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Gastro + Gen Surg > Surgical Complications > Flashcards

Surgical Complications Flashcards

1
Q

What are the possible anaesthetic complications and what are the consequences of these complications?

A

Reaction to anaesthetic drugs i.e. anaphylaxis

Malignant hyperpyrexia

Cardiovascular collapse= fall in BP= poor cerebral and renal perfusion

Hypoxia= poor ventilation causing insufficient tidal vol

AKI= due to excess fluid loss via urine, blood, loss of skin barrier with open surgery

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2
Q

What is malignant hyperpyrexia?

A

Patients with underlying muscle disease develop high rise in body temp, metabolic acidosis and muscle rigidity when put under general anaesthetics

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3
Q

What are the different mechanism which fluid can be lost during surgery?

A

Urine

Blood/bleeds

Loss of skin barrier meaning water evaporates from heat of surgical lights

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4
Q

What are the general types of surgical complication?

A

Have to convert from laparoscopic to open surgery

Findings are worse when start to operate

Haemorrhage

Damage to surrounding structures

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5
Q

What are the different classifications of haemorrhages?

A

Primary= cut blood vessel
Reactionary
-patient gains control of BP at end of operation which leads to increase in BP and causing bleeding from vessels which didn’t bleed under lower BP
Secondary
-occurs post-surgery due to inflammatory and local damage

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6
Q

What is the conservative, medical and surgical management of haemorrhage?

A

Con

  • apply pressure to stim haemostasis and spasm of BV
  • drain

Med
-give fluids and blood to maintain intravascular volume

Surgical

  • re-op if bleed occurs post-op
  • diathermy= burns vessels shut
  • suturing
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7
Q

What are specific examples of accidental damage to structures during surgery?

A

Cutting of ureters (pelvic surgery)

Clamping CBD (cholecystectomy)- iatrogenic jaundice

Damage to recurrent laryngeal nerve (total thyroidectomy)- hoarse voice or complete closure of vocal cords with bilateral damage

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8
Q

What 3 factors influence the risk for post-operative complications?

A

Type of surgery
Pre-operative state i.e. how comorbidities where managed
Post-op management

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9
Q

Given examples of post-op complications and when they would occur within the 10 days post-op?

A 
Pyrexia + bleeding= day 0
N+V= day 1 
Pain= day 1+2 
Chest infection= day 3+4 
Wound infection= day 5+6 
Ileus= day 3-6
PE+DVT= day 3-9
Anastomotic leak= day 7-9
Dehiscense of wound= day 7-9 
Intra-abdo/pelvic collection= day 10+ 
Sepsis= day 10+
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10
Q

Why are post-op patients at risk over developing chest infection?

A

Decreased ventilation and clearing of chest during surgery

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11
Q

What causes patients to be at risk of anastomotic leak and what are the possible consequences?

A

Decreased oxygenation or blood supply leads to decreased wound healing

Leaking into abdominal cavity can lead to peritonitis or sepsis

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12
Q

Why are surgical patients at increased risk of PE+DVT?

A

Loss of calf muscle pump and inflammatory state induces thrombophilic state

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13
Q

What are the consequences of patient being in pain post-surgery?

A

Raised blood pressure and heart rate due to muscle straining and contractions

Poor mobilisation= increased DVT risk and poor wound healing

Poor cough= not able to clear chest properly i.e. increased risk of chest infection

Poor oral intake= poor nutrition effects wound healing

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14
Q

What are the 3 steps of pain management for patients post-op?

A

Step 1: (mild pain)
-paracetamol +/- NSAIDs

Step 2: (mild-moderate)
-add opioid= codeine/tramadol

Step 3: (moderate-severe)
-change opioid (morphine/fentanyl/methadone)

Adjuvant TX (can be used throughout)

  • regional nerve block
  • epidurals
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15
Q

Why is minimising N+V associated with operation so important?

A

Can be the reason for unplanned admission especially post day care surgery

Can increase length of hospital stay

Can cause patient to be very concerned

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16
Q

Which surgeries and patients carry an increased risk of PONV?

