The document discusses postoperative complications, their prevention and management. Some key points: - Surgical patients are at risk of complications during and after surgery, ranging from minor to serious. The risk depends on the surgery, patient health, and care. Complications increase costs, length of stay, and suffering. - Prevention techniques include pre-assessment, managing pre-existing conditions, proper antibiotics and analgesia, early mobilization, and maintaining asepsis during surgery. - Management of complications involves respiratory care like deep breathing exercises; circulatory care like ambulation; pain control; fluid and electrolyte monitoring; encouraging activity; and wound care like inspection and dressing.

1. Post operative complications, its
prevention and management
Presented by
Samina BK
Oshan Dev
BNS 3rd year

2. Introduction
• The surgical patients are potential for complications
during and after surgery: some transient, others
serious.
• The likelihood of postoperative complications is
influenced by the type of surgery, the pre patients pre-
existing comorbid state and perioperative management.
• Post-operative complications cause death and suffering
, longer hospital stays and increase costs.

3. Cont..
• At all stages of the patients perioperative ‘journey’ there
are techniques and strategies that health care professionals
can use to help stop postoperative complications.
• An anesthesia provider requires combination of skills, such
as anatomical knowledge of the airway, knowledge of the
varied pharmacologic agents used, along with their effects
and interactions, drug titrations, ability to manage stress
and provide relief to an anxious, often critically ill patient.

4. Postoperative complications
• General postoperative complications include:
 Post operative fever
 Atelectasis
 Wound infection
 Embolism
 Deep vein thrombosis(DVT)

5. Specific complications occur in the following
patterns:
• Immediate
• Early
• late

6. • Immediate
 Primary haemorrhage
 Basal atelectasis: minor lung collapse.
 Shock: blood loss, acute MI, septicemia
 Low urine output: inadequate fluid replacement
intraoperatively and postoperatively

7. • Early
 Acute confusion
 Nausea and vomiting
 Pneumonia
 Wound infection
 DVT
 Acute urinary retention
 Urinary tract infection
 Paralytic ileus

8. • Late
 Bowel obstruction due to fibrous adhesions
 Incisional hernia
 Persistent sinus
 Recurrence of reason for surgery – e.g., malignancy

9. Its prevention are:
• Pre-assessment clinic
• Fitness and risk assessment
• Correct diagnosis and treatment of comorbidities
• Continue/stop relevant drugs
• Correct and timely antibiotics
• Good analgesia

10. Cont’d….
• Early mobilization
• Hydration
• Regular postoperative ward rounds
• Local postoperative outcome data collection
• Maintain strict surgical aseptic technique
• Pulmonary exercise (e.g., turning, coughing, deep
breathing, and incentive spirometer use)

11. Management
1.Respiratory care
 Asses respiratory status. Assess the breathing pattern.
 As a result of effects of anesthetic agents and
narcotics, respiratory depth may be reduced, leading
to hypoxia. Clinical manifestations of hypoxia
include confusion, restlessness, pale skin, pulse
oximetry readings below 90% and cool skin. Major
complications following surgery are decreased lung
expansion, atelectasis or aspiration of retained
secretions.

12. Cont’d…
 Respiratory exercise( coughing, deep breathing and
incentive spirometry) are essential to minimize
respiratory complications in postoperative period.
 Encourage the patient for breathing and coughing
exercise every two hours. The patient should be
encouraged to splint any chest and abdominal
incisions with a pillow to decrease the pain caused by
coughing. Demonstrate and encourage incentive
spirometry with incisional splinting. The patient’s
response to spirometer use(i.e. cough, sputum
production) should be recorded.

13. 2. Circulatory Care
 Assess vital signs frequently(e.g. every 15 to 30
minutes).
 Assess skin color and temperature. Assess fluid
volume deficit.
 Because the patient has been immobile during the
operation that diminished circulation, extremities must
be evaluated for weakness, circulation, and numbness.
Bony prominences should be assessed for stage I
pressure ulcer and deep tissue injury.

14. Cont’d…
 All patients must be encouraged to get out of bed and
walk as soon as possible to prevent the formation of
thrombus and emboli.
 A thrombus can form in any blood vessels. If the
thrombus dislodges and travels via the blood stream,
it can move to the lings, creating a pulmonary
embolus.
 Walking can prevent the threat of thrombus formation.
Early ambulation is especially important after the
surgery of the abdominal area.

15. Cont’d…
• The patient should be turned every two hours, and
should at least be sitting on the edge of the bed by
eight hours after surgery, unless contraindicated (e.g.
after hip replacement). Encourage leg exercise
frequently.

16. 3. Pain control
 Liberal use of postoperative analgesics is essential for
recovery.
 Adequate pain control allows for early ambulation
and decreased overall stress.
 The most effective regimen for pain control requires
small frequent dosing, preferably via the intravenous
route at prescribed intervals before pain becomes
severe to prevent breakthrough pain that is difficult to
control.

17. Cont’d…
 Determine whether the patient is obtaining a sufficient
dose of medication, whether pain is being controlled,
or whether it is causing side effects(e.g. nausea,
vomiting).
 Comfort measures such as backrub or turning
positioning may be provided to the patient to further
promote pain relief or reduction. If pain is controlled,
postoperative activities are more readily performed
and help prevent complications.

18. 4. Fluid and Electrolyte Management
 All IV lines must be checked for patency, type of fluid
to be infused, and rate of infusion.
 Assess the insertion site for any sign of redness,
swelling, or pain. If any problems are noted, the
catheter may have to be removed from vein.
 Monitor for serum electrolytes(sodium, and potassium
levels) to determine need for replacements.
 Monitor vital signs to detect fluid imbalances and plan
appropriate interventions.

19. Cont’d…
 Urine output is closely monitored for 24 to 72 hours
after surgery.
 The quantity and color of urine are important
indicators for fluid and hydration status.
 An average of 0.5ml/kg/hour is desirable. If the
patient does not have a urinary catheter, the bladder
should be assessed for distension, and the patient
monitored for inability to urinate.

20. 5. Encouraging activity
 Encourage patients to ambulate as soon as permitted
by surgeon.
 Anticipate and avoid orthostatic hypotension.
 Assess patients feeling of dizziness and his or her
blood pressure first in the supine position, after
patients sits up, again after patient stands, and 2 to 3
minutes later.
 Initiate and encourage patient to perform bed
exercises to improve circulation.

21. 6. Wound care
 The operative dressing can be removed after 24-48
hours. However, if wound drainage is noted upon
inspection, a sterile dressing must be replaced until
the drainage ceases.
 Inspect the incision site for redness, swelling, or signs
of dehiscence to detect complications.
 Note the amount and character of any drainage every
shift for comparison with earlier assessments.

22. Cont’d…
• Cleanse the area around the incision with an
appropriate antiseptic solution to reduce local
pathogens.
• Inspect the area around the tube or drain insertion site
for redness and skin breakdown.
• Ensure the drains are appropriately secured and
labelled.
• Cleanse the area around any tube or drain site to
prevent wound contamination.