Postoperative complications can occur across several body systems. Common complications include surgical site infections (SSIs), wound dehiscence, hematomas, seromas, respiratory issues like hypoxemia and pneumonia, gastrointestinal complications like ileus and anastomotic leaks, delirium, deep vein thrombosis (DVT), urinary tract infections (UTIs), hypertension, hypotension, arrhythmias, and stroke. Close monitoring of vital signs and the surgical site are important to promptly identify and manage any complications in the postoperative period.
Regional anesthesia is anesthesia affecting only a specific area of the body when the patient is conscious, e.g. foot, arm, lower extremities, insensate to stimulus of surgery or other instrumentation.
Regional anesthesia is anesthesia affecting only a specific area of the body when the patient is conscious, e.g. foot, arm, lower extremities, insensate to stimulus of surgery or other instrumentation.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
Complications of anesthesia
This topic aim to provide information on some common clinical condition that occur to the patients after anesthetized required procedure
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
Complications of anesthesia
This topic aim to provide information on some common clinical condition that occur to the patients after anesthetized required procedure
A condition affecting the blood's ability to clot and stop bleeding.
In disseminated intravascular coagulation, abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood's clotting factors, which can lead to massive bleeding in other places. Causes include inflammation, infection and cancer.
Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts of the body.
Post Operative Care | PACU | Complications | Treatment Yashasvi Verma
Post operative period is the most crucial and
critical span of time after completion of surgery
In this period numerous complications occur and if not treated on time can prove fatal hence increasing the mortality rate .
The specialized care provided to the patient after completion of surgery till the patient is fully conscious
This specialized care is provided in a specialized area called PACU
SEVERAL POST OPERATIVE COMPLICATIONS LIKE
HYPOXIA , HYPERTENSION , HYPOTENTION , HYPO THERMIA , HYPERTHERMIA , MODIFIED ALDERT SCORE , PAIN ASSESMENT AND TREATMENT , POST OPERATIVE NAUSEA AND VOMITING , ETC. MIGHT OCCUR .
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Outline
• Introduction
• Common Complications
• Surgical Site Infections
• Wound Dehiscence, Hematomas and Seromas
• Gastrointestinal Complications
• Delirium
• DeepVenousThrombosis
• UrinaryTract Infection
• References
3. Introduction
• Surgical site infections (SSIs) alone affect >500,000 patients annually and are
associated a 2 to 11 times increase in the risk of postoperative mortality.
• Good communication among all providers caring or surgical patients is
fundamental.
• Patients should know about the complications before the procedure and a
consent form must be signed.
• The patient’s vital signs (including pulse, blood pressure and pulse oximetry
reading), level of consciousness, pain and hydration status are monitored in the
recovery room and supportive treatment is given.
4. Classification of postoperative
complications
• There are three common approaches for the classification of postoperative
complications of surgery:
• Linked to time after surgery:
• Immediate (within 6 h of procedure);
• Early (6–72 h);
• Late (>72 h).
• Generic and surgery specific.
• Clavian-Dindo: this system relates to surgical complications only and is used to
objectively and reproducibly measure the impact of the surgical complication on
the outcome of the procedure
5. Postoperative Bleeding
• All patients must have their vital signs (pulse rate, blood pressure, oximetry,
central venous pressure, if available, and urine output) monitored regularly.
• Dressings and drains should be inspected regularly in the first 24 hours after
surgery.
• If hemorrhage is suspected, blood samples should be taken for a full blood count,
coagulation profile and cross match.
• The decision about when to transfuse should be based on the individual patient
• In general, the accepted transfusion trigger is 75 g/L except in the presence of
known or suspected coronary artery disease when a higher trigger is acceptable.
6. Postoperative Pain
• Patients in this phase of care are often unable to verbalize pain due to effects of anesthesia
• Pain assessments are often based on other objective assessments such as blood pressure,
heart rate, respiratory rate and signs of agitation.
• The most commonly used intravenous opioids for postoperative pain are morphine,
hydromorphone (dilaudid), and fentanyl.
• Morphine is the standard choice for opiates and is widely used.
