Post operative complications

1
Post operative complications
2
Hypotension

• Causes
• Hypovolemia (most common cause ) it could be due
  to inappropriate replacement of blood and/or
  fluids pre and/or post operatively.
• Decrease systemic vascular resistance (residual
  effects of anesthetics , sepsis)
• Arterial hypoxemia.

3

• Causes
• 4. Cardia dysrhythmias.
• 5. Pulmonary embolus.
• 6. Decreased myocardial contractility (M.I).
• 7. Pneumothorax.
• 8. Cardiac tamponade.

4
Management

• Confirm the accuracy of the blood pressure
  measurement.
• Oliguria (less than 0.5ml/kg/h) which increase
  after fluid challenge (200ml).
• Low haematocrit.
• Replacement of fluid properly if not benefit
• Put central venous line and measure CVP

5

• -If Bp was low and CVP high it may indicate heart
  failure (inotropic drugs).
• If Bp was low and CVP low it may indicate
  hypovolemia (IV fluids).
• If Bp was low and CVP high or low it may indicate
  sepsis (proper antibiotic).

6
Hypertension

• Causes
• Arterial hypoxemia.
• Enhanced sympathetic nervous system activity
  (pain, bladder distension).
• Preoperative hypertension.
• Hypervolemia.
• Hypercarbia.

7
Management

• Confirm the accuracy.
• Correct the cause.
• Use Hypotensive agents (Hydralazine)

8
Cardiac dysrhythmias

• Causes
• Arterial hypoxemia.
• Hypovolemia.
• Hypothermia.
• Hypertension.
• Pain.
• Myocardial ischemia.
• Anticholinesterase.

9

• Causes
• Electrolyte abnormality
• Hypokalemia.
• - Hypocalcaemia.
• Respiratory acidosis.
• Digitalis toxication.
• Preoperative cardiac dysrhythmia.

10
Management

• Most cardiac dysrhythmias which occur in post
  operative period do not require treatment other
  than correction of the underlying cause.
• Patency of the upper airway and good oxygenation
  could be enough as a treatment.

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• Drug therapies
• Atropine for treatment of bradycardia.
• Verapamil to decrease heart rate.
• Lidocaine to suppress ventricular ectopics.
• Electrical cardioversion for treatment of
  hemodynamically significant atrial or ventricular
  tachydysrhythmias.

12
Renal dysfunction

• Patients at high risk
• Co-existing renal disease.
• Major trauma.
• Sepsis.
• Advanced age.
• Multiple intraoperative blood transfusions.
• Prolong intra operative hypotension.
• Cardiac or vascular surgery.
• Biliary tract surgery in presence of obstructive
  jaundice.

13
Management

• Put a urinary catheter for early recognition of
  oliguria ( less than 0.5ml/kg.hr) in high risk
  patients and treat accordingly.

14

• Thank You