perioperative complicationsurinary tract complications ii. •urinary tract infection • -tipically...
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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