• Morphine has a rapid onset of action with peak effect occurring in 1 to 2 hours.
• Fentanyl and hydromorphone are synthetic derivatives of morphine and are more potent,
have a shorter onset of action, and shorter half-lives compared with morphine.
7. POSTOPERATIVE HYPERTENSION
• Cardiovascular Complications are the leading cause of death after 30-days of non-Cardiac
Surgeries
• Pain and elevated catecholamines can contribute to hypertension and tachycardia.
• β-blockers should be continued in the perioperative setting for patients who took them
preoperatively.
• Hypertension in the PACU is most commonly caused by pain and/or a history of
hypertension.
• Procedures such as carotid endarterectomy, require immediate and aggressive control of
systolic blood pressure regardless of etiology to avoid catastrophic vascular, cardiac, or
neurologic complications.
• For patients with pre-existing hypertension requiring medication, it is generally most
appropriate to gradually reintroduce the preoperative antihypertensive regimen with the
exception of diuretics in the immediate postoperative period.
8. POSTOPERATIVE HYPOTENSION
• Usually due to:
• Hypovolemia
• Narcotic and benzodiazepine administration
• Epidural anesthesia; Postoperative bleeding.
• Sepsis
• Arrhythmias
• Tension pneumothorax
• Pulmonary embolism
• Pericardial tamponade and anaphylaxis.
9. Postoperative Hypotension
• Postoperative hypotension can lead to end-organ dysfunction when
• Decreased urine output <0.5 mL/kg/h
• Decreased level of consciousness
• Myocardial ischemia
• Capillary refill >2 seconds
• In which it needs immediate management with fluid and may require the use of
vasopressors and inotropes.
• Invasive monitoring with a urinary catheter, central line, or arterial line should be
utilized if a patient remains hypotensive despite initial resuscitation with
crystalloid.
10. Postoperative Hypotension
• Epidural anesthesia can cause hypotension by blunting sympathetic tone and
decreasing vascular resistance.
• Treatment of epidural-related hypotension should include administration of a fluid
bolus.
• Temporarily holding the anesthetic infusion can also be helpful until euvolemia is
obtained.
• Treatment should be aimed at the cause.
11. Arrhythmias
• When they occur in the postoperative period, arrhythmias can cause hypotension,
myocardial ischemia and cardiac arrest.
• Tachycardia (sinus or supraventricular) may occur due to anxiety, pain, myocardial
ischemia or infarction, hypovolemia, sepsis or hypoxia in the postoperative period.
• Consideration should be given to correction of the underlying causes and rate controlled
with β-blockers, amiodarone or cardioversion, depending on the state of the patient.
• Sinus bradycardia may be normal in athletes but it may also be associated with hypoxia,
preoperative β-blockers, digoxin and increased intracranial pressure.
• Pharmacological options include glycopyrrolate or atropine intravenously.
12. Stroke
• Stroke is a recognized complication of carotid endarterectomy surgery both early
(secondary to emboli) and later (secondary to cerebral hyperperfusion syndrome).
• It is also a recognized consequence of both hypotension and hypertension.
• Thrombolysis may be indicated but the neurology and surgical teams must discuss
together the risks and benefits of such a treatment plan.
13. Immediate respiratory complications
AIRWAY
• Upper airway obstruction is one of the commonest immediate postoperative
complications and can be due to:
• Laryngospasm,
• Persisting relaxation of airway muscles
• Soft tissue oedema,
• Hematoma
• Vocal cord dysfunction or foreign body.
14. POSTOPERATIVE RESPIRATORY
INSUFFICIENCY
• Most patients will require some supplemental oxygen immediately after surgery.
• Dyspnea, tachypnea, wheezing, and signs of respiratory distress are not normal
postoperative signs and symptoms, and need to be addressed in the PACU.
• The causes and degree of risk to postoperative respiratory insufficiency are complex
and patient specific.
• All patients recovering from anesthesia require close monitoring o their respiratory
status, with personnel and equipment or reintubation readily available.
