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Perioperative complications (respiratory)


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Perioperative complications (respiratory)

  1. 1.  Due to anesthesia  Due to surgery  Anesthetic complications depend on the mode (General or Local) and types of anesthetic agent used (anesthetic agent toxicity).
  2. 2. DUE TO SURGERY  Perioperative  Complications Postoperative complications Immediate/early complications Late  PERIOPERATIVE COMPLICATIONS Refers to problems arising during surgery
  3. 3. 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
  4. 4. Respiratory complications 1) Complications of laryngoscopy and intubation 2) Respiratory obstruction 3) Hypoxemia 4) Hypercapnia and hypocapnia 5) Hypoventilation 6) Aspiration pneumonia
  5. 5. I- Complications of laryngoscopy and intubation 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 of laryngoscopes.  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
  6. 6. 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
  7. 7. 3. Physiologic responses to airway instrumentation  a. Sympathetic stimulation  b. Laryngospasm  c. Bronchospasm 4. ETT malfunction:  a. Risk of ignition during laser surgery  b. ETT obstruction  c. Cuff perforation
  8. 8. Signs  1. Inadequate tidal volume.  2. Retraction of the chest wall and of thesupraclavicular, infraclavicular and suprasternalspaces.  3. Excessive abdominal movement.  4. Use of accessory muscles of respiration.  5. Noisy breathing (unless obstruction is absolute andcomplete).  6. Cyanosis.  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.
  9. 9. II- Respiratory obstruction Sites of obstruction  At the lips.  By the tongue  Above the glottis  At the glottis: laryngeal spasm, relaxed vocalcords and FB.  Bronchospasm  Faults of apparatus: Kink or obstruction of ETT
  10. 10. Upper airway obstruction in PACU  include incomplete anesthetic recovery, laryngospasm, airway edema, wound hematoma, and vocal cord paralysis.  Airway obstruction in unconscious patients is most commonly due to the tongue falling back against the posterior pharynx.
  11. 11. Laryngospasm and laryngeal edema A. Definition Laryngospasm  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 pulmonary edema
  12. 12. 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 minutes,  hydrocortisone IV may be considered.  Reintubation with a smaller tube may be helpful
  13. 13. III- Hypoxemia  PaO2 less 60 mmHg or SaO2 less 90% Causes:      1. Decreased FiO2 2. Hypoventilation 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 Treatment  oxygen therapy with or without positive airway pressure. Additionally, treatment of the cause
  14. 14. IV) Hypercapnia  PaCO2 or ETCO2 > 40 mmHg. Causes:  1-Increased FiCO2  2-Hypoventilation  3-Increased dead space  4-Increased CO2 production by tissues Treatment:  of the cause
  15. 15. V) Hypoventilation A. Causes  1- Respiratory obstruction  2- Factors affecting the ventilatory drive    a. Respiratory depressant drugs b. Hypothermia c. CV stroke  3- Peripheral factors      a. Muscle weakness b. Pain 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 neuromuscular blockade. C.Treatment   should be directed at the underlying cause. Marked hypoventilation may require controlled ventilation until contributory factors are identified and corrected.