ways to prevent postoperative complications, zirgham 611

Prepared by:Zirgham HafeezGr#611Gr#611

Ways to Prevent Ways to Prevent Post-Post-operative operative complicationscomplications

OBJECTIVESOBJECTIVES

RISK FACTORSRISK FACTORS

TYPES OF PATHOLOGYTYPES OF PATHOLOGY

TYPES OF SURGERYTYPES OF SURGERY

COMPLICATIONS & THEIR MANAGEMENTCOMPLICATIONS & THEIR MANAGEMENT

Postoperative Complications (Morbidity) Account for:

1. Considerable human pain and suffering.

2. Increased cost of the health- care.

3. Can lead to postoperative death.

Postoperative Complications (Morbidity) Account for:

1. Considerable human pain and suffering.

2. Increased cost of the health- care.

3. Can lead to postoperative death.

Accept that complications are best anticipated and avoided.

Recognize the incidence of co-morbidity.

Understand the importance of matching the procedure to the associated risks.

Appreciate the importance of recognizing complications early and treating them vigorously.

Accept that complications are best anticipated and avoided.

Recognize the incidence of co-morbidity.

Understand the importance of matching the procedure to the associated risks.

Appreciate the importance of recognizing complications early and treating them vigorously.

So the objectives areSo the objectives are:-:-So the objectives areSo the objectives are:-:-

Can be generally applicable to all the procedures OR specific to the operations.

Age both extremes (Very young & Very old)

Obesity

Can be generally applicable to all the procedures OR specific to the operations.

Age both extremes (Very young & Very old)

Obesity

Co-morbid conditions: Cardiovascular diseases Respiratory diseases DM Renal diseases Metabolic factors Infections Wound healing Peripheral vascular diseases

Co-morbid conditions: Cardiovascular diseases Respiratory diseases DM Renal diseases Metabolic factors Infections Wound healing Peripheral vascular diseases

Drug therapy (Concurrent drugs used)[Steroids, Immunosuppressant, Antibiotics]

Blood transfusion

Drug therapy (Concurrent drugs used)[Steroids, Immunosuppressant, Antibiotics]

Blood transfusion

Obstructive Jaundice

Neoplastic Diseases

Obstructive Jaundice

Neoplastic Diseases

Minimally Invasive Surgery

Orthopedic Surgery

Gynaecology

Thoracic & Upper Abdominal Surgery

Prolonged Operations

Minimally Invasive Surgery

Orthopedic Surgery

Gynaecology

Thoracic & Upper Abdominal Surgery

Prolonged Operations

Complications of surgery may broadly be classified as those:

I. Due to Anesthesia

II. Due to Surgery

Complications of surgery may broadly be classified as those:

I. Due to Anesthesia

II. Due to Surgery

The anesthetic complications depend upon the mode (General, Regional & Local) and types of anesthetic (the anesthetic agent toxicity).

The anesthetic complications depend upon the mode (General, Regional & Local) and types of anesthetic (the anesthetic agent toxicity).

(A) LOCAL ANESTHESIA: (A) LOCAL ANESTHESIA: Injection site: Pain, haematoma, Nerve

trauma, infection

Vasoconstrictors: Ischemic necrosis

Systemic effects of LA agent: Allergic reactions, toxicity

Injection site: Pain, haematoma, Nerve

trauma, infection

Vasoconstrictors: Ischemic necrosis

Systemic effects of LA agent: Allergic reactions, toxicity

(B) SPINAL, EPIDURAL & CAUDAL

ANESTESIA:

(B) SPINAL, EPIDURAL & CAUDAL

ANESTESIA: Technical failure Headache due to loss of CSF Intrathecal bleeding Permanent N. or spinal cord

damage Paraspinal infection Systemic complications

(Severe hypotension)

Technical failure Headache due to loss of CSF Intrathecal bleeding Permanent N. or spinal cord

damage Paraspinal infection Systemic complications

(Severe hypotension)

(C) GENERAL ANESTESIA: (C) GENERAL ANESTESIA: Direct trauma to mouth or

pharynx.

