SURG consents Flashcards
Spinal anaesthesia
Less risk of a chest infection after surgery
Less effect on lungs and breathing
Excellent pain relief immediately after surgery
Less need for strong pain-relieving medicines and their side effects, including nausea, confusion, drowsiness and constipation
Less sickness and vomiting
Quicker return to drinking and eating after surgery
Less risk of becoming confused after the operation, especially if you are an older person
Improved bowel recovery
Improved blood flow after vascular surgery
See baby straight away
Risks Low blood pressure N and V Shivering Itching Urinary retention pain during the injection headache Bruising Pain and tenderness at the injection site Aches and pains Prolonged numbness and tingling Chest infection
Uncommon side effects Severe headache Temporary nerve damage Overdose of medicines which --> slow breathing Anaesthetic does not fully work Allergic reaction Existing medical problems getting worse
Rare side effects Permanent nerve damage --> possible paralysis Severe breathing difficulty Injection Short term deafness Double vision Blood clot with spinal cord damage Serious allergic reaction Equipment failure Leaking of stomach content into the lungs Seizures Meningitis Cardiac arrest Severe harm or death
Breast - Fibroadenoma/Ctst
Bruising around site Depression in breast at site of lump Scarring may pull nipple out of shape Thickened or red coloured scar Further necessary surgery if inadequate pathology test
Breast - FNA
Bruising
Need further biopsy
Innacurate report
Collapse of lung
Breast - WLE +/- SLNB
Operation site continues to ooze
Layers of wound not healing adequately –> long term wound care and antibiotics
Loss of sensation to nipple
Wound not healing normally
Swelling of arm
Loss of sexuality, depression, emotional issues
Regrowth of tumour
Risks of SLNB
<1% risk of missed lymph node spread
Small risk of incorrect information
Axillary dissection if positive, or unable to find SLNB
Anaphylaxis to dye, dye stain, blue/green pee for a while after
If in abnormal site - partial separation of ribs / risk of lung injury
Small radiation risk
SLNB - reduced lymphedema risk, reduced shoulder stiffness, reduced risk of numbness of axilla
Mastectomy
Continuous oozing Edges of wound change colour --> need further surgery Weakness and numbness of arms and chest Difficulty with arm movement Layers of wound may not heal --> burst open Wound --> thickened and painful Swelling of arm Recurrence of tumour Chronic pain Depression, anxiety, loss of sexuality
Breast tissue biopsy
Bruising around operation site Depression of breast at site Nipple out of shape Scar thickened and red coloured Further treatment - pathology
Breast Abscess / Haematoma
Wound continue to drain for some time and require dressings
Incision may not drain away all the fluid
Final healed scar thickened and painful and coloured
Alteration in shape
CABG/Vlave surgery - ONLY COS I SAW like 50 on cardio-thoracics so i know it - not necessary for exams
Common Bleeding Dysrhthmias - usually tmporary Short term memory, cognition, visual blurring Chest wall pain --:> sometimes chronic Breathlessness and easy tiring Wound may not heal properly Numbness on left side of chest due to harvesting the donor artery Blood clot in the leg - DVT
Uncommon Lung collapse Kidney failure if kidney problems Infection in the chest, breastbone, blood, leg or arm wounds Heart attack Graft blocked with a blood clot Leaking of a valve Respiratory failure Changes in heart rhythm BE Blood transfusions Stroke Death -N.B. SUPER HIGH RISK OF DYING IF jehovah's witness
Angiogram +/- angioplasty and stenting
Bruising at puncture site - sometimes major bruising
Re-narrowing
Loss of pulse in arm if radial arm procedure
Uncommon
Abnormal heart rhythm
Heart attack
Surgical repair of the groin/arm puncture site
Rare risks
Stent may suddenly close within first month –> angina or heart attack –> may need another angioplasty
Emergency heart surgery due to complications
A reaction to the medications given to prevent blood clotting
Minor reaction to the X-ray dye like hives, or loss of kidney function, or major reaction
Stroke
Higher lifetime risk of cancer from x-ray exposure
