Complications in the first 48hrs after oral &/ dental implant courses

INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
POST OPERATIVE
COMPLICATIONS IN THE
FIRST 48Hrs
www.indiandentalacademy.com

WHAT ARE WE
GOING TO
DISCUSS……….?
Immediate post-op phase when pt is recovering from
GA.
Intermediate post-op phase when pt is confined to
the ward.

How does one pick up
complications…?
Problem based structure of post-op notes
SOAP
Subjective: Patients view
Objective : Observations by the doctor
Active problems: Analysis of key problems
Plan:Action taken based on the analysis.

www.indiandentalacademy.comwww.indiandentalacademy.com
Indian Dental academy
• www.indiandentalacademy.com
• Leader continuing dental education
• Offer both online and offline dental courses

VITAL SIGNS
TEMPERATURE 98.6*f
PULSE RATE 70/MIN
RESPIRATORY RATE 20/MIN
BLOOD PRESSURE 120/80mm of Hg

GENERAL POST-OP CHECK
Greet the pt – Assess consciousness and morale
General look – Cyanosis, pain, shock, dyspnoea
Ask pt to cough – Pain ,sputum retention ,Chest
infection
Temp chart – Pyrexia
Pulse & BP chart – Shock
Skin tugor & urine output – Hydration rate
Heels and buttocks – Pressure areas
Wound – Infection & dischargewww.indiandentalacademy.com

CHOAKING………!
Causes: Clot , bone fragment , gauze piece , tooth etc
Fall back of the tongue.
Spasm of vocal chords
Pt not completely recovered
from GA [No cough reflex]
Continuous laryngeal
spasm.
Asphyxia
Cyanosis
Recovered pt
Aspiration into the lungs

Management
High power suction.
Cricothyrotomy
Administer oxygen
In cases of lung aspiration –
Attempt suction.
If unsuccessful
Chest x-ray followed by immediate specialist opinion

Oxygen administration
Oxygen is usually given through a face mask or a nasal
cannula.
Through these devices inspired oxygen concentration varies
from 35% to 55% [ atmospheric Oxygen 21% ].
Flow rate varies from 4 to 10 l per minute.
Ensure maintenance of hypoxic drive in COPD.

MANAGEMENT OF POST-OP
LARYNGOSPASM
Chest compressions with positive pressure ventilation.
Administer 3mg/kg of succinylcholine I.M via submental
transcutaneous injection. 25 gauge needle is used.
Transtracheal administration.

COMPLICATIONS DUE TO
TRACHEOSTOMY IN THE 1ST
48 HRS.
Death.
Pneumothorax.
Haemorrhage.
Subcutaneous emphysema.

POST-OP VOMITING AND
REGURGITATION
Incidence 20% to 30%
Responsible factors:
SURGICAL: Type of surgery
Duration of surgery
PATIENT: Age – common in younger patients
Sex – Females
Medical problems: Obesity, anxiety, motion
sickness, Diabetes, colecystitis & neuromuscular
disorders.

POST-OP FACTORS: Pain, dizziness{ hypotention or
hypertension} , early oral intake, drugs.
CTZ [Not protected by BBB]
Paraventricular reticular formation{Emetic center}
Vomiting
Blood borne toxins, serotonin,
Dopamine, Histamine, Drugs
[narcotics, GA drugs]
Impulses from
pharynx,GIT,Mediastinum,
eyes,nose.
Mechanism

Management
Patient must be laid on his side to prevent aspiration of
vomitus.
ANTIEMETIC DRUGS: [For post-op vomiting]
5-HT3 Antagonists – Block vagal afferents from GIT and CTZ
Ondansetrone [Emeset] 4mg SOS and Grainsterone
Neuroleptics – Chlorpromazine, Haloperidol
Prokinetic drugs – Metoclopramide, Domperidone, cisapride
I.V fluid administration.

