A Project Report On: Complications of General Anesthesia

COMPLICATIONS OF GENERAL ANESTHESIA
A Project Report on
REPORT SUBMITTED TO THE PT. BHAGWAT DAYAL SHARMA UNIVERSITY OF HEALTH

SCIENCE, ROHTAK
B.PHARMACY 7TH SEMESTER
Presented by
AJAY KUMAR (BPH2062)
Under the Supervision of MS. TWINKLE CHADDA
RPIIT TECHNICAL AND MEDICAL CAMPUS
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R.P EDUCATION TRUST OF INSTITUTION , KARNAL
CERTIFICATE
This is to certify that the work contained in this project report entitled “COMPLICATIONS OF
GENERAL ANESTHESIA ” submitted to partial fulfillment of the requirement for the degree
of Bachelor of Pharmacy in Branch to PT. BHAGWAT DAYAL SHARMA UNIVERSITY OF
HEALTH SCIENCE,ROHTAK embodies research work carried out by AJAY
KUMAR himself under my supervision and guidance at R. P EDUCATIONAL TRUST
GROUP OF INSTITUTIONS, KARNAL. The work has not been submitted in part of full
for the award of any other degree in any other University in my knowledge. Supervisor
MS. TWINKLE CHADDA
Assistant professor
R.P. Educational Trust Group of Institutions,
Karnal (132001), Haryana
Forwarded by
Mrs. DIVYA KIRAN
Assistant professor and HOD
R.P Educational Trust Group of Institutions
Karnal(132001) Haryana
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Acknowledgement
I express my sincere thanks to Mrs. DIVYA KIRAN, HOD, RPIIT College of Pharmacy, for
his valuable time, suggestions and motivation. A special thanks to my mentor MS.
TWINKLE CHADDA, Asst. Professor RPIIT College of Pharmacy, for providing his
valuable support and time whenever I needed. I consider myself fortunate that I got an
opportunity to work with him. it is his generous guidance that kept my attitude positive
and has developed all my skills .I extend thanks to all the faculty members of RPIIT
College of Pharmacy for their valuable time and advice.
Last but not least, I would like to thanks to my parents and almighty God for their
blessings.
AJAY KUMAR
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INDEX
SR.NO CONTENT PAGE NO.
1. INTRODUCTION 05
2. EPIDEMIOLOGY 05-06
3. STAGES 07
4. COMPLICATIONS OF GENERAL ANESTHESIA 08-09
5. TYPES OF GENERAL ANESTHESIA 09-10
6. POSTOPERATIVE NAUSEA AND VOMITTING 10-11
7. PULMONARY COMPLICATIONS 12-17
8. CIRCULATORY COMPLICATIONS 17-23
9. NEUROLOGICAL COMPLICAYIONS 23-24
10. TREATMENT OF GENERAL COMPLICATIONS OF 25-26

