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    Post Operative Complications

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    drhiwaomer
    Upper airway obstruction Arterial hypoxemia Hypoventilation Hypotension Hypertension Cardiac dysrthymia Oliguria Bleeding Decreased body temperature Agitation (emergence delirium) Delayed awakening Nausea and vomiting Pain

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    Post Operative Complications

    Uploaded by

    drhiwaomer
    3K views17 pages
    Upper airway obstruction Arterial hypoxemia Hypoventilation Hypotension Hypertension Cardiac dysrthymia Oliguria Bleeding Decreased body temperature Agitation (emergence delirium) Delayed awakening Nausea and vomiting Pain

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    Post operative complications

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    Upper airway obstruction Arterial hypoxemia Hypoventilation Hypotension Hypertension Cardiac dysrthymia Oliguria Bleeding Decreased body temperature Agitation (emergence delirium) Delayed awakening Nausea and vomiting Pain

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    3K views17 pages

    Post Operative Complications

    Uploaded by

    drhiwaomer
    Upper airway obstruction Arterial hypoxemia Hypoventilation Hypotension Hypertension Cardiac dysrthymia Oliguria Bleeding Decreased body temperature Agitation (emergence delirium) Delayed awakening Nausea and vomiting Pain

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 17

    Post operative complications

    1. Upper airway obstruction


    2. Arterial hypoxemia
    3. Hypoventilation
    4. Hypotension
    5. Hypertension
    6. Cardiac dysrthymia
    7. Oliguria
    8. Bleeding
    9. Decreased body temperature
    10. Agitation (emergence delirium)
    11. Delayed awakening
    12. Nausea and vomiting
    13. Pain
    Upper airway obstruction

    1. Occlusion of the pharynx by the tongue.

    2. Laryngeal obstruction
    • Laryngospasm
    • Laryngoedema
    Signs and symptoms:

    • Flaring of the nares


    • Retraction at the suprasternal notch
    (tracheal tug)
    • Retraction of intercostal and subcostal
    spaces
    • Vigorous diaphragmatic and abdominal
    contractions
    :Treatment

    • Elimination upper airway obstruction due


    to occlusion of the pharynx by the tongue,
    by head tilt-jaw thrust method, this
    maneuver stretches muscles attached to
    the tongue serving to pull the tongue away
    from the posterior pharyngeal wall.
    • If not beneficial a nasopharyngeal or
    oropharyngeal airway can be inserted (the
    nasopharyngeal airway is better tolerated
    by patients awakening from general
    anesthesia
    Laryngospasm
    • In complete laryngospasm treated by extension
    of the head and anterior displacement of the
    mandible plus application of positive airway
    pressure with bag and mask delivering pure
    oxygen.
    • Complete laryngospasm that persist despite
    these maneuvers should be treated by IV
    succinylcholine, laryngoscopy and intubation of
    the trachea with cuffed tube. If intubation was
    impossible do cricothyrotomy which will provide
    temporary oxygenation until tracheostomy can
    be performed.
    Laryngeal odema treated by:

    • Humidifying the inhaled gases

    • Administering nebulized epinephrine

    • Dexamethasone ??
    Arterial hypoxemia
    (PaO2<60mmHg)
    Factors leads to post operative arterial
    hypoxemia:
    2. Right-to-left intrapulmonary shunt (atelectasis)
    3. Mismatch of ventilation to perfusion
    4. Decreased cardiac output
    5. Alveolar hypoventilation (residual effects of
    anesthetics and/or muscle relaxants)
    6. Inhalation of gastric contents (aspiration)
    7. Pulmonary embolism
    8. Pulmonary edema
    Pneumothorax
    Posthyperventilation hypoxia
    Increased oxygen consumption (shivering)
    Advanced age
    Obesity
    Smoking
    Lung disease
    Diagnosis:
    2. Clinical (cardiac dysrthmias, agitation,
    cyanosis)
    3. Pulseoximeter (arterial hemoglobin
    oxygen saturation)
    4. Measurement blood gas
    (PaO2<60mmHg)
    Treatment:
    2. Oxygen supplementation
    3. Eliminate the cause of hypoxia:
    • If due to residual effects of muscle relaxants
    (may be not enough dose of neostigmine
    given)
    • If due to residual effect of opioids give
    naloxone
    • If due to pneumothorax insert chest tube (if
    circulatory depression accompanies a tension
    pneumothorax, emergency treatment is
    placement a 12-14 gauge needle into the 2nd
    anterior intercostal space
    • If oxygenation alone was not benefit incubate
    at once and put the patient on ventilator
    Hypoventilation
    Factors leading to postoperative hypoventilation
    2. Drug induced CNS depression (volatile
    anesthesia, opioids)
    3. Residual effects of muscle relaxants
    4. Suboptimal ventilatory muscle mechanics
    (patient position, obesity, gastric dilation, site
    of surgical incision)
    5. Increased production of CO2 (hyperthermia)
    6. Co-existing chronic obstructive pulmonary
    disease
    Diagnosis:
    • Clinical (signs of CO2 retention such as
    tachycardia, hypertension)
    • Capnograph (PaCO2>45mmHg)
    • Blood gas measurement
    (PaCO2>45mmHg)
    Treatment:
    • Clear airway and ventilate the patient
    • If due to residual effect of opioids give
    naloxone
    • If due to residual effects of muscle
    relaxants (not enough dose of
    neostigmine, succinylcholine apnea,
    myasthenia gravis, any potentiation of
    Nondepolarizing muscle relaxants like
    ABs, Mg, respiratory acidosis,
    hypokalemia----etc. Treat accordingly)
    Thank you

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