complications of anaesthesia

1. Anaesthesia (management of patient during operation
and post operation, system complications of
anaesthesia, types of anaesthesia, indications)
19/BSU/BNS/074
19/BSU/BNS/034

2. ANAESTHESIA
• This is away to control pain during a surgical procedure by using
medicine called anesthetics.
• It involves loss of feeling or sensation in part or all of the body.
• TYPES OF ANAESTHESIA
• General anaesthesia
• Local anaesthesia
• Regional anaesthesia

3. ANESTHESIA
LOCAL
ANAESTHESIA
REGIONAL
ANAESTHESISA
GENERAL ANAESTHESIA
TOPICAL
INFILTRATION
Peripheral
nerve block
Total inhalation
anaesthesia
Balanced
anaesthesia
Total
intravenous
anaesthesia
Inhalant anaesthesia
Injectable anaesthesia
anestheticadjuncts
epidural
spinal
Intravenous
regional

4. Total inhalaion spinal

5. EPIDURAL
Peripheral nerve block

6. Intravenous regional

7. TYPE OF ANAESTHESIA INDICATIONS
GENERAL ANAESTHESIA • Major head and neck General tracheal
• Upper abdominal
• Intrathoracic
• Ear, nose and throat
• Endoscopic
LOCAL ANAESTHESIA • Minor surgeries
• Hemorrhoids
• Minor burns
• Incision and drainage
• Painfully invasive diagnostic procedures or incised abscess
• Removals of cysts, residual infection areas, neoplastic growths
• Circumcision for adults
REGIONAL
ANAESTHESIA
• Caesarean
• • Laparotomy
• • Repair of third and fourth degree perineal tears

8. SYSTEMIC COMPLICATIONS OF ANAESTHESIA
CARDIOVASCULAR COMPLICATIONS
RESPIRATORY COMPLICATIONS
GASTROINTESTINAL COMPLICATIONS
URINARY COMPLICATIONS
NEUROLOGICAL COMPLICATIONS
COMPLICATIONS IN EYE SURGERY
OTHER COMPLICATIONS

9. CARDIOVASCULAR COMPLICATIONS
Hypotension
Management
• Find and treat cause
• Start rapid infusion of fluids
• Increase the concentration of oxygen and reduce the concentration of
anaesthetic agent .if blood pressure is below 80mmHg then turn off the
volatile agent and give the patient 100% oxygen.
• Use vasopressors to raise the blood pressure when its dangerously
low(below 80mmHg). In spite f the above measures mentioned above.
Vasopressors are of most use if the cause of hypotension is due to
peripheral vasodilation .
• The patients feet can be raised above the level the trunk to help venous
return

10. Hypertension
Management
• Correct and treat the cause
• Deepen anaesthesia
• Relieve pain
• Increase ventilation
• Elevate the head of the table
• Drug treatment
• NB: if the above measures do not reduce the blood pressure and the
diastolic blood pressure persists above 100mmHg, the a hypotensive
agent such as Hydralazine(5mg IV) or propranolol(1mg IV) may be
used and repeated as necessary. Also increase of volatile agent should
be tried first.

11. Bradycardia
Management
• Find and treat the cause
• If the pulse is less than 60b/min and the patient is hypotensive, give atropine 0.6mg IV in
divided doses.
• The indication to treat the bradycardia would be its effect on the cardiac output and
therefore on the blood pressure .
• If the bradycardia is associated with a fall in blood pressure , treatment is needed more
urgently.
Tachycardia
Management
• Find and treat the cause
• An ECG is necessary to diagnose the type of arrhythmia
• Treatment of specific arrhythmia must be left in the hands of the doctor.

12. Air embolism
Management
• Speedy recognition is essential
• Prevent further entry of air into the blood stream by jugular compression and by folding the wound by
saline.
• Place the patient in the left lateral head-down position. This will help to tap the air bubbles in the right
atrium and prevent entry into the lungs
• Discontinue N2O
• Give 100% oxygen if intubated, treat hypotension and arrhythmias
• Aspirate the air from right heart by means of a catheter.
• Fat embolism(usually associated with fractures of long bones of lower limbs, particles of fat are
carried in the blood stream and deposited in the lungs, brain and skin)
• Management
• Stabilize fracture
• High doses of steroids have been advocated but their use is not supported by clinical data

14. RESPIRATORY COMPLICATIONS
Coughing
Management
• Remove the airway and suction the pharynx
• Give O2 if required
• Deepen anaesthesia
Tachypnoea
Management
• The cause must be found first
• Assist ventilation
• Control ventilation, necessary depending on how rapid the respiration is.

15. • Pneumothorax
• Closed(air is trapped in the pleural cavity when the chest wall is intact)
• Open(there is an opening the chest wall or breach pleural chest fistula leading to a communication with the atmosphere)
• Tension (a flap of pleura may act as a valve , this will enable air to enter the pleural cavity during respiration but prevent it from
leaving during expiration)
• Management
• Discontinue nitrous oxide and give 100% oxygen
• 14g or 16g needles must be inserted into the pleural cavity on the affected side in the 2nd intercostal space in the
midclavicular line.
• Pulmonary embolism( occurs when a clot from vein I the lower limb or pelvis is detached and carried to
the lung)
• Management
• Give oxygen
• Give analgesia for pain
• Start in anticoagulants e.g.. Heparin
• Surgery (embolectomy)
• Treat any arrhythmias which may occur

17. GASTROINTESTINAL COMPLICATIONS
• Vomiting and aspiration
• Vomiting is an active process involving expulsion of material from alimentary tract by muscular contraction.
• Management during anaesthesia
• Position the patient head-down lateral( this minimizes the chance of vomited material being aspirated)
• Suction, clears the airway of any vomitus
• Give oxygen
• Always watch for signs of aspiration . The patient may show evidence of dyspnea, wet or moist breath sounds,
wheezing either at the time vomiting or some hours after the incident. A chest x-ray must be done if this is
suspected.
• Management of aspiration during anaesthesia
• Oxygen therapy
• Give bronchodilators (Ventolin 250micrograms IV 50micrograms IM)
• IPPV with oxygen
• Bronchoscopy
• Active chest physiotherapy.