A

History of PONV or motion sickness
Females
Gynaecological/emergency or middle ear surgery
Opioids drugs used

17
Q

How can you minimise the development of PONV?

A

Epidural or regional anaesthesia
Reduce the need for opioids i.e. use laparoscopic surgery > open
Ensure patient adequately hydrated with fluids during surgery
Antiemetic

18
Q

What are the 3 main types of anti-emetics? What is their MOA and what adverse effects or CI do they have?

A

Cyclozine (antihistamine)
-CI= BPH i.e can lead to urinary retention
Closed angle glaucoma

Ondansetron (5HT receptor blocker)

Metoclopramide (dopamine antagonist)
-CI= bowel obstruction due to increased peristalsis causing increased pressure and risk of perforation

19
Q

What are the 7 C’s which can cause pyrexia?

A 
Cut 
Collection (abscess)
Chest 
Catheter 
Cannula 
Central venous catheter 
Calves
20
Q

What does SIRS stand for and what are the possible features? What is the criteria for infection to be classified as SIRS? What is the criteria for SIRS to be sepsis?

A

Systemic inflammatory response syndrome

Tachycardia
Tachypnoea
Raised temp
Raised WCC

Must has >=2 of features

Needs likely site of infection for SIRS to be sepsis

21
Q

What are the different types of late post-operative complications?

A

Wound dehiscence

Adhesions

Incisional hernia

Recurrence of reason for surgery

Keloid formation

22
Q

What is wound dehiscence and what increases the risk of it occuring? How can it be managed?

A

Breakdown of wound along suture line due to poor healing

Risk factors:

  • diabetes
  • infection = decreased blood supply and strength of wound
  • tension
  • resp disease or smoking= decreased O2 supply decreases wound healing

Management:

  • pack + dry
  • vac dressing= sucks out infections and can bring edges of wound closer together
23
Q

Why do adhesions for post-op and what are the consequences of their formation? How are they treated?

A

Healing process and formation of scar tissue leads to fibrous bands forming between loops of bowel

Bowel obstruction (external cause) 
-bowel loops no longer able to move freely

Wait and rest bowel rather than surgery as can exacerbate the problem

24
Q

Why do incisional hernias occur and what can be done to minimise the risk of them occurring?

A

Failure of wound to close/heal completely, meaning decreased strength of abdominal wall

Prevention:

  • surgical technique= incision in linea alba (strongest point and less likely to cause problem
  • early mobilisation post op
  • advice to improve wound healing
25
Q

What is a keloid formation?

A

Overgrowth of granulation tissue which leads to raised lump that goes beyond boundary of normal scar

26
Q

What are the benefits of the enhanced recovery pathway?

A

Increases patient understanding= improves patient outcomes

Earlier discharge

27
Q

What is involved in the pre-operative enhanced recovery pathway?

A

Patient education
Early discharge planning i.e. early mobilisation, nutrition
Reduce fasting duration to prevent reflux post-anaesthesia and reduce occurrence of ileus
Carbohydrate loading= decreases rate of ileus
VTE prophylaxis
Abx prophylaxis
Pre-warming to prevent patient temp from dropping

28
Q

What intra-operative measures are used as part of enhanced recovery pathway?

A

Active warming
Opioids sparing surgical technique= reduces complication of constipation
Avoidance of prophylactic NG tubes and drains
Peri-operative fluid management
Pain and nausea management

29
Q

What are the post-operative measures as part of the enhanced recovery pathway?

A

Early oral nutrition
Early ambulation
Early catheter removal
Defined discharge criteria

30
Q

What are increases the risk of post-operative ileus? What are the consequences of this?

A

Long fasting period prior to surgery= causes loss of bowel activity

Lack of carbohydrate loading pre-op

Handling of bowel during surgery

Consequences/complications:

  • increased length of hospital stay
  • poor nutrition= leads to longer healing process
31
Q

What are examples of opioid sparing surgical techniques?

A

Laparoscopic surgery i.e. decreased size of incision means decreased strength of pain medication required

Regional and local anaesthesia

Gastro + Gen Surg (45 decks)

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