Anesthesia 5th year, 12th lecture/part one (Dr. Aamir)

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The lecture has been given on May 10th, 2011 by Dr. Aamir.

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Anesthesia 5th year, 12th lecture/part one (Dr. Aamir)

  1. 1. Post operative complications
  2. 2. Bleeding abnormality <ul><li>Causes: </li></ul><ul><li>Hemorrhage 2ndary to inadequate surgical hemostasis. </li></ul><ul><li>Coagulopathies: </li></ul><ul><li>A. Decreased platelet count or defect in its function in patients on aspirin treatment. </li></ul><ul><li>(Diagnosis by platelet count &bleeding time) </li></ul>
  3. 3. <ul><li>B. Disseminated intravascular coagulation </li></ul><ul><li>diagnosis by thrombocytopenia prolong prothrombin time ,decrease serum conc. Of fibrinogen and increased circulatory level of fibrin split products. </li></ul><ul><li>C. Dilution of factors V and VIII after massive whole blood transfusion Diagnosis by: prothrombin time ,partial thromboplastin time. </li></ul>
  4. 4. Decreased body temperature <ul><li>Causes: </li></ul><ul><li>Cold operative room. </li></ul><ul><li>Patient age (pediatrics & geriatrics). </li></ul><ul><li>Use of large volumes of cold fluid and blood. </li></ul><ul><li>Massive bleeding. </li></ul><ul><li>Cold gases inhalation spc. in prolong surgery. </li></ul>
  5. 5. Treatment <ul><li>Maintain operating room temperature near 21ºC . </li></ul><ul><li>Worm the inhaled gases. </li></ul><ul><li>Use skin surface warming (water blanket). </li></ul><ul><li>All fluids & blood should be wormed before giving it to the patient. </li></ul>
  6. 6. Agitation (Emergence delirium) <ul><li>Patients at risk: </li></ul><ul><li>Young patients. </li></ul><ul><li>Apprehensive. </li></ul><ul><li>Individuals who fear pain. </li></ul><ul><li>Arterial Hypoxemia and/or Hypercapnia. </li></ul><ul><li>As a Perception of pain. </li></ul><ul><li>Patient who took scopolamine preoperatively. </li></ul><ul><li>Urinary retention. </li></ul>
  7. 7. Treatment <ul><li>According to the cause </li></ul>
  8. 8. Delayed awakening <ul><li>Causes: </li></ul><ul><li>Residual drug effects (most common cause) (opioids, benzodiazepines). </li></ul><ul><li>Hypothermia. </li></ul><ul><li>Hypoglycemia. </li></ul><ul><li>Electrolyte disturbances </li></ul><ul><li>Arterial hypoxemia. </li></ul><ul><li>Increased ICP (cerebral hemorrhage). </li></ul><ul><li>Air embolism. </li></ul><ul><li>Hysteria. </li></ul>
  9. 9. Management <ul><li>When delayed awakening occur its important to measure blood pressure, SPO2, body temp., also evaluate The ECG and perform neurologic examination. </li></ul><ul><li>Blood gas measurement, pH, blood sugar , s. electrolytes. </li></ul><ul><li>Radiographic procedures. </li></ul><ul><li>Treat the cause. </li></ul>
  10. 10. Nausea & vomiting <ul><li>Causes: </li></ul><ul><li>History of post operative emesis. </li></ul><ul><li>Female gender </li></ul><ul><li>Obesity </li></ul><ul><li>Postoperative pain </li></ul><ul><li>Type of surgery (eye muscle, middle ear, laparoscopic surgery). </li></ul><ul><li>Anesthetic drugs (opioids). </li></ul><ul><li>Gastric distension. </li></ul>
  11. 11. Management <ul><li>Give droperidol, Metoclopromide as prophylactic treatment for susceptible cases. </li></ul><ul><li>Rule out the cause. </li></ul>
  12. 12. <ul><li>Thank You </li></ul>

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