ways to prevent postoperative complications, zirgham 611
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Prepared by:Zirgham HafeezGr#611Gr#611
Ways to Prevent Ways to Prevent Post-Post-operative operative complicationscomplications
OBJECTIVESOBJECTIVES
RISK FACTORSRISK FACTORS
TYPES OF PATHOLOGYTYPES OF PATHOLOGY
TYPES OF SURGERYTYPES OF SURGERY
COMPLICATIONS & THEIR MANAGEMENTCOMPLICATIONS & THEIR MANAGEMENT
Postoperative Complications (Morbidity) Account for:
1. Considerable human pain and suffering.
2. Increased cost of the health- care.
3. Can lead to postoperative death.
Postoperative Complications (Morbidity) Account for:
1. Considerable human pain and suffering.
2. Increased cost of the health- care.
3. Can lead to postoperative death.
Accept that complications are best anticipated and avoided.
Recognize the incidence of co-morbidity.
Understand the importance of matching the procedure to the associated risks.
Appreciate the importance of recognizing complications early and treating them vigorously.
Accept that complications are best anticipated and avoided.
Recognize the incidence of co-morbidity.
Understand the importance of matching the procedure to the associated risks.
Appreciate the importance of recognizing complications early and treating them vigorously.
So the objectives areSo the objectives are:-:-So the objectives areSo the objectives are:-:-
Can be generally applicable to all the procedures OR specific to the operations.
Age both extremes (Very young & Very old)
Obesity
Can be generally applicable to all the procedures OR specific to the operations.
Age both extremes (Very young & Very old)
Obesity
Co-morbid conditions: Cardiovascular diseases Respiratory diseases DM Renal diseases Metabolic factors Infections Wound healing Peripheral vascular diseases
Co-morbid conditions: Cardiovascular diseases Respiratory diseases DM Renal diseases Metabolic factors Infections Wound healing Peripheral vascular diseases
Drug therapy (Concurrent drugs used)[Steroids, Immunosuppressant, Antibiotics]
Blood transfusion
Drug therapy (Concurrent drugs used)[Steroids, Immunosuppressant, Antibiotics]
Blood transfusion
Obstructive Jaundice
Neoplastic Diseases
Obstructive Jaundice
Neoplastic Diseases
Minimally Invasive Surgery
Orthopedic Surgery
Gynaecology
Thoracic & Upper Abdominal Surgery
Prolonged Operations
Minimally Invasive Surgery
Orthopedic Surgery
Gynaecology
Thoracic & Upper Abdominal Surgery
Prolonged Operations
Complications of surgery may broadly be classified as those:
I. Due to Anesthesia
II. Due to Surgery
Complications of surgery may broadly be classified as those:
I. Due to Anesthesia
II. Due to Surgery
The anesthetic complications depend upon the mode (General, Regional & Local) and types of anesthetic (the anesthetic agent toxicity).
The anesthetic complications depend upon the mode (General, Regional & Local) and types of anesthetic (the anesthetic agent toxicity).
(A) LOCAL ANESTHESIA: (A) LOCAL ANESTHESIA: Injection site: Pain, haematoma, Nerve
trauma, infection
Vasoconstrictors: Ischemic necrosis
Systemic effects of LA agent: Allergic reactions, toxicity
Injection site: Pain, haematoma, Nerve
trauma, infection
Vasoconstrictors: Ischemic necrosis
Systemic effects of LA agent: Allergic reactions, toxicity
(B) SPINAL, EPIDURAL & CAUDAL
ANESTESIA:
(B) SPINAL, EPIDURAL & CAUDAL
ANESTESIA: Technical failure Headache due to loss of CSF Intrathecal bleeding Permanent N. or spinal cord
damage Paraspinal infection Systemic complications
(Severe hypotension)
Technical failure Headache due to loss of CSF Intrathecal bleeding Permanent N. or spinal cord
damage Paraspinal infection Systemic complications
(Severe hypotension)
(C) GENERAL ANESTESIA: (C) GENERAL ANESTESIA: Direct trauma to mouth or
pharynx.
