Post-operative complications

Question 1

General complications

Answer 1

Immediate - anaesthetic complications (e.g. arrhythmia, hyper/hypotension, hyperthermia etc), haemorrhage

Early - fluid depletion, electrolyte imbalances, local infection or systemic infection, fluid collections, atelectasis, DVT / PE, wound break down, anastomotic break down, bed sores

Question 2

Assessing an unwell post-op pt

Answer 2

ABCDE approach
Consider the op, pre-op fitness and post-op progress
Think about specific risks associated w operation
Special attention should be given to operative site, newly placed drains and their contents

Question 3

Pyrexia

Answer 3

Assess in conjunction with other obs
Sepsis most common cause but op itself can cause low grade pyrexia
Chest infections, UTIs
Timing of pyrexia may give clue to underlying diagnosis

Wind (< 2 days) - atelectasis, pneumonia
Water (2-4 days) - UTI
Wound (5-7 days) - wound infection, infected collection
Walking (8-10 days) - VTE
Wonder drugs (any time) - drug reactions

Question 4

Hypotension

Answer 4

Identify cause and assess for organ dysfunction (ABG for lactate, UO, confusion)

Causes may include decreased intravascular volume, cardiogenic shock, sepsis and anaphylaxis, sympathetic shock

Question 5

Respiratory difficulties

Answer 5

RTI
PE
PO

Assessment of fluid status, assessment of calves, investigations for infection and ABG

Question 6

Low UO

Answer 6

< 0.5 ml/kg/hour

Pre-renal (most common): usually due to volume depletion but sometimes inadequate CO
Renal: secondary to nephrotoxic drugs
Post-renal: prostatic hypertrophy, raised intra-abdominal pressure

Fluid status assessment, medicine review, catheter examination / bladder scan