GENERAL ANESTHESIA
11. CONCLUSION 27
12. REFERENCES 28-32
1. Introduction-
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Anesthesia is Greek word meaning loss of sensation, and involves painful invasive procedure to be
performed with little distress and no pain to the patient. Postoperative anesthetic complications are very
common and duration of surgery is frequently cited as major risk factor for postoperative complications.
The recognition and treatment of these complications are important when providing good quality care.
The purpose of this study was to evaluate mild, moderate, and severe postoperative complications in
patients undergoing maxillofacial surgery under general anesthesia and also determine the safety of
general anesthesia in healthy and patients with comorbidities.General anesthesia is a reversible state of
controlled unconsciousness, produced by combination of different medicine. With general anesthesia,
surgical procedures can be done to the patient, which would otherwise inflict unbearable pain. Essential
to successful general anesthesia, is balanced hypnosis, analgesia and optimal muscular relaxation. It is
desirable that sufficient amnesia through hypnosis is achieved.
The use of general anesthesia is increasingly safe, but it may come with certain risks and complications.
These complications range from an instant perioperative issues such as an anesthetic anaphylaxis to
minor and major post-operative complications. The minor post-operative complications are common and
include throat soreness, post-operative nausea and vomiting and dental damage. The major complications
consist of pulmonary, circulatory and neurologic complications. The range of different medication and
techniques used during general anesthesia and the patient’s own general condition can induce an array of
these issues. It is important for nurses to know how to react and observe changes in order to prevent such
complications from causing major damage, further complications and hospital ca1re, or even possible
death.
2. Epidemology
General anesthesia is a medical technique used to induce a reversible state of unconsciousness and
insensitivity to pain during surgical procedures. It involves the administration of drugs that depress the
central nervous system, leading to a loss of sensation, amnesia, and immobility. General anesthesia is
typically administered by an anesthesiologist or a certified nurse anesthetist and requires careful
monitoring to ensure patient safety.
While general anesthesia is generally considered safe, there are potential risks and complications
associated with its use. Some of the epidemiological aspects related to general anesthesia include:
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Adverse events: Although rare, adverse events can occur during general anesthesia. These events may
include anesthesia awareness (consciousness during surgery), allergic reactions to anesthetic drugs,
cardiovascular complications, respiratory problems, and nerve injuries.
Mortality: General anesthesia-related mortality is relatively low, with estimates ranging from 1 in 10,000
to 1 in 100,000 cases. The specific risk depends on various factors such as patient age, overall health, and
the complexity of the surgical procedure.
Age-related considerations: Older adults are more susceptible to complications related to general
anesthesia. They may experience postoperative cognitive dysfunction, delirium, and increased risks of
cardiovascular events or respiratory complications.
Surgical site infection: While not directly related to general anesthesia, the administration of anesthesia
plays a role in preventing surgical site infections. Proper infection control practices, including sterile
techniques during the administration of anesthesia, help reduce the risk of infections.
Awareness under anesthesia: Anesthesia awareness, where patients become conscious or experience
partial awareness during surgery, is a rare but significant concern. The reported incidence of awareness
varies, but it is estimated to occur in approximately 0.1% to 0.2% of cases. Advances in monitoring
techniques and anesthetic drugs have helped reduce the occurrence of awareness.
Neurodevelopmental effects: Concerns have been raised about the potential long-term effects of general
anesthesia on the developing brains of young children. Animal studies have suggested a link between
multiple or prolonged exposures to anesthesia during early childhood and neurocognitive deficits.
However, more research is needed to determine the extent and clinical significance of these effects in
humans.
It's important to note that the field of anesthesiology continually evolves, and ongoing research and
advancements aim to improve the safety and outcomes of general anesthesia. Anesthesiologists and other
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healthcare professionals involved in perioperative care closely monitor and manage patients to minimize
the risks associated with anesthesia administration.
3. Stages :-
General anesthesia is typically divided into four stages:
I. Induction: This is the initial stage where the anesthetic agent is administered to induce
unconsciousness. It usually involves the use of intravenous medications or inhaled anesthetics. During
this stage, the patient transitions from wakefulness to loss of consciousness.
II. Maintenance / Excitement : Once the patient is unconscious, the anesthesia is maintained to
ensure a stable and controlled state of unconsciousness. The anesthetic agents are continuously
administered to keep the patient in a deep state of anesthesia. This stage also involves monitoring
vital signs and adjusting anesthesia levels as needed.
III. Surgical anesthesia: This is the desired stage during which the patient is in a state of deep
anesthesia, ensuring complete loss of sensation and reflexes. It allows the surgical procedure to be
performed without pain or awareness.
IV. Emergence/ medullary depression : After the surgical procedure is completed, the anesthesia is
gradually discontinued, and the patient begins to regain consciousness. This stage involves carefully
monitoring the patient’s vital signs and ensuring a smooth transition to a fully awake state.
Postoperative care is initiated during this stage to manage pain and facilitate recovery.
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Fig.01. Stages of GA
Complications of general anasthesia
While general anesthesia is generally considered safe, there can be potential complications and risks
associated with its use. It’s important to note that the occurrence of complications is relatively rare, and
anesthesiologists take numerous precautions to minimize risks. However, here are some possible
complications of general anesthesia:
a) Adverse reactions to medications: Some individuals may have allergic or adverse reactions to the
medications used during anesthesia. These reactions can range from mild skin rashes to more severe
complications like anaphylaxis, a severe and potentially life-threatening allergic reaction.
b) Respiratory problems: General anesthesia can temporarily suppress the normal reflexes that
control breathing. This can lead to respiratory complications such as airway obstruction, pneumonia,
or lung infections. Patients with pre-existing lung conditions, such as asthma or chronic obstructive
pulmonary disease (COPD), may be at a higher risk.
c) Cardiovascular issues: Anesthesia can affect blood pressure, heart rate, and cardiac function. In
rare cases, it may lead to irregular heart rhythms (arrhythmias), heart attacks, or other cardiovascular
problems, particularly in patients with underlying heart conditions.
d) Nausea and vomiting: Some individuals experience postoperative nausea and vomiting (PONV)
after receiving general anesthesia. This can be an uncomfortable side effect and may require
medication for management.
e) Delayed emergence: Occasionally, patients may take longer than expected to wake up from
anesthesia. This may be due to factors such as individual variations in drug metabolism, prolonged
drug effects, or underlying medical conditions.
f) Awareness during surgery: Although extremely rare, some patients may have brief periods of
awareness or recall during surgery while under general anesthesia. Anesthesiologists utilize various
monitoring techniques to minimize this risk.
g) Postoperative cognitive dysfunction (POCD): In certain cases, particularly in older adults, general
anesthesia may be associated with temporary or long-term cognitive changes, such as memory loss or
difficulties with thinking and concentration.
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Fig .02 . Complications of GA
It’s crucial to discuss any concerns or specific risks with your healthcare provider or
anesthesiologist before undergoing surgery or receiving general anesthesia. They will consider
your medical history, conduct a thorough evaluation, and take appropriate measures to minimize
potential complications.
4. Types of general anesthesia
Some common types of general anesthesia:

I. Inhalation anesthesia: This involves administering anesthetic gases or volatile liquids through
inhalation. The patient breathes in a mixture of oxygen and anesthetic agents, such as sevoflurane,
desflurane, or isoflurane. Inhalation anesthesia can be adjusted easily to maintain the desired level of
anesthesia.
II. Intravenous (IV) anesthesia: In this type, anesthetic drugs are administered directly into the
patient’s bloodstream through an intravenous line. Common IV anesthetics include propofol, etomidate,
and thiopental. IV anesthesia can be used alone or in combination with inhalation anesthesia.
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III. Total intravenous anesthesia (TIVA): TIVA refers to the exclusive use of intravenous medications
for the induction and maintenance of anesthesia. A combination of IV anesthetics, such as propofol and
opioids, is used to achieve the desired level of unconsciousness and analgesia.
IV. Balanced anesthesia: Balanced anesthesia involves a combination of different drugs to achieve the
desired effects. It typically includes a combination of inhalation agents, IV anesthetics, analgesics,
muscle relaxants, and other medications tailored to the patient’s needs.
V. Regional anesthesia: While not strictly considered general anesthesia, regional anesthesia
involves the numbing of a specific region or part of the body, such as spinal or epidural anesthesia. It
can be used alone or in combination with sedation or general anesthesia to provide pain relief during
surgery.
Fig. 03. Types of GA

5. Post-operative nausea and vomiting
The most common minor post-operative side effects include nausea, vomiting, sore throat or dental issues
from the usage of endotracheal intubation, shivering and sleepiness. Nausea is a state of discomfort often
followed by the expulsion of stomach contents, also known as vomiting. The occurrence in the recovery
room ranges from an overall percentage of 20% to 30%. Postoperative nausea and vomiting is due
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to the effects of combined factors such as the background of the patient, surgery done, anesthesia and
medication used and the environmental factors. Patient factors are female gender, previous postoperative
nausea and vomiting history, tendency of motion sickness, nonsmoking status and age. Anesthesia related
risk factors include the use of volatile anesthetics, extended time of surgery and anesthesia and post-
operative opioid use. (Apfel, Heidrich, Anesthesia rises as a risk through the use of volatile anesthetic
agents contributing to brain stimulation leading to nausea and vomiting. Often high doses of opioids are
used for pain alleviation and they are recognized to trigger nausea and vomiting.
Fig.04. Nausea and vomiting
Post-operative nausea and vomiting can be prevented and treated through a set of measures ranging from
all the way from pre-admission to post-operative care. These measures are the use of antiemetic medicine
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throughout the care and proper hydration through I.V. fluids. In the post-operative phase, depending on
the circumstance, the patient can be kept nil per os (NPO), nothing by mouth, to prevent further nausea,
although the use of ice chips will aid in the prevention.
6. Pulmonary complications
Breathing is a major part of a surgical procedure done in general anesthesia. The patient is solely
dependent on the caregivers as his or her respiratory system is manually kept going through the use of
respiratory machines. The muscle relaxants used in the induction make it so that the patients tongue
blocks the airways, thus an intubation tube is inserted in order to keep the airways open. Breathing of the
patient should be monitored closely after the procedure as well to ensure right oxygenation levels and
effortless respiration. (Niemi-Murola 2014.) The objective of the post-operative care related to respiration
is to stabilize the patients breathing.