Rupture of a blood vessel requiring surgical repair and blood transfusion
Skin injury from radiation, causing reddening of the skin
Death as a result of the procedure is rare
Exercise stress test
Mild angina
SOB
MSS discomfort
Low BP - uncommon
Rare Fainitng Arrhytmia FLuid in lungs Severe chest pain heart attack Death
OPEN appendectomy
Deep bleeding Infections Weakness in wound Wound thickened and red Adhesions Fistula between stump and wound
Anal sphincter
Bleeding from site Deep abscesses Wound thickened and red Muscular control of anus not fixed Operation may not fix condition
BLOOD and Blood products consent (for jehovahs)
High temperature
Rash, itching, hives
Feeling a bit unwell
Rare: Having too much blood/fluids --> SOB Haemolysis Antibodies --> complicate future or later on Lung injury Spread of viral or other infections Very rarely, cause death
Ileostomy/Colostomy
Deep bleeding
Bowel closure may leak and infection develop
Loose bowels initially - temporary
Adhesions
Weakness around wound - rupture - further surgery
Healing may be abnormal - thickened, and scar may be painful
Fistula - Faecal/ Small bowel / Gastric
Difficulty in passing urine
Deep bleeding
part of bowel may need removal
Damage to other parts of the bowel
Infections such as pus collections
The bowel movement may be paralysed or blocked
Weakness can occur in the wound with complete or incomplete
Wound can thickened and red
Adhesions may form and cause bowel obstruction
Fistula may occur
Haemorrhoidectomy
Pain and bleeding
Difficulty passing urine
Tissues about the anus may swell and bruise
Blood may be passed with bowel actions for some days after the operation
Heavy bleeding from haemorrhoid wound may occur up to 1-2 weeks
Skin tags
The anus may scar up in the years to come and cause stricture
More haemorrhoids may occur in the future
Uncommon risks and complications: Anal fissure Incontinence of faeces or flatus Heart attack or stroke Blood clot - DVT
Rare risks and complications:
Extensive skin necrosis and infection around the area requiring further surgery
Death
Haemorrhoid - Staple
Difficulty passing urine Tissues above the anus Infection in the stapled area in 1/8 cases Heavy bleeding from haemorrhoid Anus may scar in the years More haemorrhoids can occur
Large bowel resection
Bowel movement may be paralysed
Ileus - N + V
Leakage of anastomosis if done
Weakness in wound
Some cases healing abnormal - thickened and red
Adhesions
The bowel actions may be looser than before
Section that is removed will be examined by a pathologist
Increased risk in smokers of wound and chest infections
Small areas of lung can collapse, increasing the risk of chest infection
Infections
Uncommon risks and complications: Deep bleeding Bleeding Heart attack or stroke DVT Death
Rare:
Surgical damage to nearby organs –> further surgery
Formation of blood clots in the veins near the bowel –> further treatment
Lateral Sphincterotomy / Anal stretch / Treatment of Anal Fissure
Heavy bleeding may occur from the wound 1-2 weeks after surgery
The condition can recur –> further surgery
Rarely the muscles at the anus may be over stretched or over cut with a resultant weakness in the area –> could cause problems with control of the bowels –> wear pad
Sigmoidoscopy
Mild pain and discomfort in the abdomen for 1-2 days after the procedure –> settles with walking, moving around
Uncommon:
1/5000 - perforation
Missed polyps, growths or bowel disease
Bleeding - 1/1000 risk, 1/100 if polyp removed
Rare:
Bacteraemia
Death
If sedation: N+V Faintness, dizziness Headache Pain, redness or bruising at sedation site Muscle aches and pains Allergy Dead arm Worsening existing medical condition Anaphylaxis Heart and lung problems Stroke
Resection of Rectum
Leakage where bowel was stitched together
Deep bleeding
Ileus
Infected wound
UTI
Infection in abdomen
Stoma - failed blood supply (further surgery), excess fluid loss, stoma prolapse, parastomal hernia, local skin irritation
Bleeding into abdomen
Damage to ureter
Abnormal emptying of bladder
Inability to have and/or maintain erection / dyspareunia in woman
Abnormal wound – thickened red and painful
Looser bowel actions
Adhesions
1/16-1/63 chance of death