Muscle pains:
All depolarising agents produce wide
spread fasciculations. Most commonly associated with
suxamethonium.
These fasciculations are responsible for post-op muscle
pains.
Commonly experienced 24hrs after minor procedures that
do not keep the patient bedfast.
Usually subsides in a couple of days.www.indiandentalacademy.com

SORE THROAT
Occurs in almost all cases post-op.
Usually due the placement of throat pack or due to minor
injury during the placement of endotracheal tube.
Sometimes occur when the patient’s head is moved with the
tube in position.
Antiseptic solutions used during the surgical procedure.
Resolves uneventfully.

POST-OP FEVER
Causes for fever within 48hrs post-op
MILD PYREXIA:
Tissue damage and necrosis
Haematoma.
HIGH PERSISTENT PYREXIA:
Atelectasis
Specific infection related to the
surgery.
[UK – Medical encyclopedia ]www.indiandentalacademy.com

MANAGEMENT
Do not treat fever , TREAT THE CAUSE.
In cases of persistent fever a through investigation that
includes chest x-ray, blood investigation, ECG must be
done.
Antibiotics must be administered for infections.
Antipyretics like paracetamol [ inj Mol] , Diclofinac
sodium [Voviran] must be given.
With every 1 degree C rise in temp heart rate increases
by 9 to 10 beats. www.indiandentalacademy.com

POST-OP ATELECTASIS
“Collapse of a part of the lung substance following
obstruction in the bronchus or bronchiole.”
Characteristically occurs within the 1st
48hrs.
Area of the lung affected can vary from an entire lobe to a
patchy distribution.
CLINICAL FEATURES:
Pyrexia
Increased pulse rate and respiratory rate.
Respiratory distress with diminished chest movements.
Cyanosis.

Sputum:First frothy and clear later purulent.
Chest x-ray: Opacity in the involved area.
CAUSES FOR POST-OP ATELECTASIS
Pre-op causes:Preexisting chest infection- secretions, heavy
smokers,conditions like emphysema ,ankylosing spondylitis
that make coughing difficult.
Operative factors: Irritant anesthetic drugs.
Post-op factors: Thoracic or abdominal incisions which
inhibits the expectoration of accumulated bronchial secretions.
UK Medical encyclopedia.www.indiandentalacademy.com

MANAGEMENT
Remove impacted secretions by physiotherapy.
Postural drainage.
Analgesia.
Aspiration of secretions.
Antibiotics [ Pneumoccus most common-
Augumentin] and Metronidazole.
Positive pressure ventilation.

POST-OP URINARY RETENTION
INCIDENCE:3.8%
Males 4.7% Females 2.9%
More common in elderly
CAUSES:
Hypovolemia- MOST COMMON cause.
GA drugs
Intermittent vomiting
Lack of abulation
Blocked catheter www.indiandentalacademy.com

OTHER LESS COMMON CAUSES:
Subclinical obstructive bladder dysfunction and stones.
Overdistention of bladder before or during surgery.
Prostatic hyperplasia
Psychic inhibition.
Kidney stones www.indiandentalacademy.com

PHYSIOLOGY BEHIND POST-OP
URINARY RETENTION
Reduction in sodium excretion 36 to 48hrs post-op.
Secretion of ADH in response to stressful stimuli like
pain.
Increase in potassium excretion which is directly
proportional to tissue damage.www.indiandentalacademy.com

MANAGEMENT
Identification of cause is crucial.
If hypovolemia is the cause
STEP 1: Administer 500ml/hr fluids[ 250ml in cardiac
patients] and check JVP and pulse.
STEP 2: If urine output increases with corresponding rise in
JVP and fall in pulse continue and maintain IV fluids.
-In case of no improvement consider severe
hypovolemia.Continue fluids at the same rate.
-No improvement in output with increase in JVP and fall in
pulse warrants specialist opinion.www.indiandentalacademy.com

OTHER TREATMENT OPTIONS
Warm bag application.
Catheterisation- Not only useful in collecting urine but also to
measure its volume.
If catheter is blocked, change catheter.

