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Ways to prevent postoperative complications, zirgham 611

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  • 1. Ways to PreventPost-operativecomplications Prepared by: Zirgham Hafeez Gr#611
  • 2. OBJECTIVESRISK FACTORSTYPES OF PATHOLOGYTYPES OF SURGERYCOMPLICATIONS & THEIRMANAGEMENT
  • 3. Postoperative Complications(Morbidity) Account for:1. Considerable human pain and suffering.2. Increased cost of the health-care. 3. Can lead to postoperativedeath.
  • 4. So the objectives are:- 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.
  • 5. C an be g e n e r a lly a p p lic a b le t o a ll t h e proc e dure s OR s p e c if ic to the o p e r a t io n s . Age both extremes (Very young & Very old)
  • 6.  Co-morbid conditions:  Cardiovascular diseases  Respiratory diseases  DM  Renal diseases  Metabolic factors  Infections  Wound healing  Peripheral vascular diseases
  • 7.  Drug therapy (Concurrent drugs used) [Steroids, Immunosuppressant, Antibiotics] Blood transfusion
  • 8.  Obstructive Jaundice Neoplastic Diseases
  • 9.  Minimally Invasive Surgery Orthopedic Surgery Gynaecology Thoracic & Upper Abdominal Surgery Prolonged Operations
  • 10. C o m p lic a t io n s ofs u r g e r y m a y b r o a d lybe c la s s if ie d astho s e :I. Due to AnesthesiaII. Due to Surgery
  • 11. Th e a n e s t h e t icc o m p lic a t io n sde pe nd upon themode ( G e n e r a l,R e g io n a l & L o c a l)a nd typ e s ofa n e s t h e t ic ( the
  • 12. (A) LOC ALA N E S T H E S IA :Injection site: Pain, haematoma, Nerve trauma, infection Vasoconstrictors: Ischemic necrosis Systemic effects of LA agent: Allergic reactions, toxicity
  • 13. ( B ) S P IN A L , E P ID U R A L& C AUDALA N E S T E S IA : Technical failure Headache due to loss of CSF Intrathecal bleeding Permanent N. or spinal cord damage Paraspinal infection Systemic complications (Severe hypotension)
  • 14. (C ) G ENERALA N E S T E S IA : 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.
  • 15.  Allergic reactions to the anesthetic agent:  Minor effects eg: Postoperative nausea & vomiting  Major effects eg: Cardiovascular collapse, respiratory depression) Haemodynamic Problems: Vasodilation & shock
  • 16. Specific (Procedure Related): Perioperative: Haemorrhage, organ damage, electro- cautery related etc… Postoperative complications which may be considered under 2 headings: I. Immediate OR early II. Late
  • 17.  Respiratory:  Collapse, consolidation, aspiration etc. Cardiovascular: Haemorrhage (Primary, Reactionary, Secondary)  Shock (Hypovolemic, septic, cardiogenic, neurogenic)  Myocardial infarction  Deep venous thrombosis
  • 18.  Thromboembolic Septic:  Wound, abscess collections Gastrointestinal:  Intestinal obstruction  Anastomotic leakage, intraabdominal abscess formation, enterocutaneous fistulae Wound complications:  Infections, dehiscence, etc.
  • 19.  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.
  • 20.  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.