Post operative complications

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• Post operative complications
• Classification
• Specific to operation
• General ( Immediate early late)

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E.GComplication of a Bowel Resection for colon ca
Specific Intraoperative Haemorrhage Wound infection Anastomotic leak Intra-abd.abscess Adhesion Stricture hernia
General to anaeshesia MI Anaphylactic Reaction Pumonary collapse DVT Cannula phlebitis UTI - PE
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• Common clinical presentation
• Low urine output (oligo-anuria)
• Urine output is a reflection of GFR which is a
  reflection of RBF hence hydration
• Surgery produces the stress response. Which leads
  to decreased urine volume.
• Other factors can affect GFR not just RBF

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• Min. acceptable urine output is 0.5ml/kg
• Important to act on urine output to avoid tubular
  damage and necrosis hence acute renal failure

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• Patient has oligo-anuria
• Catheterize ? retention
• If catheter flush
• If real oligo - anuria
• Check for low Assess for signs
• Cardiac output of hypovolaemia

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• Treat causes of trial of fluid
  Challenge
• Low cardiac output bolus up to
  5ml/kg
• (e.g arrhythmias)
• Consider icu support if failed consider
• 
  further challenge
• 
  monitored by cvp

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• Advanced therapies
• Furosemide
• Dopamine
• water
• Renal support indication k
• 
  urea (to toxic bwels)
• failure to regulate
  acid-base

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• 2- Confusion (D.A.M HYPOS)
• Drugs
• - Anaesthetic agents
• - Analgesics (opiates)
• - Normal drugs being given
• - Normal drugs not being given

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• Acute systemic infection
• - Wound infection
• - Anastomotic leak
• - Chest infection

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• Metabolic disturbance
• Hypokalaemia / hyper
• Na Na
• Sugar / sugar
• Fluid overload
• - Alcohol withdrawal

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• Hypotension
• - Occult haemorrhage
• Inadequate fluid infusion
• Low cardiac output (MI arrhythmias, PE)

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• HYPOXIA
• PYREXIA

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• HYPOXIA
• Common especially in thoracic abdominal surgery
  cause may be multifactorial
• Have a low index of suspicion mild confusion
  mild hypotension and slight tachycardia may be
  the only signs -

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• Basic physiology. Adequate analgesia, proper
  patient positioning, humidified oxygen and
  physiotherapy
• Most post-op respiratory problems are not due to
  classical pneumonia. Provided the collapse and
  hypoventilation that underlies many problems is
  treated, any infectious element usually settles
  spontaneously.

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• Common or important problems
• Anastomotic leak
• - Between days 4 14 postoperatively
• manefist as
• Peritonitis
• Intra abdominal abscess
• Enteric fistula. (path or least resistance i.e
  through wound or drain site)

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• 2- Wound complication
• Wound infection
• Wound dehiscence.
• Wound hernia

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• 3- Cannula related sepsis
• 4- UTI

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• 5- Intestinal obstruction
• Mechanical uncommon as early complication
  following surgery late due to adhesion.
• Paralytic

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• 6- Fluid and electrolyte imbalance
• May occur as a result of.
• Inappropriate administration of fluid
  replacement therapy by the medical staff.
• Excessive losses e.g due to NG tubes. High
  intestinal stoma output , intestinal fistulae,
  diuretics etc.
• Intrinisic renal disease exacerbated by surgery
  or drugs

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• 7- Thromboembolic disease.
• Upto 20 of patients that stay longer than 7 days
  can develop DVT
• Highest in women on ocp pelvic surgery
• Majority will not be clinically apparent .

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• 8- Adhesions
• Fibrnonos usually resolve 6-9 weeks
• Can become fibrosed dense fibrotic adhesion.
  In abdomen these bands of tissue may form between
  or over loops of small bowel in particular. may
  lead to kinking or compression of small bowel
  loops, causing obstruction and even infarction of
  the blood supply. Such complication may occur
  shortly after the adhesions form. Within months
  of surgery, or many years after.

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• Factors that cause adhesion include
• Genetic
• Infection/inflammation at time of surgery
• Use of powdered (starch) surgical gloves)
• Use of biological suture material
• Cooling of intestinal loop.

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• THANK YOU