Slow recovery from anesthesia due to drug interactions OR in-appropriate choice of drugs or dosage.

Hypothermia due to long operations with extensive fluid replacement OR cold blood transfusion.

Direct trauma to mouth or pharynx.

Slow recovery from anesthesia due to drug interactions OR in-appropriate choice of drugs or dosage.

Hypothermia due to long operations with extensive fluid replacement OR cold blood transfusion.

Allergic reactions to the anesthetic agent:

Minor effects eg: Postoperative nausea &

vomiting Major effects eg: Cardiovascular collapse,

respiratory depression)

Haemodynamic Problems: Vasodilation & shock

Allergic reactions to the anesthetic agent:

Minor effects eg: Postoperative nausea &

vomiting Major effects eg: Cardiovascular collapse,

respiratory depression)

Haemodynamic Problems: Vasodilation & shock

Perioperative: Haemorrhage, organ damage,

electro-cautery related etc…

Postoperative complications which may be considered under 2 headings:

I. Immediate OR early II. Late

Perioperative: Haemorrhage, organ damage,

electro-cautery related etc…

Postoperative complications which may be considered under 2 headings:

I. Immediate OR early II. Late

Specific (Procedure Related): Specific (Procedure Related):

Respiratory: Collapse, consolidation,

aspiration etc. Cardiovascular: Haemorrhage (Primary,

Reactionary, Secondary) Shock (Hypovolemic, septic,

cardiogenic, neurogenic) Myocardial infarction Deep venous thrombosis

Respiratory: Collapse, consolidation,

aspiration etc. Cardiovascular: Haemorrhage (Primary,

Reactionary, Secondary) Shock (Hypovolemic, septic,

cardiogenic, neurogenic) Myocardial infarction Deep venous thrombosis

Thromboembolic

Septic: Wound, abscess collections

Gastrointestinal: Intestinal obstruction Anastomotic leakage,

intraabdominal abscess formation, enterocutaneous fistulae

Wound complications: Infections, dehiscence, etc.

Thromboembolic

Septic: Wound, abscess collections

Gastrointestinal: Intestinal obstruction Anastomotic leakage,

intraabdominal abscess formation, enterocutaneous fistulae

Wound complications: Infections, dehiscence, etc.

Renal: Oliguria, acute renal failure Hepatic: Jaundice, hepatocellular

dysfunction/ insufficiency Cerebral: Psychological, Neuropsychiatric

complications (delirium, etc.) Drug-related: Anesthetic, antibiotics, specific

medical disease treatment toxicity Nerve injuries: Compression, traction, cautery,

severed, etc.

Renal: Oliguria, acute renal failure Hepatic: Jaundice, hepatocellular

dysfunction/ insufficiency Cerebral: Psychological, Neuropsychiatric

complications (delirium, etc.) Drug-related: Anesthetic, antibiotics, specific

medical disease treatment toxicity Nerve injuries: Compression, traction, cautery,

severed, etc.

Wound: Hypertrophic scar, keloid, wound sinus,

implantation dermoids, incisional hernia

Adhesions: Intestinal obstruction, strangulation Altered anatomy/Pathophysiology: Bacterial overgrowth, short gut

syndrome, postgastric surgery syndromes, etc.

Susceptibility to other diseases: Malabsorption, incidence of cancer, tuber-

culosis, etc.

Wound: Hypertrophic scar, keloid, wound sinus,

implantation dermoids, incisional hernia

Adhesions: Intestinal obstruction, strangulation Altered anatomy/Pathophysiology: Bacterial overgrowth, short gut

syndrome, postgastric surgery syndromes, etc.

Susceptibility to other diseases: Malabsorption, incidence of cancer, tuber-

culosis, etc.