Should be given only if congestive
cardiac failure or systemic overload is
suspected.
Furosemide [Lasix] 2mg or 4mg SOSwww.indiandentalacademy.com

POST-OP FLUID THERAPY
PRINCIPLES AND AIMS
To maintain fluid input under normal
circumstances.
To match any ongoing losses.
To replace any deficit occurring post-op.www.indiandentalacademy.com

MAINTAINENCE OF FLUIDS
Average fluid intake normally – 1.5ml/Kg/Hr [2.5 l/day]
Corresponding urine output - 1.2ml/Kg/Hr [2 l/day]
THE 4,2,1 THUMB RULE FOR FLUID
MAINTAINENCE
4ml/kg/hr for the first 10kgs – 40ml/hr
2ml/kg/hr for the next 10kgs – 20ml/hr
For each kg after that - 10ml/hr
An average adult will require 2500ml/day – approx 125ml/hr

FLUID DEFICIT
CLINICAL FEATURES:
Reduced skin tugor.
Dry mucous membranes.
Weight loss.
Tachycardia and orthostatic hypotension indicating
intravascular fluid retention.
Persistant oliguria – Most important sign

DIAGNOSIS
Clinical examination.
Measurement of urine output.
Haematocrit.
Urine sodium and osmolality: In dehydration body conserves
Na producing small volumes of concentrated urine. If
osmolalities more than 400 mosmols/kg and Na cons less than
20 m osml/l are measured – severe dehydrationwww.indiandentalacademy.com

WHICH FLUID? HOW MUCH? HOW
FAST?
The fluid rule:
1. The composition of the fluid given should be
similar to that which its replacing.
2. Rate of administration should equal the rate of
loss plus a rapid replacement of any pre
existing deficit.

WHICH FLUID GOES WHERE….?
INTRAVASCULAR COMPARMENT: Colloids are best retained
because the capillaries are impermiable to them. Used in hypovolemic
states and shock. Eg blood, albumin , gelatin,hydroxy ethyl
starch,dextrans.
INTERSTITIAL COMPARTMENT: O.9% Saline is retained here as
NaCl will freely cross the vascular comparment but will not cross the
cell membrane..There will be an initial increase in intravascular
comparment which will eventually come down as the solution gets out of
the vascular system.
INRAVASCULAR COMPARMENT: 5% Dextrose when given freely
crosses the capillaries to reach the interstitial comparment glucose is
metabolised increase in osmolality of ECF Water moves into the
cell.

POST-OP “THIRD-SPACE” LOSS
Tissue trauma, inflammation, infection
Increased vascular permiability
increased fluid movement into the extracellular space
Edema Reduction in intravascular volume
Colloids are most important to treat post-op hypovolemia
Its important to alternate them with crystalloids to restore
extracellular fluid volume.

DNS Dextrose normal saline:4.3% dextrose and
0.18% saline.
RL Ringer lactate: SODIUM- 130 mEq/l ,
CHLORIDE-109mEq/l, BICARBONATE-28mEq/l,
POTASSIUM-4mEq/l, CALCIUM-2.7mEq/l,
LACTATE-28mEq/l

POST-OP HYPOKALEMIA
CAUSES
Increased loss of potassium from the cell.
Loss of pottasium from kidneys to conserve sodium.
Starvation.
Most common during the first 72hrs after surgery.
CLINICAL FEATURES:
Drowsiness, slurred speech, muscular hypotonia.
Low BP and pulse rate, reddish face [filled up veins].
Thirst coupled with urinary incontinence.www.indiandentalacademy.com

MANAGEMENT
2gm kcl over a period of 4hrs IV.
Hyperkalemia occurs rarely due to over infusion.
POST-OP HYPONATREMIA:
Due to dehydration eyes appear shrunken.
Dry mouth. Tongue is hard and reddish brown in colour.
Skin is wrinkled and laxed
Low BP and high pulse rate.
Dark urine with high specific gravity.
TREATMENT: I.V 0.9% Saline and RL.