Fig. 05 . Pulmonary Complications
Post-operative pulmonary complications, shortly referred as PPCs, are a group of complications, which
are related to the patient’s respiratory system. These complications may in the worst-case scenario lead to
further treatment after the surgery, such as intensive care unit care or further hospital stay, though through
monitoring and preventive procedures the risk can be reduced. (Hadder 2013.) Risk factors for PPCs
include higher American Society of Anesthesiologists classification, diabetes, obesity, advanced age,
smoking and chronic obstructive pulmonary disease (COPD) or other respiratory condition. General
anesthesia is listed as one of the anesthetic causes, which increases the risk for said issues as it in multiple
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ways decreases the post-operative oxygenation levels by affecting the respiration of the patient and
depressing pulmonary functions. Residual anesthetic drugs also cause issues by inducing residual
paralysis or residual neuromuscular blockage.
Hypoventilation
Hypoventilation, inadequate ventilation, can occur during and after the surgery and affects post-operative
care. A patient experiencing hypoventilation can develop hypoxemia, oxygen deficiency in arterial blood,
or hypoxia, impaired tissue oxygenation. These are challenging pulmonary complications of
generalanesthesia. Hypoventilation can be caused by various reasons making it difficult to pinpoint the
reason: fluid overload or pulmonary embolism, cardiac arrest, atelectasis, the complications of an
underlying respiratory illness such as asthma or COPD, a breathing machine error or a diffusion deficit
which all lead to a lower concentration of oxygen and higher concentration of carbon dioxide in the
blood. Low oxygenation levels are shown in the patient through cyanotic skin and affect the status of the
patient through the higher risk of wound infection and possible inducement of delirium. Inspecting the
triggering factor behind the low oxygen levels starts the treatment. Oxygenation of the patient is
extremely important to raise the oxygenation levels to the desired range. Proper oxygenation is important
even in the transfer from the operating theater to the recovery room if the general condition of the patient
indicatesso .Fig.06. Hypoventilation
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Pulmonary atelectasis
Pulmonary atelectasis, the collapse or impaired functioning of a lung or a part of a lung, is very common
among anesthetized patients. First symptoms can be coughing, chest pain and difficulty in breathing with
breathlessness. Atelectasis results in the reduction of functional residual capacity, which decreases
inhaled oxygen volumes. Atelectasis occurs in a complication called pneumothorax. It can be triggered by
the changes in the absorption of gases and pressures occurring during general anesthesia or by a bronchial
obstruction. This results in the deflation of the alveoli, also called blebs, in the lungs. Air is then leaked
into the pleural cavity from the ruptured blebs in the lung, which balances the pressure within the pleural
cavity to air pressure, leading to lung collapse followed by insufficient respiratory function. This
occurrence adds to the risk of re-intubation and inducing post-operative hypoxemia. (Kuukasjärvi,
Laurikka & Tarkka 2010; Hadder 2013.) Mild cases of atelectasis are treated post-surgically through
physiotherapy and breathing exercises, while in more major cases surgical removals of obstructions or
suctioning may be necessary. This condition needs immediate medical attention; the air needs to be
released from the cavity and the lung reflated. This can be done through insertion of a pleural drain or a
chest tube. Nurse assists a doctor in the insertion of the drain through preparation of the required
instruments and by assembling the draining device. (Hadder 2013.)
Fig. 07. Pulmonary Atelectasis
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Pulmonary aspiration
Pulmonary aspiration of gastric contents is a serious complication. The contents of the patient’s stomach
rise up from the esophagus and end up in the trachea as the patient is under heavy sedation and cannot
control swallowing and couching him or herself. (Niemi-Murola 2014.) The consequences can be acute
lung damage or pneumonia that can ultimately lead to death of the patient. It can happen post-operatively
due to several factors. These risk factors include emergency surgery, general anesthesia, an inexperienced
anesthetist and patient dependent reasons such as lack of fasting, delayed gastric emptying or gastric
hyper secretion. (Engelhardt & Webster 1999.)
Fig.08. Pulmonary aspiration
Bronchospasm and laryngospasm

