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Complications of major surgery

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  • 1. COMPLICATIONS OF MAJOR SURGERY
    OLUSEYE AYOOLA SOYEBO
    DEN/2005/075
  • 2. OUTLINE
    INTRODUCTION
    Definition
    CLASSIFICATION
    Due to anesthesia
    Complications of G.A.
    Due to surgery
    Perioperative complications
    Postoperative complications
    Immediate/early
    Late complications
  • 3. INTRODUCTION
    SURGERY:
    Medical treatment that involves operations on or manipulations of the patient's body and, usually, cutting the body open to perform these.
    COMPLICATION:
    a disease or problem that arises in addition to the initial condition or during a surgical operation.
  • 4. Complications of major surgery can be broadly classified as those:
    Due to anesthesia
    Due to surgery
  • 5. DUE TO ANESTHESIA
    Anesthetic complications depend on the mode (General or Local) and types of anesthetic agent used (anesthetic agent toxicity).
  • 6. COMMON COMPLICATIONS OF G.A.
    Direct trauma to the mouth
    Slow recovery from anesthesia due to drug interactions or inappropriate choice of drug dosage.
    Hypothermia due to long operations with extensive fluid replacement/cold blood transfusion.
    Allergic reaction to anesthetic agent
    Minor effect: post-op nausea & vomiting
    Major effect: CVS collapse, respiratory depression
  • 7. DUE TO SURGERY
    Perioperative complications
    Postoperative complications
    Immediate/early complications
    Late complications
  • 8. PERIOPERATIVE COMPLICATIONS
    Refers to problems arising during surgery, which include:
    Hypotension
    Blood loss
    Mismatched blood transfusion
    Vasodilatation from a combination of premedication and anesthetic agents.
    Raised blood pressure
    Use of ketamine
    Phaechromocytoma
    Uncontrolled hypertension
  • 9. Cardiac arrest
    Air embolism
    Tissue hypoxia
    Blood loss
    Air embolism
    Increase in circulating catecholamine
    Use of exogenous adrenaline in the presence of hydrogenated hydrocarbons e.g. Halothane
    Hypoxia
    Reduced o2 in inspired air
    Inadequate blood flow in myocardial failure
    Inadequate alveolar ventilation due to respiratory depression
    Insufficient functioning hemoglobin
  • 10. Asphyxia
    Combination of hypoxia & hypercapnia, caused by respiratory obstruction
    SIGNS:-
    Noisy breathing during partial obstruction
    In the presence of endotracheal tube, difficulty in inflating & deflating the lungs
    Cyanosis
    CAUSES:- physical & mechanical.
    Flexed head in anesthetized px with/without endotracheal tube.
    Endotracheal tube blocked by pus, blood, foreign bodies.
  • 11. Pressure on trachea from without, during operations on large tumors of the neck e.g. thyroidectomy
    Chemical causes
    Inhalation of intestinal contents {can be due to stimulation of the back of the tongue by foreign bodies e.g. laryngoscope
  • 12. POST OPERATIVE COMPLICATIONS
    Refers to complications arising after surgical operations
    Immediate/Early complications
    Respiratory,
    Cardiovascular,
    CNS,
    Genito-urinary,
    GIT and
    Wound complications
  • 13. Respiratory Complications
    Respiratory insufficiency
    Airway obstruction
    Often caused by the tongue which falls back to block the oro- and nasopharynx
    Presence of foreign bodies e.g. gastric contents, blood, pus, forgotten throat packs.
    Aspiration
    Aspiration of gastric contents in px that have recently eaten
    Hiccough
    Clonic spasm of the diaphragm with reflex closure of the glottis. It may occur soon after operation due to irritation of the mucosa of the esophagus and stomach by anesthetic gases
  • 14. Atelectasis(pulmonary collapse)
    Increased quantity/viscosity of bronchial secretion
    Deficiency in mechanism for expelling bronchial secretion
    Intubation of respiratory tract
    Bronchopneumonia
    Infection of Atelectasis
  • 15. CVS
    Hemorrhage
    Reactionary (occurring within 24hrs)
    Dislodgement of a blood clot/loose ligature at the cut end of a blood vessel
    Oozing of blood from an extensive raw area
    Platelet deficiency resulting in impaired clotting
    Prothrombin deficiency, e.g. in liver dx
  • 16. Secondary hemorrhage (after 7days)
    Bleeding follows necrosis of blood vessels from infection and may be accompanied or preceeded by fever
    SIGNS
    Pallor, sweating and cool skin
    Bleeding from wound
    CARDIAC ARREST
    Commonest cause is tissue hypoxia which may result from:
    Resp. obstruction
    Severe hemorrhage
    shock
  • 17. Deep venous thrombosis
    Venous stasis
    Age
    Roughening of the endothelium resulting from trauma
    Myocardial infarction
  • 18. CNS
    Failure to recover consciousness
    May be due to cerebral hypoxia as a result of e.g. hypoglycemia
    Convulsion
    Attacks of involuntary tonic or clonic movements of the trunk, limbs and face with or without loss of consciousness.
    Predisposing fx in the post-op period are:
    Pyrexia
    Epilepsy
    hypocalcaemia
  • 19. GENITO-URINARY
    Retention of urine
    failure to pass urine within 12-24hrs of surgery when bladder is distended.
    more common after pelvic and perineal operations.
    Due to action of atropine & other cholinergic anesthetic agents (decrease muz contractility)
    Pain in operation site
    Urinary tract infections
  • 20. GIT
    Nausea & vomiting
    May be caused by anesthetic agents
    Peritonitis &intra-abdominal abscesses
    Following operation in septic conditions
    Diarrhea
    Drugs: oral antibiotics, laxatives, magnesium containing antacids.
    Operations: vagotomy & drainage, gut resection.
    Upper GI bleeding
  • 21. WOUND COMPLICATIONS
    Hematoma
    Predisposes to infection and delays wound healing
    Infection
    Usually occurs 5-7days after surgery
    Contributing factors:
    Longer duration of operation
    Age
    Poor surgical technique
    Wound dehiscence
    Raised intra-abdominal pressure
    Weakness of wound
  • 22. POST OPERATIVE PYREXIA
    Pyrexia after operation may be caused by:
    Metabolic response to trauma in the first 24hrs
    Infection or hematoma of the wound
    Laryngo-tracheitis from endotracheal intubation
    Peritonitis or intra-abdominal abscess
    Complications of blood transfusion: mismatched blood
    Drug sensitivity
    Injection abscess
  • 23. LATE COMPLICATIONS
    WOUND
    Hypertrophic scar, keloid, wound sinus.
    ADHESIONs
    Strangulation, intestinal obstruction
  • 24. THANK YOU

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