15. Postoperative Respiratory Insufficiency
• The primary factors that contribute to postoperative respiratory insufficiency
include:
• Use of general anesthesia
• Upper abdominal and thoracic surgeries
• Longer duration surgeries
• Use of endotracheal intubation
• Use of narcotics.
16. Hypoxemia
• This may occur as a consequence of:
• Acute pulmonary oedema (fluid overload, cardiac failure, postobstructive)
• Bronchospasm
• pneumothorax
• Aspiration
• Pulmonary embolism.
• De novo pneumonia is very unusual in the immediate postoperative period.
• Hypoxemia develops most quickly in patients with obstructive sleep apnea,
lung disease and obesity, who should therefore be closely observed.
17. Hypoxemia
• Patients with hypoxemia should be treated urgently.
• If the patient is breathing spontaneously, oxygen should be administered at
15 L/min using a non-rebreathing mask.
• A head tilt, chin lift or jaw thrust should relieve obstruction related to
reduced muscle tone.
• Suctioning of any blood or secretions and insertion of an oropharyngeal
airway may be needed.
20. Early and late postoperative pulmonary
complications
• Significant cause of postoperative
morbidity and mortality (between 5%
and 70%).
• Complications include:
• Fever (due to microatelectasis)
• Cough
• Dyspnea
• Bronchospasm
• Hypercapnoea
• Atelectasis
• Pneumonia
• Pleural effusion
• Pneumothorax
• Respiratory failure.
21. • Thoracic or abdominal surgery carries the highest risk.
• Risk Factors include
• Obese
• Smokers
• Chronic lung disease
• Obstructive sleep apnea
• Poor nutritional status.
• Can be identified preoperatively, facilitating the development of strategies that will
reduce the impact of surgery on the individual patient.
Early and late postoperative pulmonary
complications
24. Low Urine Output
• Intravascular volume depletion may occur concurrently with pulmonary
edema due to increased vascular permeability associated with perioperative
inflammation
• Administration of diuretics or postoperative pulmonary edema can
exacerbate intravascular depletion, hypotension, and inadequate end-
organ perfusion.
• Postoperative oliguria (less than the equivalent of 0.5 cc/kg/h) requires
urgent evaluation.
25. POSTOPERATIVE NAUSEA ANDVOMITING
• Common.
• The causes are multifactorial.
• Prior history is the most significant risk factor
• Other risk actors include longer duration procedures, use of volatile
anesthetics (such as isoflurane), and procedures involving the inner ear,
eye, and abdominal viscera.
• Patients at moderate to high risk benefit from prophylactic antiemetics,
motility agents, or a scopolamine patch before emerging from anesthesia
26. POSTOPERATIVE FEVER
• About 40% of patients develop pyrexia after major surgery
• Low-grade fevers in the first 48 hours after surgery are a normal sequelae of
inflammation, atelectasis, or hematoma absorption following surgery, and usually
not from an infectious process.
• In the absence of any localizing signs or symptoms, self-limited fever within the first
48 hours postoperatively usually does not need infectious work-up.
• After 48 hours, temperatures greater than 38.5°C should prompt a complete fever
workup.
• In the postoperative patient, the surgical wound and site of venous access are
potential sources of infection and need to be carefully examined.
27. SURGICAL SITE INFECTION
• Account for approximately 30% of nosocomial infections and are the most
common infections after surgery.
• Associated with a 7-Day increased length of stay.
• Classified as
• Superficial; Infections involving the skin and subcutaneous tissues.
• Deep; Involve the Fascia or the Muscles below
• Organ space infections; Involve organs below the muscular and cutaneous layers
28.
29. Surgical Site Infections
• Wound infections
• Despite the most rigorous aseptic technique, all wounds are contaminated to
some degree and have some risk of infection.
• Even “clean” wounds have a 1.5% risk of infection.
• Wound infections commonly occur between 5 and 10 days after an operation.
• Antibiotics are not necessary for simple wounds that have been drained.
• Deep space infections usually require drainage; antibiotics alone are insufficient.
30. Surgical Site Infections
• Risk factors for wound infection are patient and operation dependent.
