Post Operative Complication

1. Respiratory Complications
Complicatio
n
1.Airway
Obstruction

Definition

Causes

Signs and
symptoms

Nursing
Interventions

2.Aspiration

3.Larnngosp
asm and
Bronchospas
m

A. Definition

4.Hypoxemi
a

PaO2 less
60 mmHg
or SaO2
less 90%

1. initial
treatment
includes
100%oxygen,
anterior
mandibular
displacement,
and gentle CPAP
(maybe applied
by face mask). If
laryngospasm
persists and
hypoxiadevelops
, succinylcholine
(0.25-1.0 mg/kg;
10-20 mg).

: Laryngospasm
is a forceful
involuntary
spasm of
thelaryngeal
musculature
caused by
sensory
stimulation of
the superior
laryngeal nerve.
Triggering
stimuli include
pharyngeal
secretionsextub
ating in stage 2.
The large
negative
intrathoracic
pressuresgener
ated by the
struggling
patient in
laryngospasm
can
causepulmonar
y edema

Decreased
FiO22.
Hypoventilati
on3. V/Q
mismatch4.
Increased O2
utilization by

sweating,
tachycardia, cardiac
arrhythmias,hyperte
nsion, and
hypotension) are
nonspecific;
bradycardia,hypoten

oxygen therapy
with or without
positive airway
pressure.Additio
nally, treatment
of the cause

5.Pulmonary
Embolism

Blood clots
that has
moved to
the lungs
and blocks
a
pulmonary
artery

6.Pneumoni
a

Inflammati
on of the
Alveoli

7.Atelectasis

Collapse of
the Alveoli

tissues5.
Tissue
hypoxia

sion, and cardiac

arrest are late signs

stasis of
the venous
blood from
immobility
Venous
injury from
fractures/duri
ng surgery
Use of oral
contraceptive
s high in
estrogen
Preexisting
coagulation
or circulatory
disorder
Infections,
toxins,
irritants,
IMMOBILITY,
andIMPAIRED
VENTILATION

Sudden chest pain

Shortness of
breath
Cyanosis
Shock
(tachycardia, low
blood pressure)

Mucous
plugs
blocking
bronchial
passageways
Inadequate
lung
expansion
Analgesics
IMMOBILITY

-Increased
temperature
-Cough
-Expectoration of
blood
tinged/purulent
sputum
-Dyspnea
-Chest pain
Dyspnea
Tachypnea
Tachycardia
Diaphoresis
Anxiety
Pleural pain
Decraesed chest
wall movement
Dull or absent
breath sounds
Decreased oxygen
saturation (SPO2)

8.Pulmonary
Edema

2.Cardiovascular Complication
Complicati
on
1.Hypoten
sion

Define

Causes

Hypovolemia (most
common cause )
itcould be due to
inappropriatereplace
ment of blood and/or
fluids preand/or post
operatively.3.Decreas
e systemic vascular
resistance(residual
effects of anesthetics
, sepsis)4.Arterial
hypoxemia

Signs and
Symptoms

Nursing
Intervent
ions
luid
challeng
e;
pharmac
ologic
treatmen
t
includesi
notropic
agents
(dopamin
e,
dobutami
ne,
epinephri
ne) and
alpharec
eptor
agonists
(phenyle
phrine).
CVP and
PA
catheter
monitori
ngmay
be
needed
to guide
therapy

2.Hemorrh
age

Internal and
external
bleeding

Disruption of sutures

Insecure ligation of
blood vessels

3.Hypovol
emic
Shock

Response of
the body to
a decrease in
the
circulating
blood
volume
,results to
inadequate
tissue
perfusion
and
inadequate
tissue
oxygenation(
tissue
hypoxia)

Severe hypovolemia
from fluid deficit
orhemorrhage

4.Hyperte
nsion

Arterial
hypoxemia.3.Enhanc
ed sympathetic
nervous
systemactivity (pain,
bladder
distension).4.Preoper
ative
hypertension.5.Hyper
volemia.6.Hypercarbi
a.

Rapid weak pulse,

increasing
respiratoryrate,
restlessness,
lowered BP, cold
clammy skin,
thirst,pallor,
reduced urine
output.
Rapid, weak pulse,
Decreased blood
pressure

Dyspnea

Tachypnea

Restlessness &
anxiety

Urine output less

than 30 ml/hr

Cool clammy skin,

Thirst, Pallor

Progressive
weakness, then
death

Early
recogniti
on of
signs

correctio
n of the
initiating
cause;
various
medicati
onscan
be used
to treat
hyperten
sion
including
beta
blockers,
calciumc

hannel
blockers,
nitroprus
side or
nitroglyc
erin
5.Coronar
y
Thrombosi
s
6.Air
Embolism
7.Venous
Stasis
8.Deep
Vein
Thrombosi
s
9.Cardiac
Dysrhyth
mias

Arterial
hypoxemia.Hypovol
emia.Hypothermia.
Hypertension.Pain.
Myocardial
ischemia.Anticholine
sterase.