POST-OP HYPERNATREMIA
Real hypernatremia occurs due to excess infusion of Na in the
early post-op period.
Apparent hypernatremia occurs when there is severe fluid loss
with sodium conc remaining normal.
CLINICAL FEATURES: Puffy face, pitting edema in the
sacral region, weight gain and polyurea.
TREATMENT: Stop infusion.
In case of edema give diuretics

POST-OP
HAEMORRHAGE
CAUSES:
Incompletely ligated or cauterised vessels.
Wound infection.
Coagulopathy.
Rebound effect of hypotensive anesthesia.
Reactionary haemorrhage due to slippage of sutures occurs
within 24hrs. www.indiandentalacademy.com

CLINICAL FEATURES:
Increased BP and fall in pulse rate [thready pulse].
Restlessness and deep sighing respiration.
Cold calmmy exterimities.
Fall in urine output.
MANAGEMENT: Pressure
Rest and sedation. Pack
Pressurepacking. Pray
Operative methods.[reopen, suture,socket pack]
Local haemostatics like gelatin sponge ,bone wax.
Blood transfusion.

SHOCK
It’s a state of sudden circulatory collapse
during which the circulation fails to meet
nutritional needs of the cell and also fails to
remove the metabolic waste products.
In the first 48hrs after major maxillofacial surgery one can
expect:
Hypovolemic shock – Due to fall in blood volume
Anaphylactic shock – Due to drugs or transfusion
Septic shock - Following severe sepsis.

COMPENSATORY OF HYPOVOLEMIC
SHOCK
Adrenergic discharge[Shunts blood from visera to heart]
Hyperventilation [ Sucks blood from extrathoracic sites]
Release of vasoacive hormones[ ADH & Angiotensin]
Resorption of fluids from intra and extra cellular compts
Renal conservation of fluids[Renin angiotensin aldosterone]

POST-OP ANAPHYLACTIC SHOCK
Endotoxin released by gram –ve bacteria or drugs
Fixation of antigen with antibody bound mast cells/ basophils
Release of Histamine
Vasodialatation with bronchoconstriction
Deathwww.indiandentalacademy.com

CLINICAL FEATURES:
Sweating with pallor
Fall in BP with rapid pulse.
Hyperventilation.
Fall in urine output.
Reduction in CVP.

POST-OP SEPTIC CIRCULATORY
FAILURE
CAUSES
Surgical procedures carried out in the presence of sepsis.
General spread from a focus.
Compromised immunity.
Blood stream contamination from needles and cannulas.

PATHOLOGY:
A direct effect of cytokines and
other inflammatory mediators.
Arteriolar dilatation.
Capillary leak
Reduction in blood volume.
SHOCK

CLINICAL FEARURES
High pyrexia.
Hypertension.
Tachycardia.
A warm periphery.
MANAGEMENT
Resuscitation with I.V fluids.
I.V antibiotics.
Re-exploration to look for the septic focus.

MANAGEMENT:[HYPOVOLEMIC]
Ressusitation; A B C
Immediate control of haemorrhage
Fluid repacement- administer colloids or give RL 1000ml
to 1500ml in 45min.
Monitor vitals and urinary output.
ANAPHYLACTIC SHOCK
Lay patient flat with legs raised and administer oxygen.
0.5ml 1 in1000 adrenaline I.M, repeat every 10 min.
Give10 – 20mg chlorphiniramine I.V
Give 200mg hydrocortisone every 6hrs upto 4 times.

COMPLICATIONS FOLLOWING BLOOD
TRANSFUSION
Transfusion reactions:
1. INCOMPATIBILIY: Blood used after prolonged storage.Pt
developes rigor,fever, headache, nausea and vomiting, loin
pain.
Pt developes dyspnoea and oliguria in severe cases.Rarely
renal failure ensues with haemoglobinuria.
MANAGEMENT:
Stop transfusion.
Alkalinize blood with10ml sodium lactate I.V to
precipitate haematin.

Give frusemide 80 – 120 mg I.V for diuresis.
Antihistamines and steroids.
In severe cases haemodialisis.
2.PYREXIAL REACTIONS: Occur due to improperly
sterilized transfusion sets, infected blood , sulphor
compounds in tubing.
Treated by antihistamines and antipyretics.
3.ALLERGIC RECTIONS: Mild tachycardia, utricaria,
fever dyspnoea ,sometimes circulatory collapse.
Allergy is usually due to the plasma of donor.
Treated by antihistamines and steroids.