• Patient related risk actors include:
• Large body habitus
• Diabetes
• Disability
• Immunosuppression
• Malnutrition
• Smoking
31. Surgical Site Infections
• Operative Risk Factors include:
• Certain operations, such as those involving the colon or small bowel, are
higher risk than others.
• Operating room conditions
• Surgical technique (eg, laparoscopic or open)
• Administration of antibiotic prophylaxis
• Hypoxia or hypotension during the procedure.
32. Surgical Site Infections
• Prophylactic antibiotics are very effective at reducing the risk of SSIs
• They should be administered within 1 hour of incision and continued for no
more than 24 hours after surgery.
• In the event of significant contamination in the OR, wounds may be left open
and managed with delayed primary closure or wet to dry dressings.
33. Surgical Site Infections
• The hallmarks of a wound infection are
• FEVER
• PAIN/TENDERNESS
• PURULENT DRAINAGE
• The typical presentation is between 5 and 10 days postoperatively.
• Clostridial necrotizing wound infection should be suspected when a patient has a very
high fever in the immediate postoperative period; immediate surgical evaluation and
drainage.
34. Surgical Site Infections
• Deep space infections occur in enclosed spaces with some degree of isolation from
blood supply, making them relatively impervious to antibiotics.
• Such infections usually require drainage either percutaneously or in the operating
room.
• Anastomotic leaks typically occur between postoperative days 5 and 7 and should
be suspected in surgical patients with tachycardia, abdominal pain, fever, and
elevated white count.
• These leaks can often be managed with percutaneous drainage, but inability to
control the infection may require operative drainage
35.
36.
37.
38. Wound Dehiscence, Hematomas and Seromas
• Wounds typically heal to a maximum of 80% of the tensile strength within 6 weeks
among healthy, well-nourished patients.
• Most surgeons restrict postoperative activities to avoid stress on the wound for 4 to 6
weeks.
• Wounds that have been closed primarily should be kept clean, dry and well covered
for 48 hours post-surgery.
• Dry, sterile wound dressing should be kept for the second post-operative day;
Showering.
39. Wound Dehiscence
• It is the disruption of any layer of the surgical wound.
• This rare complication results from increased pressure on the wound and can arise due to a
variety of reasons.
• May need a return into the operation room
• Poor wound healing often leads to dehiscence.
• Malnutrition, liver disease, diabetes, immunosuppression, and chronic steroid use inhibit
normal wound healing and are risk factors.
• Most common layers involved; Skin and Fascia
• Sudden release of serosanguinous fluid of the wound is usually the first sign of Dehiscence
40.
41. Wound Dehiscence
• Management depends on: Size, location and patient’s condition
• Fascial dehiscence; separation of the deepest layer of the abdominal wall;
typically requires urgent closure in the operating room.
• In the most severe cases, dehiscence leads to extrusion of intra-abdominal
contents (eg, evisceration).
• Evisceration is a surgical emergency that requires immediate return to
operating room.
42. Hematomas
• More common
• Can be caused either by inadequate hemostasis during surgery or disruption of
hemostasis Postoperatively
• Risk factors include bleeding disorders and anticoagulant use.
• Can result in; wound elevation, pressure, pain, dehiscence, and infection.
• Management; depending on the size and location;
• Watchful waiting to re-exploration in the OR.
• Hematomas following neck exploration may rapidly compromise the airway in the
postoperative period.
43. Hematomas
• Precipitating factors include:
• Abrupt increases in intrathoracic pressure from coughing
• Emesis;Vomiting
• Valsalva maneuvers; moderately forceful attempted exhalation against a
closed airway, usually done by closing one's mouth, pinching one's nose
shut while expelling air out as if blowing up a balloon
• Treatment; emergent evacuation of the hematoma prior to reintubation.
44.
45. Seromas
• Collections of serous fluid that form after procedures involving disrupted
lymphatic flow and raised skin flaps.
• Generally the result of a normal physiologic response to anatomic dead
space.
• Their incidence is dependent on the anatomic location of the wound
• Procedures associated; inguinal hernia repair, groin exploration, and
mastectomy.
• Suction drains may be left in place at the end of the procedure to increase
tissue apposition and remove fluid.