Most
cardiac
dysrhyth
mias
which
occur
inpost
operative
period do
not
requiretr
eatment
other
than
correctio
n of
theunder
lying
cause.P
atency of
the
upper
airway

and
goodoxy
genation
could be
enough
as
atreatme
nt. Drug
therapies
:Atropine
for
treatmen
t of
bradycar
dia.Verapami
l to
decrease
heart
rate.Lidocaine
to
suppress
ventricul
ar
ectopics.
Electric
al
cardiover
sion for
treatmen
t of
hemodyn
amically
significan
t atrial or
ventricul
ar
tachydys
rhythmia
s.

3.Thermoregulation
Complication

Define

Causes

1.Hypothermia

It is
unintentional
decrease of
core body
temperature to
< 35 C
duringanesthe
sia

Drop in core
temperature.2Central
inhibition of
thermoregulati
on
Contributing
factors
:
Extremes of
age, prolonged
surgery, cold
infusion or
irrigationfluids,
muscle
relaxants.
Heat loss by
radiation,
evaporation,
convection
and
conduction.

Signs and
Symptoms

Nursing
Interventions
ncrease
ambient temp
and humidity2warm
solutions3enclose
exposed
viscera4humidify the
inspired
gases5-warm
mattress and
blanket6-use
low flow
anesthesia.

2.Hyperthermi
a

4. Gastrointestinal
Complication
1.Nausea and
Vomiting

Define

Causes

Signs and
Symptoms

Nursing
Interventions

Pain

Abdominal
distention

Complaints of
feeling sick to
the stomach

Retching or

IV fluids until
peristalsisretur
ns; then clear
fluids, full
fluids and

Ingesting of
food and fluids
before return
of peristalsis

Certain
medication

Anxiety

gagging

Throwing up

regular
dietwhen
peristalsis
returns.

2.Hiccups

3.Paralytic
Ileus
4.Instestinal
Obstruction

5.Genitourinary
Complication

Define

Causes

Signs and
Symptoms

Nursing
Interventions

1.Urinary
Retention

Inability to
empty
excessive
accumulati
on of urine
in the
bladder.
Accumulati
on of urine
in the
bladderand
inability of
the bladder
to empty
itself.
Inflammati

depressed
bladder tone
from narcotics
andanesthetics

Handling of
tissues during
surgery
onadjacent
organs
(rectum/vagina
)

Fluid intake
larger than
output;
inability tovoid
or frequent
voiding of
small
amounts,
bladderdistent
ion,
suprapubic
discomfort,
restlessness.

Monitoring of
fluid intake
andoutput,
interventions to
facilitate
voiding.

IMMOBILIZATIO

Burning

Adequate fluid

2.Urinary Tract

Infection

on of the
bladder.

Limited fluid
intake

Instrumentatio
n of urinary
tract

sensation
during voiding

Urgency

Cloudy urine

Lower
abdominal
pain
Signs and
Symptoms

intake,
earlyambulatio
n, early
ambulation,
good perineal
hygiene.

Complication

Define

Causes

Causes

Signs and
Symptoms

Nursing
Interventions

poor aseptic
technique
lab analysis of
woundswab
identifies
causative
microorganism

Purulent
exudates

Redness

Tenderness

Elevated
temperature

Malnutrition
(emaciation,

Increased
incision

Nursing
Interventions

6.Shock
Depression

7.Depression

8.Wound Complications
Complication

Define

1.Wound
Infection

2.Dehiscence

Separation of
an incision line

before incision
heals

obesity)

Poor circulation

Excessive
strain on
suture line

drainage

Tissues
underlying
skin becomes
visiblealong
parts of the
incision

3.Evisceration

REFERENCES

Reference: Kozier, B., et. al. (2004).

Fundamentals of Nursing
(5th ed.). Jurong, Singapore: Pearson EducationSouth Asia PTE Ltd

COMPLICATIONS OF GENERAL ANESTHESIABy Dr. Salah A. IsmailAssistant Professor

of AnesthesiaFaculty of Medicine, King Faisal University2007/2008