SENSITISATION OF PLATELETS AND LEUKOCYTES:
Occurs in patients who have undergone multiple transfusions.
Antibodies against WBC and platelets.
Treated with antipyretics, antihistamines and steroids
Transmitted diseases:
Serum hepatitis
HIV- AIDS
Bacterial infections

REACTIONS DUE TO MASSIVE TRANSFUSION:
Acid-base imbalance.
Hyperkalemia
Citrate toxicity.
Hypothermia.
Failure of coagulation.
COMPLICATION DUE TO OVER OR RAPID
TRANSFUSION:
Congestive heart failure.
Systemic venous congestion.www.indiandentalacademy.com

POST-OP HAEMATOMA
Most commonly due to inadequate haemostasis or overtight
suturing.
Reddish tender swelling.
Slight rise in body temperature.
Superadded bacterial infection may develop.
MANAGEMENT:
If seen during the immediate period and if bleeding does not
stop shift pt to theater and manage.
If seen in the subsequent post-op day remove a few sutures to
secure drainage.
Aspiration with a wide bore needle.

POST-OP OEDEMA
Excessive post-op edema occurs due to:
Tight suturing
Rough tissue handling.
Pulling on flaps.
Traumatic bone cutting.
MANAGEMENT:
Loosen sutures.
Steroids like dexamethazone or.[decadran 4mg I.V].
Hydrocortisone.

MANAGEMENT OF POST-OP PAIN
Why treat post-op pain……..?
Autonomic response to pain produces a neuro endocrine
response with increased secretion of GH, Cortisol,
Catecholamines, ADH etc increased protein
catabolism inhibition of healing.
Pain can prevent patients from deep breathing and
coughing pulmonary complications.
Best way to avoid cardiopulmonary complications is
early mobilisation which is possible only with adequate
analgesia.
Pain can delay gastric emptyingwww.indiandentalacademy.com

PAIN PREDICTORS;
SURGICAL SITE: Superficial & peripheral sites
produce less pain than deep and central sites.
WOUND MOVEMENT: Exacerbates pain.
PSYCHOLOGICAL STATE: Pain is an emotional
experience so anxiety and low mood enhance pain

MANAGEMENT
DRUGS: Opioids like morphine 10mg I.M 4-hourly
Codeine 60mg oral 8-hourly
Non opioids Paracetamol
Diclofenac Na
Ibuprofen
REGIONAL ANESTHESIA:
Epidural: LA or opiate like diamorphine or fetanyl
Peripheral nerve block:e.g. Brachial plexus block
. www.indiandentalacademy.com

Psychological/ Behavioral/ Alternative management:
Positive environment.
Good nursing and medical care.
Hypnosis, psycho prophylaxis and biofeedback.
Acupuncture

ACUTE CONFUSIONAL STATE
CAUSES:
Immediately life threatening
Pain- seek cause,treat appropriately.
Hypo perfusion- Bleeding, hypovolumia, Circulatory collapse,
shock ,stroke.
Hypoxia- Collapse, pulmonary embolism, respiratory distress.
Potentially life threatening
Urinary retention.
Renal failure.
Epilepsy and encephalopathy.www.indiandentalacademy.com

OTHER CAUSES
Drugs
Electrolyte imbalance
Disorientation – Common in elderly
MANAGEMENT
Sedatives given NOT TO TREAT but to DIAGNOSE.
Administer oxygen.
If narcosis is suspected give a test dose of reversal agent, if
improvement occurs, give stipulated dose.
Specific treatment based on diagnosis.www.indiandentalacademy.com

POST-OP DEEP VEIN THROMBOSIS
Life threatening condition which may lead to sudden death
due to pulmonary thromboembolism or a post-thrombotic
limb with ulceration.
WHAT HAPPENS IN DVT……..?
VIRCHOW’S TRIAD
Vessel endothelial damage
Stasis of blood flow.
Hypercagulability

Commonly occurs in the popletial and
the femoral vein.
Stasis and reduction in blood flow due to
immobilization is the most important cause

