Due to anesthesia
Due to surgery
Anesthetic complications depend on the
mode (General or Local) and types of
anesthetic agent used (anesthetic agent
DUE TO SURGERY
Refers to problems arising during surgery
Due to anesthesia
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
1) Complications of laryngoscopy and intubation
2) Respiratory obstruction
4) Hypercapnia and hypocapnia
6) Aspiration pneumonia
I- Complications of laryngoscopy
1. Errors of ETT positioning
a. Esophageal intubation
b. Endobronchial intubation
c. Position of the cuff in the larynx
mild or severe injury caused by rough and inexperienced use
These include minor damage to the soft tissues within the
throat which causes a sore throat after the operation to major
injuries to the larynx and pharynx causing permanent
scarring, ulceration and abscesses if left untreated.
Additionally, there is a risk of causing tooth damag
2. Airway trauma:
a. Tooth damage.
b. Dislocated mandible.
c. Sore throat.
d. Pressure injury on trachea.
e. Edema of glottis or trachea.
f. Post intubation granuloma of vocal cords
3. Physiologic responses to airway
a. Sympathetic stimulation
4. ETT malfunction:
a. Risk of ignition during laser
b. ETT obstruction
c. Cuff perforation
1. Inadequate tidal volume.
2. Retraction of the chest wall and of thesupraclavicular, infraclavicular
3. Excessive abdominal movement.
4. Use of accessory muscles of respiration.
5. Noisy breathing (unless obstruction is absolute andcomplete).
7. The natural heave of the chest and abdomen becomesreplaced by an
indrawing of the upper chest and anoutpushing of the abdomen because
of strongdiaphragmatic action.
II- Respiratory obstruction
Sites of obstruction
At the lips.
By the tongue
Above the glottis
At the glottis: laryngeal spasm, relaxed
vocalcords and FB.
Faults of apparatus: Kink or obstruction
Upper airway obstruction in PACU
include incomplete anesthetic recovery, laryngospasm,
airway edema, wound hematoma, and vocal cord
Airway obstruction in unconscious patients is most
commonly due to the tongue falling back against the
Laryngospasm and laryngeal
is a forceful involuntary spasm of the laryngeal
musculature caused by sensory stimulation of the
superior laryngeal nerve.
Triggering stimuli include pharyngeal secretions
extubating in stage 2.
The large negative intrathoracic pressures generated
by the struggling patient in laryngospasm can cause
B.Treatment of laryngospasm
initial treatment includes 100%oxygen,
anterior mandibular displacement,
and gentle CPAP (maybe applied by face mask).
If laryngospasm persists and hypoxia develops,
succinylcholine (0.25-1.0 mg/kg; 10-20 mg).
Treatment of glottic edema and subglottic edema
administer humidified oxygen by mask,
inhalation of racemic epinephrine,repeated every 20
hydrocortisone IV may be considered.
Reintubation with a smaller tube may be helpful
PaO2 less 60 mmHg or SaO2 less 90%
1. Decreased FiO2
3. V/Q mismatch
4. Increased O2 utilization by tissues
5. Tissue hypoxia
Clinical signs of hypoxia
(sweating, tachycardia, cardiac arrhythmias,hypertension,
and hypotension) are nonspecific;
bradycardia,hypotension, and cardiac arrest are late signs
oxygen therapy with or without positive airway pressure.
Additionally, treatment of the cause
PaCO2 or ETCO2 > 40 mmHg.
3-Increased dead space
4-Increased CO2 production by tissues
of the cause
1- Respiratory obstruction
2- Factors affecting the ventilatory drive
a. Respiratory depressant drugs
c. CV stroke
3- Peripheral factors
a. Muscle weakness
c. Decreased diaphragmatic movement.
d. Pneumo or hemothorax.
e. Decreased chest wall compliance e.g. kyphoscoliosis.
B. Hypoventilation in the PACU is most commonly caused by
residual depressant effects of anesthetic agents on respiratory drive or persistent
should be directed at the underlying cause.
Marked hypoventilation may require controlled ventilation until contributory factors are
identified and corrected.