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Patients with an underlying respiratory condition have a higher risk of having a bronchospasm, which is a
contraction of smooth muscles in the bronchus, or a laryngospasm, the full closure of the vocal cords
muscles. (Lukkarinen, Virsiheimo, Hiiva, Savo & Salomäki 2012.) These both lead to insufficient airflow
and respiratory defect, the latter with a complete halt of spontaneous breathing. Spasms can develop due
to a faulty state of anesthesia during the endotracheal intubation or extubation phase of the operation or
due to a foreign matter or irritant (Niemi-Murola 2014). Switching to 100% oxygen and manual
ventilation starts the acute treatment of bronchospasms. If the patient is still under anesthesia, it must be
deepened, as most of the volatile anesthetic agents are bronchodilators. Medications used in the treatment
are nebulized or slow I.V. salbutamol, which is a selective beta 2-agonist, and inhaled ipratropium
bromide, which is an anticholinergic bronchodilator. Both medications block the bronchoconstriction in
the smooth muscles. In more extreme cases adrenaline, magnesium sulphate, aminophylline and ketamine
are used. (Looseley 2011.) The development of spasms can be prevented with thorough cleaning of the
upper airways, the avoidance of incorrect intubation and pre-mature extubation (Koivuranta, Leutola &
Ala-Kokko 2002).
Fig.09. Laryngospasm Fig.10.Bronchospasm
Pulmonary edema
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Pulmonary edema is often a result of heart failure, as the removal of blood in the circulation of the lungs
is not done adequately. Damage done to the repeated inhalations against an upper airway obstruction,
through the aspiration of gastric fluids or by the sudden changes of pressure in the lung blood circulation.
(Powell, Graham, O’Reilly & Punton 2015.
The opioids used to treat pain may also induce post-operative opioid-induced respiratory depression,
where the effect of the used opioids is above the therapeutic margin, which then causes a respiratory
arrest (Overdyk 2009). This is a serious complication ultimately leading to death of the patient, which
could be prevented with proper recognition and monitoring. (Lee et al. 2015.) Residual neuromuscular
block is also a main cause for post-operative pulmonary complications.
Fig.11. Pulmonary Edema
7. Circulatory complications
General anesthesia can cause changes in the cardiovascular function of the patient. These changes range
from hypotension, hypovolemia and hypothermia to myocardial infarction, heart failure and cardiac
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arrest. (Harris & Chung 2013.) Surgery and general anesthesia are also listed as risk factors for venous
thromboembolism, which includes deep vein thrombosis and pulmonary embolism. (Desciak & Martin
2011.) Recognition of these changes and the underlying reason for them is key in starting the correct
treatment for the patient.
Hypotension
Post-operative hypotension can happen due to a variety of different factors, either in combination or
alone. These factors either reduce the cardiac output, the systemic vascular resistance, or both of the
above. These factors are; hypovolemia, vasodilation, cardiac arrhythmias or reduced myocardial
contractility. (Gwinnut 2004, 75-76.)
Fig.12. Hypotension
Hypovolemia
Hypovolemia is considered the most common cause of hypotension after general anesthesia. Reason for
hypovolemia most often is post-operative bleeding or fluid loss. The diagnosis of hypovolemia can be
confirmed by finding tachycardia, inadequate urine output, hypotension or reduced peripheral perfusion.
In management of hypovolemia sufficient oxygenation is needed along with adequate intravenous fluids,
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either crystalloids or more rarely colloids. In this situation, pressure can be used to speed up the rate of
administration. In the case of external hemorrhage, direct pressure should be used and if any internal
hemorrhage is suspected, surgical assistance should be asked. (Gwinnut 2004, 76.)
Fig.13. Hypovolemia
Hypertension
Post-operative hypertension is most common amidst patients with already underlying hypertension. The
existing condition can be aggravated, or entirely caused by events such as; hypothermia, hypoxemia,
hypercapnia, confusion or by pain. Primary treatment for hypotension, is correcting the above-mentioned
conditions – if one exists. (Gwinnut 2004, 78.) Although making unconditional recommendations about
the treatment is hard, because of the inconsistent definitions of hypertension (Haas & LeBlanc 2004,
1670). If hypertension prevails even after correcting the condition, consulting anesthesiologist and using
vasodilating medicine or beta-blockers could be of help (Gwinnut 2004, 78).
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Fig.14. Post operative Hypertension
Treatment of hypertension in the postoperative period is essential, because untreated it can result in grave
neurological and cardiovascular complications (Haas & Leblanc 2004, 1661).
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Fig.15. Hypertension
Cardiac arrhythmias
Cardiac arrhythmias can occur during or after general anesthesia. Most of the arrhythmias are benign,
which require no treatment and revert back to sinus rhythm before the patient is discharged. Preventive
measures, such as monitoring, risk factor charting and choosing of correct anesthetic agents, should be
done prior the surgery. (Lorentz & Vienna 2011.) Risk factors for arrhythmias are age, ASA rating of 3 or
4, previous cardiovascular diseases and electrolyte imbalance (Harris & Chung 2013). Some anesthetic
agents can cause dysrhythmias; anesthetic drugs can exacerbate the arrhythmias if the patient has a
history of cardiovascular disease. The more severe arrhythmias can be corrected through the use of
antidysrhytmic drugs. An early recognition of arrhythmia reduces the amount of potential harm caused by
them: for example an increased beating rate of the heart, tachycardia, can lead to ischemia through
increased myocardial oxygen consumption
Fig.16 Cardiac arrythemia