RISK FACTORS FOR POST-OP DVT
HIGH RISK: Urologic surgery in pt over 40yrs, extensive
surgery for malignant neoplasms, major abdominal and
lower limb orthopedic surgery.
MODERATE RISK: Any form of general surgery in pt
aged over 40yrs lasting more than 30min. & in patients
aged below 40yrs who are on oral contraceptives.
LOW RISK: Uncomplicated surgery in patients aged
under 40yrs without risk factors. & minor surgery in pt
over 40yrs lasting less than 30min.www.indiandentalacademy.com

PHYSICAL FINDINGS;
Most common site is the calf.
Swelling and tenderness.
Homan’s sign: Forceful dorsiflexion of the foot will elicit
pain in the calf.
Moses’s sign: Squeezing the the calf muscles from side to
side produces pain.
SPECIAL INVESTIGATIONS:
-Phlebography - Plethismography
-Radioactive fibrinogen test. -Venous pressure
-Doppler ulrasonography measurment

MANAGEMENT:
CONSERVATIVE MANAGEMENT:
Bed rest and analgesia.
Elevation of leg above the level of the heart.
When walking is started an elastic stocking must be
used.for 6months.
Heparin 5000 to 10000 units every 4hrs for 7days.
Gradually taper the dose over the next 3 days to avoid
heparin rebound [new thrombus].
Fibrinolytics like streptokinase
Cumarin derivatives – prescribed for 4weeks.

PULMONARY THROMBOEMBOLISM:
Thrombi break off from the DVT
Get into the venous circulation to enter the right heart
Pass on to the pulmonary circulation
Create blocks in the pulmonary circulation
Pulmonary hypertension Local ischaema
Right heart failure Pulmonary infarction

CLINICAL FEATURES
Dyspnoea
Chest pain: Substernal sharp and stabbing in nature,
occurs during breathing.
Haemoptysis due to pulmonary infarction.
PHYSICAL EXAMINATION
Tachycardia with tachypnoea.
Hypertension.
Pleural friction rubs.
Signs of RHF www.indiandentalacademy.com

INVESTIGATIONS
CHEST X-RAY: Diminished pulmonary vascular markings.
ECG: ST depression : T inversion.
BIOCHEMISTRY:Elevated serum LDH, bilirubin.
PULMONARY ARTERIOGRAPHY: Filling defects.
PULMONARY RADIO-ISOTOPE SCAN: Iodine131www.indiandentalacademy.com

MANAGEMENT
ANTICOAGULANTS: Heparin 40,000 units daily till
clotting time is brought to twice the normal.
This is followed up with oral anticoagulants for at least
6months.
FIBRINOLYTIC AGENTS:Streptokinase is infused at a dose
of 600,000 units followed by 100,000 units hourly for 3days.
BICARBONATES: For metabolic acidosis.
IONOTROPIC DRUGS
SURGERY: Ligation and division,Venous interruption,
pulmonary embolectomy.

PREVENTION OF DVT AND PTE
BEFORE OPERATION:
Minimise time spent in waiting room before surgery.
Leg elevation above the level of the heart.
DURING SURGERY:
Maintain leg level above heart.
In high risk cases give 5000 units of heparin 2hrs before
procedure and continue the same course every 8th
hourly
for the next 7days.
Intermittent pneumatic compression, electrical calf
stimulation,active plantar flexion prevents venous stasis.www.indiandentalacademy.com

AFTER SURGERY:
Administer low molecular weight dextran dosage not to
exceed 1.5g/kg body weight.
Aspirin
Elastic stockings to increase velocity of venous blood flow.
Leg elevation.

SUPERFICIAL VEIN THROMBOSIS
Also called thrombophlebitis
.Occurs after I.V fluid infusion
.Staphylococcus in usually involved
CLINICAL FEATURES
Painful cord-like inflamed area.
Local redness, tenderness, and local induration.
Embolism is very rare.