Slow recovery from anesthesia due to drug interactions OR in-appropriate choice of drugs or dosage.
Hypothermia due to long operations with extensive fluid replacement OR cold blood transfusion.
Direct trauma to mouth or pharynx.
Slow recovery from anesthesia due to drug interactions OR in-appropriate choice of drugs or dosage.
Hypothermia due to long operations with extensive fluid replacement OR cold blood transfusion.
Allergic reactions to the anesthetic agent:
Minor effects eg: Postoperative nausea &
vomiting Major effects eg: Cardiovascular collapse,
respiratory depression)
Haemodynamic Problems: Vasodilation & shock
Allergic reactions to the anesthetic agent:
Minor effects eg: Postoperative nausea &
vomiting Major effects eg: Cardiovascular collapse,
respiratory depression)
Haemodynamic Problems: Vasodilation & shock
Perioperative: Haemorrhage, organ damage,
electro-cautery related etc…
Postoperative complications which may be considered under 2 headings:
I. Immediate OR early II. Late
Perioperative: Haemorrhage, organ damage,
electro-cautery related etc…
Postoperative complications which may be considered under 2 headings:
I. Immediate OR early II. Late
Specific (Procedure Related): Specific (Procedure Related):
Respiratory: Collapse, consolidation,
aspiration etc. Cardiovascular: Haemorrhage (Primary,
Reactionary, Secondary) Shock (Hypovolemic, septic,
cardiogenic, neurogenic) Myocardial infarction Deep venous thrombosis
Respiratory: Collapse, consolidation,
aspiration etc. Cardiovascular: Haemorrhage (Primary,
Reactionary, Secondary) Shock (Hypovolemic, septic,
cardiogenic, neurogenic) Myocardial infarction Deep venous thrombosis
Thromboembolic
Septic: Wound, abscess collections
Gastrointestinal: Intestinal obstruction Anastomotic leakage,
intraabdominal abscess formation, enterocutaneous fistulae
Wound complications: Infections, dehiscence, etc.
Thromboembolic
Septic: Wound, abscess collections
Gastrointestinal: Intestinal obstruction Anastomotic leakage,
intraabdominal abscess formation, enterocutaneous fistulae
Wound complications: Infections, dehiscence, etc.
Renal: Oliguria, acute renal failure Hepatic: Jaundice, hepatocellular
dysfunction/ insufficiency Cerebral: Psychological, Neuropsychiatric
complications (delirium, etc.) Drug-related: Anesthetic, antibiotics, specific
medical disease treatment toxicity Nerve injuries: Compression, traction, cautery,
severed, etc.
Renal: Oliguria, acute renal failure Hepatic: Jaundice, hepatocellular
dysfunction/ insufficiency Cerebral: Psychological, Neuropsychiatric
complications (delirium, etc.) Drug-related: Anesthetic, antibiotics, specific
medical disease treatment toxicity Nerve injuries: Compression, traction, cautery,
severed, etc.
Wound: Hypertrophic scar, keloid, wound sinus,
implantation dermoids, incisional hernia
Adhesions: Intestinal obstruction, strangulation Altered anatomy/Pathophysiology: Bacterial overgrowth, short gut
syndrome, postgastric surgery syndromes, etc.
Susceptibility to other diseases: Malabsorption, incidence of cancer, tuber-
culosis, etc.
Wound: Hypertrophic scar, keloid, wound sinus,
implantation dermoids, incisional hernia
Adhesions: Intestinal obstruction, strangulation Altered anatomy/Pathophysiology: Bacterial overgrowth, short gut
syndrome, postgastric surgery syndromes, etc.
Susceptibility to other diseases: Malabsorption, incidence of cancer, tuber-
culosis, etc.