia
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7
Q

What are the post-op measures taken to reduce the risk of surgical infection?

A
  • avoid unnecessary contact with wound for 48-72hrs
  • clean hands & PPE
  • involve tissue viability team when wound is not healing well/shows sign of infection
  • empirical Abx in suspected wound infection/prophylactic 2-3days post-op
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8
Q

What are the most common organisms implicated in surgical site infections?

A

Bacteria (depends on organs involved)

  • Staphylococcus (coagulase -ve) (25%)
  • Enterococcus (D) (11.5%)
  • Staph. aureus (9%)
  • Candida albicans (6.5%)
  • E. coli (6.3%)
  • Pseudomonas aeruginosa (6%)
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9
Q

What are some risk factors for poor wound healing?

A
  • chronic renal failure
  • jaundice
  • diabetes mellitus
  • smoking
  • obesity
  • advanced age
  • steroids/immunosuppressants
  • chemo/radiotherapy
  • alcoholism
  • poor nutrition
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10
Q

What are the features of clean surgery?

A

Elective/non-emergency surgery

Non-traumatic

Primarily closed

No acute inflammation

Internal tracts not entered

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11
Q

What are the features of clean-contaminated surgery?

A

Clean urgent/emergency

Elective entering of internal tracts with minimal spillage

No infected internal fluids

Abx req.

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12
Q

What are the features of contaminated surgery?

A

Penetrating trauma

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13
Q

What are the features of dirty surgery?

A

Penetrating trauma > 4hrs

Purulent inflammation

Pre-op entry of internal tracts

Abx req.

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14
Q

What is the patient zone?

A

Everything within curtain has microbes unique to the patient

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15
Q

What are the most likely surgical infections according to the post-op timeline?

A

24hrs + fever = respiratory infection (atelectasis)

1-2days = pneumonia

4-5days = UTI, surgical site infection

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16
Q

What is the general management of surgical site infections?

A
  • have high index of suspicion: timing, drains/catheters/lines, presence of risk factors, signs of infection
  • appropriate Ix
  • appropriate Abx (guided by micro. dept)
  • may req. opening of wound, debridement, or other surgical procedure
  • risk of sepsis = sepsis care pathway, higher level of monitoring, phone ITU
17
Q

What is the general management for post-op chest infections?

A
  • Hx of chest disease
  • ensure good post-op analgesia to encourage breathing and coughing
  • chest physio (bd) + nebulisers
  • Abx
18
Q

What is the prevention of post-op UTIs?

A
  • prevent by avoiding unnecessary catheterisation, good aseptic technique, remove at earliest opportunity, do not leave same one in for 2-3days
19
Q

Give examples of sources of post-op bacteraemia.

A 
Cannulas
CVP lines (sepsis causes death within hrs) 
Anastomotic breakdown/abdominal sepsis (3-7day post-op + abdo. tenderness)
20
Q

What are the risk factors for C. difficile infection?

A
  • current or recent Abx

- 65yrs

21
Q

Give some examples of post-op neurological complications.

A
  • not waking up: unconsciousness/drowsiness; caused by inhalational anaesthesia, opioids, benzodiazepines, longer ops., hypoglycaemia, neuro. surgery
  • pain: increased symp. stimulation, reduced vital capacity, reduced tidal volume, reduced forced reserve capacity, basal atelectasis, chest infections, N&V, ileus, urinary retention, DVT/PE
  • confusion/agitation: brain insult, dementia, hypoglycaemia, extremes of age, drug users, alcoholics, urinary retention, hypo/hyperthermia
  • hypothermia/shivering: thin/elderly, children; caused by paralysis, lower threshold for hypothalamic heat redistribution/muscle movement; causes increased O2 demand and reduced wound healing
22
Q

Give some examples of post-op respiratory complications.

A
  • upper airway obstruction
  • hypoventilation: resp. depression, oedema, reduced consciousness
  • reduced resp. rate OR reduced tidal volume = reduced minute volume
  • hypoxia; V/Q mismatch, shunt, increased O2 demand, pain, reduced saturation, increased resp. rate, tachycardia, unconsciousness/restlessness/agitation
  • atelectasis
  • fluid overload
23
Q

Give some examples of post-op cardiac complications.

A
  • hypotension: caused by anti-hypertensive overdose, haemorrhage, shock
  • hypertension: neurosurgery, spinal surgery, adrenal surgery, pain, pre-op hypertension, acute brain insult (Cushing’s reflex), N&V
  • MI
  • venous thromboembolism
24
Q

Give some examples of post-op GI complications.

A
  • N&V: aspiration, cannot take usual meds, reduced wound adhiscence
  • ileus —> constipation
  • distension
  • abdo. pain
25
Q

What are the risk factors for post-op N&V?

A
  • patient: motion sickness, gynae surgery, squint correction, abdo. surgery, middle ear surgery, child, female, elderly, prev. Hx of PONV
  • surgical: gynae, ENT, squint, GI, breast, long surgery
  • anaesthetic: nitrous oxide, gases, opioids, pain, dehydration
26
Q

What are the adverse effects of post-op N&V?

A 
Dehydration 
Can't take normal Rx
Aspiration 
Distress 
Poor surgical outcome 
Delayed discharge
27
Q

What is the management of post-op N&V?

A
  • prevention
  • analgesia
  • hydration
  • anti-emetics: ondasetron, cyclizine, dexamaethasone

Peri-op (15 decks)

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