post operative fever in omfs patients

8/2/2019 Post Operative Fever in OMFS Patients

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Post operative Fever in OMFS

patients

Ryaz Ansari

OMFS clinics of NA 2006: 73-79


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DEFINITION

Diurnal variation

lowest oral temperature at 6:00 am and the

maximum at 4:00 pm.

Fever is defined as a temperature of greater

than 37.2C (99F) in the early morning or

greater than 37.7C (100F) in the late

afternoon.


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THE DIFFERENCE

FEVER: is a sign of inflammation (not

infection); it is a response to the release of

inflammatory cytokines (ie, tumor necrosis

factor and interleukin [IL] 1b).

HYPERTHERMIA: hypothalamic center

remains unchanged, whereas body

temperature increases uncontrollably.

Eg.Heat stroke, MH


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HYPERPYREXIA: is used for excessively high

fevers greater than 41.5C.


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Chemical mediators of fever

Exogenous pyrogens - microbial origin, known

as toxins.

Endogenous pyrogens /pyrogenic cytokines-

Cytokines are small proteins that regulate

immune, inflammatory, and hematopoietic

processes.

These are IL-1, IL-6, and tumor necrosis factor.


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CLASSIFICATION

Post-operative fever is classified as

immediate, (0-24hrs)

acute (24

72 hours postoperatively), subacute (within the first week),

or delayed.


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Immediate fever 0-24hrs

Medication

Blood products

Infection before Sx Trauma during Sx

Drug reactions (rash+hypotension)

Infection - Clostridium perfringens /

Steptococcus groupA


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Fevers as a result of drugs five categories:

I. hypersensitivity reactions,

II. altered thermoregulatory mechanisms,

III. related directly to administration of the

drug,

IV. direct extensions of the pharmacologic

action of the drug,

V. idiosyncratic reactions

diagnosis by exclusion sequential manner


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Drugs capable of inducing fever


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Fever due to transfusion rxn

Mild - no treatment

Major - tachycardia, chills, back pain, dyspnea,

or microvascular bleeding

Stop transfusion

Significant hemolysis forced diuresis and

alkalization of the urine to prevent renal

toxicity


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Acute fever 24 72 hrs

Atelectasis,

Surgical site infection,

Intravascular catheters

Aspiration pneumonia,

Pulmonary embolism,

UTI ,

DVT,

Aspiration pneumonia


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UTI

In patients with catheters

Longer duration increases risk

Females > male

short urethra Flank pain, burning, cloudy urine

E.coli most common

Urine culture + antibiotics


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P.O Fever due to IV Catheters

I. Phlebitis inflammed vessel 2-45%

II. Thrombophlebitis Phlebitis + clot

III. Septic thrombophlebitis

Infected clot

Signs localized redness, warmth ,

tenderness and fever

Remove hardware, analgesic + antibiotic


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Sx site infection

Examine Sx site everyday

Look for swelling, erythema, pain, discharge,

and possible dehiscence.

presence of pus - indication to open the

wound.

Cultures should determine antibiotic

coverage.


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Malignant Hyperthermia

Genetic disorder (gene - RYR1)

Precipitated halothane / succinylcholine

uncontrolled efflux of calcium from

sarcoplasmic Reticulum- tetany - increasedskeletal metabolism - heat production,.

Increase in the end-tidal carbon dioxide

Muscle rigidity (masseter stiffness), sinustachycardia, skin cyanosis & significanthyperthermia (45C)

Trt: Dantrolene sodium 2mg/Kg IV

S b t b t i l d diti


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Subacute bacterial endocarditis

fever, fatigue, anorexia, back pain, and weight

loss ,Less common CVA

Strep viridans


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Dx of P.O.F


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Treatment

Accurate diagnosis

Physical examination

Lab studies Anti microbial

Anti pyeretic

post operative fever in omfs patients

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