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Perioperative Care > Postoperative Complications > Flashcards

Postoperative Complications Flashcards

1
Q

Timeframe for immediate complications

A

Within 24 hours of surgery

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2
Q

Timeframe for early complications

A

Occur within 30 days of the operation or during the period of hospital stay

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3
Q

Timeframe of late complications

A

Occur after the patient has been discharged from hospital or more than 30 days from the operation

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4
Q

Define primary haemorrhage

A
  • Occurs during the operation

- Should be controlled during the operation

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5
Q

Define reactionary haemorrhage

A
  • Occurs within the first few hours of surgery

- e.g. due to clot disturbance with rise in BP

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6
Q

Define secondary haemorrhage

A
  • Occurs a number of days after the operation

- Usually infection related but can also be due to sloughing of a clot or erosion of ligature

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7
Q

List the predisposing factors for haemorrhage

A
  • Obesity
  • Steroid therapy
  • Jaundice
  • Recent transfusion of stored blood
  • Disorders of coagulation
  • Platelet deficiencies
  • Anticoagulation
  • Old age
  • Severe sepsis/DIC
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8
Q

Causes of pyrexia 1-3 days post-op

A
  • Atelectasis
  • Metabolic response to trauma
  • Drug rections
  • SIRS
  • Line infection
  • Instrumentation of a viscus or tract causing transient bacteraemia
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9
Q

Causes of pyrexia 4-6 days post-op

A
  • Chest infection
  • Superficial wound infection
  • Urinary infection
  • Line infection
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10
Q

Causes of pyrexia beyond 7 days post-op

A
  • Chest infection
  • Suppurative wound infection
  • Anastomotic leak
  • Deep abscess
  • DVT
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11
Q

How can abdominal wound dehiscence be divided

A
  • Superficial = skin wound alone fails

- Complete = failure of all layers

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12
Q

What factors increase the risk of wound dehiscence

A
  • Malnutrition
  • Vitamin deficiencies
  • Jaundice
  • Steroid use
  • Major wound contamination
  • Poor surgical technique (i.e. not abiding by Jenkins rule)
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13
Q

Management of complete wound dehiscence

A
  1. Analgesia
  2. IVF
  3. IV antibiotics
  4. Coverage of the wound with saline impregnated gauze
  5. Arrange to return to theatre
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14
Q

When may a dehisced wound be re-sutured

A
  • Wound edges are healthy
  • Enough tissue for suitable coverage
  • Deep tension sutures are used
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15
Q

What method of re-closure should be used if the dehisced wound has some granulation tissue present over the viscera of there is high output bowel fistula present

A

Wound manager

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16
Q

Anaesthetic contributions to post-op respiratory problems

A
  • Reduced residual capacity from supine positions
  • V/Q mismatch: increased shunt or dead space
  • One-lung ventilation
  • Excessive sedation
  • Muscle relaxants
  • Impaired host defences
17
Q

What are the nutritional requirements of those with renal failure

A
  • High calorie

- High-quality protein

18
Q

List the indications for renal replacement therapy

A
  • Hyperkalaemia (persistently >6)
  • Metabolic acidosis (pH<7.2) with negative base excess
  • Pulmonary oedema/overload
  • High urea (30-40)
  • Complications of uraemia e.g. pericarditis, tamponade
  • Creatinine rising >100/day
  • The need to ‘make room’ for ongoing drug infusions
19
Q

SIRS criteria

A

Two or more of:

  • Tachycardia >90
  • Respiratory rate >20 or PaCO2 >4.3
  • Temp >38 or <36
  • WCC >12 or <4
20
Q

Insults that may result in SIRS

A
  1. Infection and sepsis
  2. Ischaemia-reperfusion syndrome
  3. Fulminant liver failure
  4. Pancreatitis
  5. Dead tissue
21
Q

Harmful effects of oxygen free radicals

A

Direct endothelial damage and increased permeability

22
Q

Role of macrophages in SIRS

A
  • Phagocytosis of debris and bacteria
  • Act as antigen-presenting cells for T-lymphocytes
  • Release inflammatory mediators, endothelial cells and fibroblasts
23
Q

Describe the ‘two-hit’ hypothesis

A
  1. Initial cellular insult e.g. trauma or shock sets up a controlled inflammatory response
  2. A second insult is then sustained by the patient e.g. from surgery which creates a destructive inflammatory response

This can cause loss of intestinal mucosal integrity and allows the translocation of bacteria into the portal circulation

24
Q

Mortality rate in two organ failure

A

50% (increasing to 66% by day 4)

25
Q

Mortality rate in three organ failure

A

80% (rising to 96%)

26
Q

Criteria for GI failure

A
  • Ileus >3 days
  • Diarrhoea >4 days
  • GI bleeding
  • Inability to tolerate enteral feed in absence of primary gut pathology
27
Q

Criteria for skin failure

A

Decubitus ulcers

28
Q

Criteria for cardiac failure

A
  • HR <54 or symptomatic bradycardia
  • MAP <49
  • VF or VT
  • Serum pH <7.24 with normal pCO2
29
Q

Criteria for respiratory failure

A
  • RR <5 or >49
  • PaCO2 >6.65
  • Alveolar-arterial gradient >46.5
  • Ventilator-dependent on day 4 in ITU
30
Q

Criteria for renal failure

A
  • Urine output <479ml in 24 hours
  • Urea >36
  • Creatinine >310
  • Dependent on haemofiltration
31
Q

Criterial for haematological failure

A
  • WCC <1
  • Platelets <20
  • Haematocrit <0.2
  • DIC
32
Q

Criteria for neurological failure

A
  • GCS <6 in absence of sedation
33
Q

qSOFA criteria

A

RR >22
GCS <15
SBP <100

34
Q

When is MI most likely post-op

A

Day 1

Perioperative Care (6 decks)

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