Post operative complications Flashcards
(37 cards)
What are some post op complications that can occur with regard to anaesthesia?
- Painful throat from airway related trauma
- Malignant hyperthermia
- Suxamethonium apnoea (inheritance of a defective cholinesterase gene)
- Reaction to anaesthetic drugs.
- Ventilation perfusion mismatch (due to increased dead space and atelectasis)
- Hypoventilation
- Pneumonia
- DVT/PE
- Pressure sores
- Post operative nausea and vomiting
What are the two main groups of immediate post operative complications?
Anaesthetic complications
Hammorrhage
What are the main early post operative complications?
Fluid depletion Electrolyte imbalance Local infection Systemic infection Fluid collection Atelectasis DVT/PE Wound break down Anastamotic break down Bed sores
What are the specific risks of large and small bowel operations?
Ileus Intestinal obstruction Anastomotic leaks Stoma retraction Intra abdominal collections Pre sacral plexus damage
What are the specific risks of cholecystectomy?
Common bile duct
What are the specific risks of vascular surgery?
Haemorrhage Graft failure Infection Re thrombosis Limb or organ ischaemia MI, CVA, PE
What are the causes of pyrexia on each of the days (0 - 10) after an operation?
Less than 2 days: atelectasis 2 - 4 days: pneumonia 4 - 6 days: anastamotic leak or infection post operative collections 6 - 8 days: wound infection 8 - 10 days: PE/DVT
On what day post operatively does an anastamotic leak occur?
5 - 7
How and when does a wound infection tend to present?
2 -3 days after operation
Pain and swelling in the wound as well as systemic effects of infection such as malaise, anorexia and vomiting. The wound will be swollen hot and tender
How and when does an anastamotic leak tend to present?
Commonly occurs 5 - 7 days after surgery.
Presents with fever, oliguria, peritonitis and diarrhoea or ileus.
What is an anastamotic leak?
A leak of luminal contents from a surgical join between two hollow viscera. these are the most important complication to recognise following GI surgery (especially a risk in anastamosis in the oesophagus or rectum)
What might you see in the wound drain of someone with an anastamotic leak?
Feculant/purulent/bilous fluid
What investigations do you need to do if you suspect an anastamotic leak?
Blood tests: FBC, CRP, U & E’s, LFTs and clotting Raised WCC and CRP. Low albumin will all be seen
Venous blood gas (raised lactate indicates the degree of tissue perfusion)
Group and save as there will possibly be surgery
CT abdo and pelvis with contrast is needed as the definitive investigation
What is the definitive investigation for an anastamotic leak?
CT scan (Abdo and pelvis) with contrast
How do you manage an anastamotic leak?
- Nill by mouth. Broad spectrum antibiotics (Amox, met and gent)
Catheter and IV fluids
Minor leaks require observation and bowel rest. Major leaks require an exploratory laparatomy adnd might require subsequent surgical intervention with a stoma or stent.
What is a post operative ilues?
A deceleration or arrest in intenstinal motility following surgery (ie a functional obstruction of the bowel)
What are risk factors for developing a post operative ileus?
Elderly Electrolyte derangement Neurological disorders such as parkinsons or dementia Anti cholinergioi medications Opiod medication Pelvic surgery
How does a post operative ileus present?
Failure to pass flatus/faecus Bloating/distention Nausea/vomiting High NG tube outlet On examination there will be abdominal distention and absent bowel sounds (different from mechanical obstruction where there is tinkling bowel sounds)
What investigations do you do if you suspect a paralytic ileus?
Bloods (electrolyte abnormalities and inflammatory markers - these may suggest another diagnosis such as ana nastamotic leak) Abdo X Ray to look for dilatation CT scan (only really useful 3 -5 days after surgery
What is the treatm,ent of a paralytic ileus (once other causes have been excluded)?
Daily U & Es (correct any abnormalities and look for AKI)
Mobilisation
Reduce opiates and other emdication that may cause constipation
How can the risk of a post operative ileus be reduced?
Minimise intra operative handling
Avoid fluid overload
Minisime opiod use
Encourage early mobilisation
What is an air leak?
Damage to the lungs which manifests as a persistent pneumothorax that fails to settle despite a chest drain.
What is a chlye leak?
Damade to the lymphatic duct which causes a pale liquid to drain from the chest drain. Occurs in oesophagogastrectomy
Is the risk of adhesions highr in open or laprascopc surgery?
Open
