Post Operative Complications Flashcards
Name some post operative complications
Anaemia
Atelectasis (due to under-ventilation),
Infections (site, chest, urinary)
Wound dehiscence (particularly after abdominal)
Ileus
Haemorrhage
DVT and PE
Shock
Arrhythmia
ACS or CVA
AKI
Urinary retention
Delerium
How can you manage post operative pain?
WHO analgesic ladder:
1. Simple analgesia
2. Mild opioids eg, codeine or tramadol
3. Strong opioids eg, oxycodone or morphine
Nerve blocks or local anaesthetic catheters
What are the NSAID side effects?
I-GRAB
- Interactions with other meds eg, warfarin
- Gastric ulceration
- Renal impairment,
- Asthma sensitivity,
- Bleeding risk
What are the risk factors for post operative nausea and vomiting?
Female sex
Age (declines with increasing age)
Motion sickness or previous PONV
Use of opioids
Non-smoker
Laparoscopic surgery
Intracranial/middle ear surgery
Squint surgery
Gynae
Prolonged operative times
Poor pain control post op
Spinal anaesthesia
Inhalation agents
Prolonged anaesthetic time
Intraoperative dehydration
Overuse of bag and mask ventilation as it can cause gastric dilation
What neurotransmitters are involved in nausea and vomiting?
Dopamine and 5HT3 act on the chemoreceptor trigger zone
Ach and histamine act on the vestibular apparatus
Dopamine acts on the GI tract
Histamine and 5HT3 acts on the vomiting centre
What are the prophylaxis measures for post-op nausea and vomiting?
Anaesthetic prevention - reduce opioids, reduce volatile gases and avoid spinal anaesthesia
Prophylactic antiemetics
Dexamethasone at the induction of anaesthesia
What are the conservative and pharmacological managements for nausea and vomiting
Conservative - Adequate hydration, analgesia and consider NG tube for gastric decompression
Pharmacological - Metaclopramide for delayed gastric emptying or ondansetron for opioid induced
What are the common causes of post op pyrexia?
Common causes of post-op pyrexia can be remembered by the 5 W’s:
Wind (pneumonia and atelectasis) suspect on day 1-5
Water (UTI) suspect on day 3-5
Wound (infection) consider surgical site day 5-7
Wonder drugs (anaesthetic reactions)
Walking (DVT)
Pyrexia is common post-operatively in the first 48 hours due to systemic inflammatory response
Investigations of post op pyrexia?
Blood tests
Imaging
Cultures
Management of post op pyrexia?
Antibiotics
Anticoagulants
Modify offending drugs
Further surgical intervention if abscess
What are the three main categories of post-op bleeding
Primary bleeding - intra-operative bleeding
Reactive bleeding - Occurs within 24 hour of an operation. This is usually due to ligature slips or a missed vessels.
Secondary bleeding - Occurs 7-10 days post operative
What are the symptoms of post-op bleeding?
Tachycardia, dizziness, agitation, raised resp rate, decreased urine output. Hypotension is a late sign so should assume a patient is not bleeding if they have a normal BP
What is the management of post-op bleeding?
A-E assessment and ensure two large bore cannulas and fluid resus.
Inspect operation site an apply pressure if there is visible bleeding
Get bloods
Reposition patient so they are supine with legs elevated so the blood can perfuse the necessary organs
Fluid challenge (up to 2000ml) or blood transfusion depending on their Hb level from FBC and estimates blood loss. They may need platelets if thrombocytopenic or FFP if abnormal coagulation
Patients with large bleeds are at risk of hypothermia so monitor temperature and may need warm fluids and warming blankets
What are risk factors for wound infections?
Dirty or contaminated operations,
Long procedures,
Diabetes (hypereglycaemia impairs immune function and wound healing)
Obesity (excess adipose tissue can impair wound healing
Smoking
Immunosupression
What are the signs and symptoms of post-op infection?
For wound infections: erythema, tenderness, purulent discharge, abscess
Other sources of infection are important to remember eg, pneumonia, UTI, bacteraemia