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Reduced myocardial contractility

Reduced myocardial contractility can happen as a post-operative complication. Most typical cause is
some sort of ischemic heart disease, which causes lack of blood supply for heart, resulting in failure of
the left ventricle. It is easy to mistake reduced this condition for hypovolemia, because they both share
symptoms such as tachycardia or poor peripheral circulation. Even though reduced myocardial
contractility has its own symptoms, an x-ray of the chest is usually needed for the diagnosis. Some of
these symptoms are distended neck veins or triple rhythm when auscultating the heart. The condition is
managed by giving the patient 100% oxygen, sitting him in upright position and constantly monitoring
blood pressure, oxygen saturation and ECG. If the cause of reduced myocardial contractility is an acute
myocardial infarction, the treatment requires the use of vasodilators in conjunction with drugs that
increase the force of contractility (known as inotropes).
Hypothermia
Post-operative hypothermia appears to develop more likely in patients that have undergone surgery with
general anesthesia than with spinal anesthesia . Studies indicate that even a slight descend in core
temperature of the body, has great effects on some patients of certain risk groups. The effects are; two- to
three times more unwanted cardiac events, doubling the amount of blood loss, three times more likely to
get a wound infection and it lengthens the time of recovery from anesthesia and the operation . During
surgery, there are multiple factors that affect the body and core temperature of the patient. General
anesthesia itself can lower the core temperature of the patient even over one Celsius. This is due to
general anesthesia’s deactivation of the thermoregulation center of the pituitary gland, which then results
in core-to-peripheral redistribution of body heat. This is the main reason of hypothermia in surgeries
under general anesthesia. The usage of muscle relaxants during the operation greatly affects the patient’s
muscles ability to shiver and produce heat, thus resulting in the temperature drop. If the temperature is
not controlled and managed during the operation it can resultin post-operative hypothermia.
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Fig.17. Hypothermia
This can then lead to unwanted physiological changes in the patient after the operation.Because of the
poor temperature distribution caused by contracted peripheral circulation, prevention of hypothermia is
easier than fixing already existing one.
The ways to raise temperature can be roughly divided in to two: active and passive methods. Active
method stands for generating heat and passive as in preserving and isolating (see Table 2).
Table 2. Active and passive methods of warming
Active methods Air warming machines and blankets
Warming mattress
Fluid warmers and warm liquids
Temperature of the room
Passive methods Isolating heat blankets
Warm blankets
Heat costumes
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Post-operative care of the patient has to take in account the neurological issues one can have after being
under general anesthesia. Post-operative cognitive dysfunction is a fairly common occurrence;
approximately 9.9% of patients have a cognitive level change after the surgery (Harris & Chung 2013).
Inducement of emergence delirium, a state of psychomotor agitation with disorganized thinking and
emotional distress after emerging from general anesthesia, causes the patient discomfort and may even be
harmful to the care if their behavior turns agitated or violent. (Card, Pandharipande, Tomes, Lee, Wood,
Nelson, Graves, Shintani, Ely & Hughes 2015.) A study done by Card et al. (2015) describes that 19% of
the 400 enrolled patients in the study had agitated emergence and 31% had delirium signs when admitted
to the post-anesthesia care unit, with hypoactive features being the most prominent. No specific nursing
interventions exist for treating post-operative delirium, but post-operative monitoring, early mobilization
and patient guidance help in preventing from injury or damage during hyperactive delirium
Residual neuromuscular block
A complication called residual neuromuscular block can lead to an extended recovery room period or a
longer ward care. The effect of muscle relaxants used in general anesthesia are reversed using specific
antidotes, such as neostigmine or sugammadex. The reversal of muscle relaxation needs to be monitored
using the train-of-four method, or by observing the patient for example lifting his or her head. If the TOF-
ratio is measured to be under 0,9 after the antidote has affected, the patient has a residual neuromuscular
block, or re-relaxation. This can be problematic to recognize and may cause increased morbidity and
mortality in the post-operative care.
General weakness Inability to speak, cough, swallow or smile
Inability to breathe deeply Facial numbness
Trouble lifting head for > 5 s. Weak hand grip
Blurred or double vision Trouble keeping eyes open for > 5 s.
Table 3. Symptoms of residual neuromuscular blockage
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The symptoms listed above may be used as warning signs in detection of post-operative muscle
weakness. If the residual neuromuscular block is not detected, it leads to post-operative pulmonary
complications:
Breathing difficulties, airway obstruction, aspiration of gastric contents, tiredness and the retention of
carbon dioxide.
Peripheral nerve damage

