post operative complications classification specific to operation general ( immediate early late)

Post operative complicationsPost operative complications

ClassificationClassification

1.1. Specific to operationSpecific to operation

2.2. General ( Immediate early late)General ( Immediate early late)

E.GE.GComplication of a Bowel Resection for colon Complication of a Bowel Resection for colon caca

Specific Specific Intraoperative Intraoperative Haemorrhage Haemorrhage

-Wound infectionWound infection-Anastomotic leakAnastomotic leak-Intra-abd.abscess Intra-abd.abscess

AdhesionAdhesion-StrictureStricture- herniahernia

General to anaeshesia General to anaeshesia -MIMI-Anaphylactic ReactionAnaphylactic Reaction

-Pumonary collapsePumonary collapse-DVTDVT-Cannula phlebitisCannula phlebitis- UTI UTI

- PE- PE

Common clinical presentationCommon clinical presentation

1.1. Low urine output (oligo-anuria)Low urine output (oligo-anuria)

Urine output is a reflection of GFR which is a Urine output is a reflection of GFR which is a reflection of RBF hence hydrationreflection of RBF hence hydration

Surgery produces the stress response. Which Surgery produces the stress response. Which leads to decreased urine volume.leads to decreased urine volume.

Other factors can affect GFR not just RBFOther factors can affect GFR not just RBF

Min. acceptable urine output is 0.5ml/kgMin. acceptable urine output is 0.5ml/kg

Important to act on urine output to avoid Important to act on urine output to avoid tubular damage and necrosis hence acute renal tubular damage and necrosis hence acute renal failurefailure

Patient has oligo-anuriaPatient has oligo-anuria

Catheterize ? retentionCatheterize ? retention

If catheter flushIf catheter flush

If real oligo - anuria If real oligo - anuria

Check for low Assess for signsCheck for low Assess for signs

Cardiac output of hypovolaemia Cardiac output of hypovolaemia

Treat causes of trial of fluid ChallengeTreat causes of trial of fluid Challenge

Low cardiac output bolus up to 5ml/kgLow cardiac output bolus up to 5ml/kg

(e.g arrhythmias)(e.g arrhythmias)

Consider icu support if failed considerConsider icu support if failed consider

further challengefurther challenge

monitored by cvp monitored by cvp

Advanced therapiesAdvanced therapies

1.1. Furosemide Furosemide

2.2. DopamineDopamine

waterwater

3.3. Renal support – indication k+Renal support – indication k+

urea (to toxic bwels)urea (to toxic bwels)

failure to regulate acid-basefailure to regulate acid-base

2- 2- Confusion Confusion (D.A.M HYPOS)(D.A.M HYPOS)

DrugsDrugs

- Anaesthetic agents- Anaesthetic agents

- Analgesics (opiates)- Analgesics (opiates)

- Normal drugs being given- Normal drugs being given

- Normal drugs not being given- Normal drugs not being given

Acute systemic infection Acute systemic infection

- Wound infection- Wound infection

- Anastomotic leak- Anastomotic leak

- Chest infection- Chest infection

Metabolic disturbanceMetabolic disturbance - Hypokalaemia / hyperHypokalaemia / hyper

- Na+ Na+Na+ Na+

- Sugar / sugarSugar / sugar

- Fluid overloadFluid overload

- Alcohol withdrawal - Alcohol withdrawal

HypotensionHypotension

- Occult haemorrhage- Occult haemorrhage

- Inadequate fluid infusionInadequate fluid infusion

- Low cardiac output (MI arrhythmias, PE)Low cardiac output (MI arrhythmias, PE)

HYPOXIAHYPOXIA

- PYREXIAPYREXIA

HYPOXIAHYPOXIA

Common especially in thoracic + abdominal Common especially in thoracic + abdominal surgery cause may be multifactorialsurgery cause may be multifactorial

Have a low index of suspicion – mild Have a low index of suspicion – mild confusion mild hypotension and slight confusion mild hypotension and slight tachycardia may be the only signs - tachycardia may be the only signs -

Basic physiology. Adequate analgesia, proper Basic physiology. Adequate analgesia, proper patient positioning, humidified oxygen and patient positioning, humidified oxygen and physiotherapy physiotherapy

Most post-op respiratory problems are not due Most post-op respiratory problems are not due to classical pneumonia. Provided the collapse to classical pneumonia. Provided the collapse and hypoventilation that underlies many and hypoventilation that underlies many problems is treated, any infectious element problems is treated, any infectious element usually settles spontaneously. usually settles spontaneously.

Common or important problemsCommon or important problems

1.1. Anastomotic leakAnastomotic leak

- Between days 4 – 14 postoperatively - Between days 4 – 14 postoperatively manefist asmanefist asa)a) Peritonitis Peritonitis b)b) Intra – abdominal abscessIntra – abdominal abscessc)c) Enteric fistula. (path or least resistance i.e Enteric fistula. (path or least resistance i.e

through wound or drain site) through wound or drain site)

2- 2- Wound complicationWound complication

a)a) Wound infectionWound infection

b)b) Wound dehiscence.Wound dehiscence.

c)c) Wound herniaWound hernia

3- Cannula related sepsis3- Cannula related sepsis

4- UTI 4- UTI

5- 5- Intestinal obstructionIntestinal obstruction

a)a) Mechanical – uncommon as early Mechanical – uncommon as early complication following surgery – late due to complication following surgery – late due to adhesion.adhesion.

b)b) Paralytic Paralytic

6- F6- Fluid and electrolyte imbalanceluid and electrolyte imbalance

May occur as a result of.May occur as a result of.

a)a) Inappropriate administration of fluid replacement Inappropriate administration of fluid replacement therapy by the medical staff.therapy by the medical staff.

b)b) Excessive losses e.g due to NG tubes. High Excessive losses e.g due to NG tubes. High intestinal stoma output , intestinal fistulae, diuretics intestinal stoma output , intestinal fistulae, diuretics etc.etc.

c)c) Intrinisic renal disease exacerbated by surgery or Intrinisic renal disease exacerbated by surgery or drugsdrugs

7- 7- Thromboembolic diseaseThromboembolic disease..

- Upto 20% of patients that stay longer than 7 Upto 20% of patients that stay longer than 7 days can develop DVTdays can develop DVT

- Highest in women on ocp + pelvic surgeryHighest in women on ocp + pelvic surgery

- Majority will not be clinically apparent . Majority will not be clinically apparent .

8- 8- AdhesionsAdhesions

- Fibrnonos – usually resolve 6-9 weeksFibrnonos – usually resolve 6-9 weeks- Can become fibrosed dense fibrotic adhesion. In Can become fibrosed dense fibrotic adhesion. In

abdomen these bands of tissue may form between or abdomen these bands of tissue may form between or over loops of small bowel in particular. may lead to over loops of small bowel in particular. may lead to “kinking” or compression of small bowel loops, “kinking” or compression of small bowel loops, causing obstruction and even infarction of the blood causing obstruction and even infarction of the blood supply. Such complication may occur shortly after supply. Such complication may occur shortly after the adhesions form. Within months of surgery, or the adhesions form. Within months of surgery, or many years after. many years after.

Factors that cause adhesion include:Factors that cause adhesion include:a)a) GeneticGenetic

b)b) Infection/inflammation at time of surgeryInfection/inflammation at time of surgery

c)c) Use of powdered (starch) surgical gloves)Use of powdered (starch) surgical gloves)

d)d) Use of biological suture materialUse of biological suture material

e)e) Cooling of intestinal loop. Cooling of intestinal loop.

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