Surgical Complications Flashcards
(31 cards)
What are the possible anaesthetic complications and what are the consequences of these complications?
Reaction to anaesthetic drugs i.e. anaphylaxis
Malignant hyperpyrexia
Cardiovascular collapse= fall in BP= poor cerebral and renal perfusion
Hypoxia= poor ventilation causing insufficient tidal vol
AKI= due to excess fluid loss via urine, blood, loss of skin barrier with open surgery
What is malignant hyperpyrexia?
Patients with underlying muscle disease develop high rise in body temp, metabolic acidosis and muscle rigidity when put under general anaesthetics
What are the different mechanism which fluid can be lost during surgery?
Urine
Blood/bleeds
Loss of skin barrier meaning water evaporates from heat of surgical lights
What are the general types of surgical complication?
Have to convert from laparoscopic to open surgery
Findings are worse when start to operate
Haemorrhage
Damage to surrounding structures
What are the different classifications of haemorrhages?
Primary= cut blood vessel
Reactionary
-patient gains control of BP at end of operation which leads to increase in BP and causing bleeding from vessels which didn’t bleed under lower BP
Secondary
-occurs post-surgery due to inflammatory and local damage
What is the conservative, medical and surgical management of haemorrhage?
Con
- apply pressure to stim haemostasis and spasm of BV
- drain
Med
-give fluids and blood to maintain intravascular volume
Surgical
- re-op if bleed occurs post-op
- diathermy= burns vessels shut
- suturing
What are specific examples of accidental damage to structures during surgery?
Cutting of ureters (pelvic surgery)
Clamping CBD (cholecystectomy)- iatrogenic jaundice
Damage to recurrent laryngeal nerve (total thyroidectomy)- hoarse voice or complete closure of vocal cords with bilateral damage
What 3 factors influence the risk for post-operative complications?
Type of surgery
Pre-operative state i.e. how comorbidities where managed
Post-op management
Given examples of post-op complications and when they would occur within the 10 days post-op?
Pyrexia + bleeding= day 0 N+V= day 1 Pain= day 1+2 Chest infection= day 3+4 Wound infection= day 5+6 Ileus= day 3-6 PE+DVT= day 3-9 Anastomotic leak= day 7-9 Dehiscense of wound= day 7-9 Intra-abdo/pelvic collection= day 10+ Sepsis= day 10+
Why are post-op patients at risk over developing chest infection?
Decreased ventilation and clearing of chest during surgery
What causes patients to be at risk of anastomotic leak and what are the possible consequences?
Decreased oxygenation or blood supply leads to decreased wound healing
Leaking into abdominal cavity can lead to peritonitis or sepsis
Why are surgical patients at increased risk of PE+DVT?
Loss of calf muscle pump and inflammatory state induces thrombophilic state
What are the consequences of patient being in pain post-surgery?
Raised blood pressure and heart rate due to muscle straining and contractions
Poor mobilisation= increased DVT risk and poor wound healing
Poor cough= not able to clear chest properly i.e. increased risk of chest infection
Poor oral intake= poor nutrition effects wound healing
What are the 3 steps of pain management for patients post-op?
Step 1: (mild pain)
-paracetamol +/- NSAIDs
Step 2: (mild-moderate)
-add opioid= codeine/tramadol
Step 3: (moderate-severe)
-change opioid (morphine/fentanyl/methadone)
Adjuvant TX (can be used throughout)
- regional nerve block
- epidurals
Why is minimising N+V associated with operation so important?
Can be the reason for unplanned admission especially post day care surgery
Can increase length of hospital stay
Can cause patient to be very concerned
Which surgeries and patients carry an increased risk of PONV?
History of PONV or motion sickness
Females
Gynaecological/emergency or middle ear surgery
Opioids drugs used
How can you minimise the development of PONV?
Epidural or regional anaesthesia
Reduce the need for opioids i.e. use laparoscopic surgery > open
Ensure patient adequately hydrated with fluids during surgery
Antiemetic
What are the 3 main types of anti-emetics? What is their MOA and what adverse effects or CI do they have?
Cyclozine (antihistamine)
-CI= BPH i.e can lead to urinary retention
Closed angle glaucoma
Ondansetron (5HT receptor blocker)
Metoclopramide (dopamine antagonist)
-CI= bowel obstruction due to increased peristalsis causing increased pressure and risk of perforation
What are the 7 C’s which can cause pyrexia?
Cut Collection (abscess) Chest Catheter Cannula Central venous catheter Calves
What does SIRS stand for and what are the possible features? What is the criteria for infection to be classified as SIRS? What is the criteria for SIRS to be sepsis?
Systemic inflammatory response syndrome
Tachycardia
Tachypnoea
Raised temp
Raised WCC
Must has >=2 of features
Needs likely site of infection for SIRS to be sepsis
What are the different types of late post-operative complications?
Wound dehiscence
Adhesions
Incisional hernia
Recurrence of reason for surgery
Keloid formation
What is wound dehiscence and what increases the risk of it occuring? How can it be managed?
Breakdown of wound along suture line due to poor healing
Risk factors:
- diabetes
- infection = decreased blood supply and strength of wound
- tension
- resp disease or smoking= decreased O2 supply decreases wound healing
Management:
- pack + dry
- vac dressing= sucks out infections and can bring edges of wound closer together
Why do adhesions for post-op and what are the consequences of their formation? How are they treated?
Healing process and formation of scar tissue leads to fibrous bands forming between loops of bowel
Bowel obstruction (external cause) -bowel loops no longer able to move freely
Wait and rest bowel rather than surgery as can exacerbate the problem
Why do incisional hernias occur and what can be done to minimise the risk of them occurring?
Failure of wound to close/heal completely, meaning decreased strength of abdominal wall
Prevention:
- surgical technique= incision in linea alba (strongest point and less likely to cause problem
- early mobilisation post op
- advice to improve wound healing
