Perioperative complications

Paszt Attila

Perioperative period

• Perioperative period, generally refers to the three phases of surgery:

• preoperative

• intraoperative

• postoperative

• The goal of perioperative care :is to provide better condition for patients before operation, during operation and after operation.

Classification of postoperative

complications

• Due to indication of the surg. treatment

• Due to the general condition of the

patients

• Other diseases

• Patients from high-risk groups

Postoperative complications

• Definition: unpredicted, acute change in the patient’s conditions.

• Mild form (E.G. local wound infection)

• Severe form (without proper treatment may lead life-threatening deterioration of vital functions)

Cardio-vascular complications

• Arrhytmias

• Cardial decompensation

• Postoperative acute myocardial infarct

• Hypertonic crisis (adrenalectomy, hypertyreoid patients)

• Shock: hypovolemic, septic, cardiogen, neurogen.

Urinary tract complications I.

• Acute renal failure (ARF) diuresis less

than:- 0.5ml/kg/h

• Prerenal, renal, postrenal: hypovolemia(blood loss), nephro-toxic drugs, incompatibile blood transfusion.

• Postrenal: prostatic gland hypertrophia, tenesmus (ischuria paradoxa), ureterolithiasis

Urinary tract complications II.

• Urinary tract infection

• -tipically causes the fever that develops on postop. days 3-6.

• 1.)-indwelling catheter or pre-existing bladder outlet obstruction is often the cause.

• 2.)abdominal pain can cause patients to empty the bladder incompletely when voiding – the residual urine predisposes to infection.

• Urinary tract infection treatment:

• -urinary samples for bactery

• -using appropriate antibiotics

• -relieving any obstruction that is present

• -removing the catheter, if feasible

Electrolyte imbalance

Na, K, pH• Hyponatraemia, (serum sodium level less than 130 mmol/l)

• Symptoms:-generally are irritability, increased deep tendon reflexes, muscles twitching, and seizures.

• Hypernatraemia,(serum sodium level greater than 145 mmol/l)

• Symptoms:-include those of volume depletion(tachycardia, hypotension) as well as other

signs of dehydration.

• Hypokalaemia, (potassium < 3,6 mmol/l)• Symptoms:-are those of depression of neural, cardiac, and muscle function.The most

serious of these are cardiac arrhytmias caused by hypokalemia, which begin as flattened or inverted T waves.

• Hyperkalaemia ( greater > 5,2 mmol/l)

• Symptoms:-are those of hyperexcitability and are primarily manifested in the GI tract as hypermotility (e.g.,nausea,diarrhea) and in the heart.

• Metabolic alkalosis, acidosis, respiratory alkalosis, acidosis

Haemostatic complications

Bleeding

Thrombosis

Embolia

Bleeding I.

Acquired coagulopathies:

• Liver diseases• K-vitamine deficiency • Sepsis• DIC• Thrombocytopenia• ITP• Thrombocytopathia• Thrombocytosis

Bleeding II.

Congenital coagulopathies:

• Haemophilia A and B

• Willebrand disease

Thrombosis, embolia

• Deep vein thrombosis

• Pulmonary embolism

• Non-thrombus causes of pulmonary embolusare rare but include:

- fat emboli from a broken femur

- in some cases, tumor tissue from cancer

Pulmonary embolism I.

• Definition: is a mechanical obstruction of the flow of blood in the pulmonary arterial system due to lodgment of a thromboembolus.

• The result of lodgment include decreased:

• - cardiac output

• - pulmonary vasospasm

• - hypertension

• - impaired blood oxygenisation

• - bronchospasm

Pulmonary complication I.

• The most common cause of fever during the first postoperative days.

• Most pulmonary problems develop because of prolonged mechanical ventilation or because of inadequate ventilation and poor cough effort

• I. Atelectasis:-usual problem and is often resolved by coughing, deep breathing and incentive spirometry

• -nasotracheal suction or bronchoscopy may be needed to remove secretions

• II. Pneumonia:- antibiotics should not be given unless evidence of infection is present(X-ray)

Pulmonary complication II.

• III. Aspiration( of gastric contents):

• -8-10% of elective cases

• Causes of aspiration:-diminished loss of consciousness and abnormal motility of the GI tract during the anaesthesia

• -paralytic or obstructive ileus

• Acid aspiration alone causes an inflammatory pulmonary reaction., even in the absence of bacterial contamination.

• Treatment:

• -nasogastric tube for gastric decompression

• -bronchoscopy:- indicated only for removal of large aspirated particulets

• - chest X-ray

• - wide spectrum of antibiotics

Pulmonary complication III.

• Other Pulmonary Complications:

• -Bronchospasm

• -Ptx

• -Pulmonary edema

• -Adult respiratory distress syndrome- ARDS

Intraabdominal complications

• Haemoperitoneum

• Abscess formation

• Peritonitis

• Biloma

• Foreign body

• Drain-related complications

Ileus I.• Definition:-intestinal obstruction-the normal flow of intestinal contents can

be blocked by a mechanical obstruction or by a functional obstruction that occurs because of impaired intestinal motility.

• -mechanical obstructions are common and have various benign and malignant causes.If not treated expeditiously mechanical obstructions can rapidly become lethal.

• Types:• -Simple obstruction: there are no complicating factor, such as ischaemia or

perforation

• -Strangulating obstruction- the blood supply to the involved segment of bowel is significantly impaired.The ischemia may result from a twisting of the intestinal blood supply upon itself or from a construction of the blood flow by a tight band or hernial opening.

• -Closed loop obstruction: both limbs of the bowel are obstructed; therefore gas and liquid cannot pass in either direction.

• -Intussusception: the bowel invaginates itself, causing a narrowing of the lumen and subsequent obstruction.The most frequent cause of intussusception is the intraluminal polypoid tumor.

• -Perforating obstruction: the bowel proximal to the obstruction overdistends and perforates.The most common area, localisation of perforation when the colon is obstructed is the cecum.

Metabolic disorders

• Diabetes mellitus (Type I. IDDM, type II.

NIDDM)

• Ketoacidosis, hyperosm.nonketotic coma

hypoglycemia

• Thyreotoxic crisis

• Postoperative myxedema, coma (rare)

• Postoperative adrenal gland insuff.

Complications of TPN

• Requires central venous access

• (Hematoma, PTX, infections, venous thrombosis, air embolism)

• Potential fluid overload

• Electrolyte abnormalities

• Hyperglycemia or hypoglycemia

• Overfeeding

• Small-bowel mucosal atrophy and impaired immune function