Post-Operative Complications Flashcards
What are some immediate complications that can occur post-op
Anaesthetic complications
- Arrhythmias
- BP - hypo or hyper
- Breathing problems
- Hyperthermia
- Tongue / teeth problems
- MI/stroke
- Allergy / drug reaction
Haemorrhage
- often not immediately obvious
- monitor drains, FBC/haematocrit, obs
What are some early post-op complications that can occur
Fluid depletion Fluid collections Electrolyte disturbance Local infection - wound Systemic infection Atelectasis DVT/PE Bed sores Anastomotic leaks Wound break down
Gastrectomy: post-op complications
Dumping syndrome Malabsorption syndrome Peptic ulcer Anastomotic ulcer Small intestinal bacterial overgrowth Abdominal fullness / gas bloating
Post-op complications in small and large bowel operations
Ileus
Anastomotic leaks (usually within 5-7 days, up to 21)
Intra-abdominal collections
Adhesions / intestinal obstruction
Damage to local structures - kidneys, ureters, bladder
Pre-sacral plexus damage
Stoma retraction
Cholecystectomy: post-op complications
CBD injury / bile leak
Biliary post-op complications
CBD/ bile leak CBD stricture Anastomotic leak Bleeding into biliary tree --> jaundice Pancreatitis
CABG / Stenting post-op complications
Reperfusion arrhythmias
Post-op ACS
Often need inotropes post-op which may reduce organ perfusion elsewhere
Vascular grafts / stents / bypass procedure post-op complications
Failure of graft Haemorrhage / haematoma Infection Re-thrombosis Limb or organ ischaemia AV fistula Cholesterol embolism Arteriopaths are high risk of - ACS, PE, stroke Contrast complications - i.e. anaphylaxis, renal injury
Thyroidectomy post-op complications
Airway obstruction 2o to haemorrhage - requires urgent opening of thyroidectomy wound
Hypocalcaemia - damage to parathyroid glands
Recurrent laryngeal nerve damage
Parotidectomy post-op complications
Facial nerve damage
Post-op complications of any orthopaedic surgery
Infection of prosthesis Loss of position / failure of fixation Non-union, malunion, delayed union Neuromuscular injury Compartment syndrome
Total hip arthroplasty post-op complications
Sciatic nerve damage Dislocation Leg length difference Loosening Wear
Post-op complications of cystoscopy / transurethral resection of prostate
High risk of UTI
TURP Syndrome - absorption of irrigation fluid –> low Na
Impotence / retrograde ejaculation
External sphincter damage –> incontinence
Urethral stricture
Post-op complication of endovascular surgery
Retroperitoneal haemorrhage
Post-op complication of lymph node dissection
Lymphoedema
Post op complication of neck dissection
Cranial nerve damage - 11, 12
Causes of post-operative fever
5W’s
Wind - <2 days - atelectasis, pneumonia
Water - 2-4 days - UTI
Wound - 5-7 days - wound infection, infected post-op collections
Walking - 8-10 days - VTE
Wonder drugs - anytime - transfusion / drug reactions
What are the aims of assessing a patient with hypotension
Identify a cause
Assess for organ dysfunction
What are the causes of hypotension in a post-op patient
Decreased intravascular volume
- long operations and evaporate fluid losses
- 3rd space losses
- haemorrhage
- poor oral intake
Pump failure (cardiogenic shock)
- surgical stress increases risk of MI (~48h post-op)
- fluid overload
- heart failure
Sepsis and anaphylaxis
Sympathetic shock
- patients with epidural analgesia and high block (T5 and above) can lose sympathetic outflow causing vasodilation and cardiogenic shock - assess epidural blocks using cold sprays
- spinal anaesthetics in elderly may contribute to loss of sympathetic tone and hypotension
What are the clinical signs of poor perfusion
Delayed CRT
Cold peripheries
Tachycardia
How to assess for organ dysfunction
ABG - lactate
Assess UO - >0.5ml/kg/hr
Confusion