Peripheral nerve damage, which is caused during the perioperative phase, may lead to severe
complications after the operation. In the case of general anesthesia the patient is rendered immobile,
which makes the patient greatly dependent on the caretakers in regards of changing his or her position
during the operation. If a nerve is stretched, compressed or kept in an extreme position for a longer
duration of time, it can lead to aforementioned nerve damage. The most common nerves to be injured are
the ulnar nerve and the common peroneal nerve. (Tighe 2009.) The operational staff has multiple
different protection methods to prevent such injuries from occurring. Most are based on usage of soft
materials and the change of center of gravity on a specific body part. (Tunturi 2013.) A common fear
among patients going to surgery is awareness during general anesthesia. If a patient is aware due to an
inadequate depth of anesthesia during surgery, it can cause post-operative anxiety, depression and even
post-traumatic stress disorder. This is fortunately extremely rare (0.03%) and is prevented through the use
of thorough monitoring and anesthetic use.
Fig.18. Peripheral nerve damage
9. Treatment of general anesthesia
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The treatment of general anesthesia focuses on managing any complications or side effects that may arise
during or after the administration of anesthesia. The specific treatment will depend on the nature of the
complication or adverse reaction. Here are some common treatments for complications associated with
general anesthesia:
Allergic reactions: If an allergic reaction occurs, the administration of the offending medication is
stopped immediately. The patient may be given antihistamines or corticosteroids to reduce the allergic
response. In severe cases of anaphylaxis, which is a life-threatening reaction, emergency measures such
as epinephrine (adrenaline) may be required.
Respiratory problems: In the event of airway obstruction or respiratory distress, the anesthesiologist will
take steps to ensure a clear airway. This may involve repositioning the patient’s head, suctioning the
airway, or providing oxygen or assisted ventilation using a bag-valve-mask device or a ventilator.
Additional measures such as bronchodilators or other respiratory medications may be administered if
necessary.
Cardiovascular issues: If there are any abnormalities in blood pressure, heart rate, or rhythm, the
anesthesiologist will monitor and manage these parameters closely. Medications to stabilize blood
pressure, control heart rate, or treat arrhythmias may be administered as appropriate. In severe cases,
additional interventions such as cardioversion or defibrillation may be required.
Nausea and vomiting: Patients experiencing postoperative nausea and vomiting (PONV) may be given
antiemetic medications to alleviate these symptoms. These medications can help prevent or treat nausea
and vomiting.
Delayed emergence: Patients who take longer than expected to wake up from anesthesia will be closely
monitored. Supportive measures such as supplemental oxygen, maintaining body temperature, and
providing fluids may be employed until the effects of anesthesia wear off.
Awareness during surgery: If a patient experiences awareness or recall during surgery, the
anesthesiologist will take immediate action to adjust the anesthesia level and ensure the patient is
properly sedated and unaware. This may involve increasing the depth of anesthesia or administering
additional medications as needed.
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Postoperative cognitive dysfunction (POCD): There is no specific treatment for POCD, as it typically
resolves on its own over time. Supportive measures such as providing a calm environment, maintaining
hydration and nutrition, and addressing any underlying medical conditions or factors contributing to
cognitive changes may be helpful.
Fig.19. POCD
10. Conclusion :
General anesthesia is an increasingly safe way of ensuring patient safety and comfort during surgery, but
it still comes with complications that have to be recognized and deal with. As technology progresses and
new techniques are introduced, the amount of complications can also decrease. (Harris & Chung 2013.)
This thesis was divided into a video presentation and a written report. The video presentation was
produced for Jyväskylän Ammattikorkeakoulu (JAMK). It can be used as a learning tool for students
undergoing their perioperative studies, if the responsible teacher approves the quality of the presentation.
This thesis was focused on the post-operative complications and during the literature search and review it
was noticed that more studies could be made on the complications of general anesthesia; pre-operative,
intra-operative and post-operative all in mind. It was also discovered, that it is not wise nor even possible,
to include all possible rare complications, since it does not serve the target group of the thesis well.
27
We both suggest a guide similar to this to be made, but with a focus on complications of local anesthesia.
It would be very useful and a good research topic.
11.Refrences
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A Project Report On: Complications of General Anesthesia