Initiate I.V antibiotics preferably cefazoline 1gm bolus 8th
hourly.
Elastic support or crepe bandange.
Anticoagulants and aspirin.
Hot baths to prevent propagation of thrombus.
TREATMENT

POST-OP CARDIAC ARREST
CAUSES
Myocardial infarction: Incidence of post-op MI is 0.7%
for a non-cardiac and 6% for a cardiac patient.
Hypoxia
Anesthetic overdose
Anaphylaxis
Severe hypertension
Cardiac arrythmias: Most common post-op cardiac
arrythmia are the premature ventricular
contractions[PVC] www.indiandentalacademy.com

DIAGNOSIS:
Loss of consciousness.
Absent arterial pulses.
After 15min
Respiratory arrest.
Pupil dilatation.
No measurable BP.

BASIC LIFE SUPPORT

MANAGEMENT OF CARDIAC ARREST

Defibrillation coupled with I.V infusion of 8.4% sodium
bicarbonate 10ml/min.
Oxygen with positive pressure respiration.
In case of absence of cardiac emergency facilities pt must
be immediately shifted to cardiac specialty unit.
Recovery is unlikely if pt is not resuscitated in 15min.www.indiandentalacademy.com

MANAGEMENT OF POST-OP MI
300mg aspirin chew.
Diamorphine 5- 10mg I.V
Cyclezine 50mg I.V
Streptokinase/ t-Pa 1.5 million units in 1 hr.
Beta blockers like metaprolol 5- 10mg.
-DRUGS
-Positive pressure ventilation.
-Defibrillation.
-CPR

POST-OP HYPOTENSION
CAUSES
Hypovolemia
Rewarming vasodialatation.
Myocardial depression [drugs]
Hypercapnoea.
MANAGEMENT
Elevate lower extremities.
Administer carefully monitored fluid boluses.
Administer vasopresors[ephedrine]www.indiandentalacademy.com

COMPLICATIONS FOLLOWING 3RD
MOLAR
SURGERY
Sensory nerve damage
Jaw fracture
Infection
LA complications
Haemorrhage
Pain and swelling

TMJ SURGERY COMPLICATIONS
Facial nerve palsy.
Auriculotemporal syndrome.
Haemorrhage
Difficulty in mouth opening.
Otologic complications: otitis externe and media.www.indiandentalacademy.com

DONOR SITE MORBIDITY
ILIAC CREST:
Pain and gait disturbance.
Haematoma.
Infection.
RIB GRAFT:
Pleural injury – Pneumothorax
Atelectasis
Pneumonia.
Infection

CALVARIAL GRAFTING:
Perforated inner cortical plate – CSF leak, meningitis.
Haematoma.
SURGERY FOR TRAUMA
Swelling and pain.
Infection.
Nerve injuries.
Malocclusion.
Damage to teeth.
Ocular injuries:Blindness, corneal abrasion, diplopia.ruptured
globe, retinal detachment.

CANCER SURGERY
Shoulder dysfunction.
Edema
Phrenic nerve injury:
Incidence – 8%
Ipsilateral diaphragm paralysis.
Mediastinal shift to the contralateral side.
Paradoxical contraction of diaphragm on augmented load
[coughing]

CLINICAL FEATURES
Cough and dyspnoea.
Chest pain.
Cyanosis.
Tachycardia and palpitations.
Extrasystoles
THORACIC DUCT INJURY
Chylous fistula
Incidence 1% to 2%. Most common left side.Massive
plasma loss and hypoalbuminemia.
Persistent loss for more than 500ml/day- neck exploration.

CAROTID BLOW OUT
Mortality rate of 18% to 50%.
Occurs in 3% of patients undergoing neck dissection.
Previous radiation therapy increases chances of carotid
blow out.
Most common in the midportion of the carotid bulb.
MANAGEMENT
Once its occurred consider the vessel as an infected
foreign body.
Control of haemorrhage and fluid replacement.

Proximal and distal artery resection and ligation.
Elective ligation and elective balloon embolisation of the
carotid artery.
ORTHOGNATHIC SURGERY:
Avascular necrosis.
Nerve injuries.
Malocclusion.
Haemorrhage.
Devitalisation of teeth.

Complications in the first 48hrs after oral &/ dental implant courses

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