18. • Hiccups (a state of intermittent spasms of the diaphragm caused by stimulation of the sensory nerve ending
in the diaphragm occurs with upper abdominal or thoracic surgery)
• Management
• Gastric decompression using NG tube
• Minimize irritation or stimulation of the diaphragm
• Deepen anaesthesia
• Use a muscle relaxant and IPPV
• Gastric distension
• Treat gastric distension by passing an NG tube.

19. URINARY COMPLICATIONS
• Difficulty in urine passing
• Occurs in patients who undergone spinal or general anaesthesia for abdominal, pelvic or perineal surgery with
heavy sedations.
• Reduction in output
• Causes:
• Pre-renal causes
• Corrected by fluid load e.g. 1ltr of saline solution administered over half an hour
• Renal causes( caused by hypoxia ,hypotension bacterial toxins, mismatched blood transfusions and drugs)
• Maintain adequate renal perfusion, maintaining electrolyte balance is necessary and in more severe cases renal
dialysis is necessary.
• Careful fluid management to avoid overload is necessary.
• Post renal causes (caused by obstruction in the urinary tract or catheter)
• Change of catheter might be necessary if the bladder is enlarged.

20. NEUROLOGICAL COMPLICATIONS
• Coma and convulsions
• These may follow the use f regional or general anaesthesia
• Management of coma
• Maintain normotension and oxygenation
• Tilt the head up at 300
• Support the circulation
• Give mannitol 20% 0.5gm/kg
• Management of convulsions
• Treat the cause
• Give oxygen
• Give anticonvulsants e.g. diazepam, midazolam or thiopetone.
• Treat any associated cerebral oedema.

21. COMPLICATIONS IN EYE SURGERY
Corneal abrasions( theses occur easily during anaesthesia if the eyes are left open, the cornea dries
very quickly and is easily injured)
Blindness
• It occurs due to excessive pressure of the mask o the eyeball especially if the patient is hypotensive, can
result in serious damage or blindness by occluding the blood supply to the eyes. Careless positioning of the
patient is prone can also cause serious eye damage.
OTHER COMPLICATIONS
Shivering
Management
• Warm blankets
• Oxygen by mask as long as the shivering continues
• Sedation if shivering is excessive

22. MANAGEMENT OF PATIENT DURING OPERATION AND POST OPERATION
• DURING OPERATION
1. Replacement therapy
• Assess blood loss , the volume of blood in the suction unit and the weight of the blood in the sponges must be
determined, blood on the drapes and floor must be taken in to account
• The volume of irrigation fluid used by the scrub nurse should be noted and deducted from the contents of the
suction bottle.
• Blood loss is replaced by crystalloid solutions,0.9% saline maybe used in quantities of 3-4 times of the blood
lost. 5% dextrose must not be used as it is dissipated rapidly into the tissue species and can result in water
intoxication.
• Colloid solutions if available are useful
• Blood is needed when the loss reaches 15m/kg (1lr in and adult) provided the patient was not anemic
preoperatively
• Auto transfusion may be considered
• In cases of intestinal obstruction, fluid aspirated from the gut must also be replaced by electrolyte solutions

23. 1. Maintenance therapy
• Saline is used 10ml/kg/hr. in the first hour then 2-5ml/kg/hr.
thereafter depending on the type of surgery, the larger volume in the
first hour compensates for the period of fasting before surgery
• Maintenance fluid makeup for the insensible water loss from the
respiratory tract and also the operative site
• Large wounds and large areas of exposed gut may produce insensible
losses of unto 10ml/kg/hr.
• NB: the use of dry anaesthetic gases can increases water loss. E.g.
nitrous oxide , halothane, ether, sevoflurane, isoflurane

24. MANAGEMENT POST OPERATIVE PATIENT
• Assess the airway of the patient, check for any obstructions, check if the tongues is falling back.
• Check for breathing, respiratory rate (16-20 breaths/min) and oxygen saturation, if its below 95% then give
oxygen to the patient
• Check for breath sounds and lung sounds using a stethoscope.
• Check the heart rhythm, blood pressure, pulse, skin colour and sensation.
• Monitor the patient’s temperature , orientation and speech.
• Check for incisions for any bleeding, tubes, drains, IV fluids and urinary output its should be greater or equal to
0.5ml/kg/hr.
• The IV fluids should be flowing normally.
• Monitor the patients diet. It should be soft solid foods in small portions. Avoid raw fruits, vegetables and hard
foods.
• Assess for pain and give pain killers depending on the severity of pain.
• Patient education is necessary for post operative patients, assuring them about their feeding, pain and effects
of anaesthesia after operation.
• Position the patient in away that the airway is open