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COMPLICATIONS OF GENERAL ANESTHESIA

REPORT SUBMITTED TO THE PT. BHAGWAT DAYAL SHARMA UNIVERSITY OF HEALTH

B.PHARMACY 7TH SEMESTER

AJAY KUMAR (BPH2062)

Under the Supervision of MS. TWINKLE CHADDA

RPIIT TECHNICAL AND MEDICAL CAMPUS

MS. TWINKLE CHADDA

R.P. Educational Trust Group of Institutions,

Karnal (132001), Haryana

Mrs. DIVYA KIRAN

Assistant professor and HOD

R.P Educational Trust Group of Institutions

College of Pharmacy for their valuable time and advice.

SR.NO CONTENT PAGE NO.

4. COMPLICATIONS OF GENERAL ANESTHESIA 08-09

5. TYPES OF GENERAL ANESTHESIA 09-10

6. POSTOPERATIVE NAUSEA AND VOMITTING 10-11

7. PULMONARY COMPLICATIONS 12-17

8. CIRCULATORY COMPLICATIONS 17-23

9. NEUROLOGICAL COMPLICAYIONS 23-24

10. TREATMENT OF GENERAL COMPLICATIONS OF 25-26

12. REFERENCES 28-32

Fig .02 . Complications of GA

4. Types of general anesthesia

Some common types of general anesthesia:

Fig. 03. Types of GA

is to stabilize the patients breathing.

Fig. 07. Pulmonary Atelectasis

Fig.08. Pulmonary aspiration

Bronchospasm and laryngospasm

Fig.09. Laryngospasm Fig.10.Bronchospasm

Fig.11. Pulmonary Edema

Fig.14. Post operative Hypertension

Fig.16 Cardiac arrythemia

Reduced myocardial contractility

Active methods Air warming machines and blankets

Fluid warmers and warm liquids

Temperature of the room

Passive methods Isolating heat blankets

Inability to breathe deeply Facial numbness

Trouble lifting head for > 5 s. Weak hand grip

Blurred or double vision Trouble keeping eyes open for > 5 s.

Table 3. Symptoms of residual neuromuscular blockage

Peripheral nerve damage

Fig.18. Peripheral nerve damage

9. Treatment of general anesthesia

Kustannus Oy Duodecim. Accessed on 1 October 2016. Retrieved from

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