46. Seromas
• Compression dressings can also reduce the risk of seroma formation.
• Seromas may increase the risk for wound disruption and infection but are usually
nothing more than a nuisance.
• Management may be expectant or include serial aspirations.
• Rarely, return to the OR is indicated to ligate contributing lymphatics.
47. DeepVenousThrombosis and Pulmonary Embolus
• Venous thromboembolism (VTE) is a leading cause of preventable death in the
postoperative setting.
• Surgical patients are at high risk forVTE due to the surgical procedure itself as well as
induction of general anesthesia, which results in prolonged immobility, hypercoagulability,
and endothelial damage.
• Patients with known hyper- coaguable states, priorVTE, and malignancy are at especially
high risk.
• High-risk surgical procedures include orthopedic surgery, trauma, and neurosurgical
treatment of head injury and brain tumors.
• Prophylaxis starts with the application of pneumatic compression devices and subcutaneous
heparin 2 hours prior to anesthetic induction.
48. DeepVenousThrombosis and Pulmonary Embolus
• Unless there are clear contraindications, such as increased bleeding risk, patients
should receive pharmacologic prophylaxis and pneumatic boots throughout and
perioperative period.
• Pulmonary embolus (PE) still causes considerable mortality in hospitalized
patients.
• PE should be suspected in all surgical patients presenting with symptoms of
dyspnea, tachycardia, and hypoxemia.
• The decision to start anticoagulation should be made with the operating surgeon,
while pending further diagnostic testing.
49.
50. UrinaryTract Infections
• Most common after vaginal or urologic surgery and any surgery with the use of
indwelling catheters.
• Women and obese patients are at highest risk.
• The most common pathogens are Escherichia coli, Staphylococcus saprophyticus,
and Proteus mirabilis.
• Hospitalized and immunosuppressed patients are also susceptible to Klebsiella,
Proteus vulgaris, Candida albicans, and Pseudomonas.
• The standard for prevention is the removal of indwelling catheters within 48 hours
of insertion.
51. UrinaryTract Infections
• The need for continued urinary catheterization should be assessed at least daily to
prevent needless prolongation of catheter placement and increased risk of
catheter-associated UTI.
52. Post-Operative Urinary Retention
• Postoperative is common but rarely prolonged.
• Common risk factors include; male sex, prostatic enlargement, epidural/spinal/prolonged
anesthesia, use of antihistamines or narcotics, and pelvic/perineal procedures.
• An overdistended bladder (>500 mL) and disruption of the neural pathways that control
voiding impairs urinary contraction and micturition.
• Prophylactic catheterization in the operating room is recommended or any procedure lasting
more than 3 hours
• Also when interruption of the sacral plexus is anticipated (eg, abdominoperineal resection).
53. Post-Operative Urinary Retention
• If a catheter is not present, patients should be encouraged to void soon after the procedure.
• If the patient has not voided for more than 6 hours, it is appropriate to evaluate retention
with a bedside ultrasound; or an in-out catheter may be used to determine the extent of
retention.
• The treatment for bladder distention is intermittent catheterization along with mitigation
of any contributing factors.
• Some patients may have prolonged urinary retention in the postoperative period (>48
hours).
• Appropriate pharmacologic treatment should be initiated and an indwelling Foley catheter
should be placed.
• Some may require subsequent outpatient urologic follow-up or a void trial after discharge
54. Acute Kidney Injury
• According to national guidance (National Institute for Health and Care Excellence,
NICE) based on several definitions, acute kidney injury can be detected by the
following criteria:
• A rise in serum creatinine of 26 μmol/L or greater within 48 hours;
• a ≥50% rise in serum creatinine known or presumed to have occurred within the past
7 days;
• A fall in urine output to less than 0.5 mL/kg/h for more than 6 hours in adults and
more than 8 hours in children and young people;
• A ≥25% fall in estimated glomerular filtration rate in children and young people
within the past 7 days.
55. References
• Principles and Practice of Hospital Medicine; Chapter 45: Postoperative
Complications
• Bailey and Love Short Practice of Surgery; Chapter 20: Postoperative Care