19) Complications of General Anaesthesia - GIT, Renal, Hepatic & Eye

Complications

PULMONARY ASPIRATION:

Pulmonary aspiration is a serious complication that is more likely in inadequately fasted patients,
those suffering gastro-oesophageal reflux disease, pregnant patients and in emergency surgery. One
study reports an incidence as high as ~1:2000 with a mortality of 1:45,000. 17% of patients required
ventilation because of the aspiration. The development of pneumonitis due to aspiration of acidic
gastric fluid has a high mortality. 

Other than CPAP or PEEP, no specific therapy has been shown to be beneficial in treatment of
aspiration pneumonitis. Management should be supportive, with ventilation and ICU admission if
required. Steroids have not been shown to improve outcomes and antibiotics are only indicated in
demonstrated pneumonia.

RENAL DISEASE AND ANESTHESIA:

 Preoperative renal dysfunction is the only reliable predictor for postoperative dysfunction
 Absolute laboratory values are almost meaningless outside the context of trends
 Cardiovascular disease is the most common cause of death in patients with ESRF
 SCh will increase by ~ 0.6 mEq/L regardless of renal status an can be safely given even when
serum [K+] > 5 mEq/L
 Always check shunts and fistulas during surgery
 Use pancuronium and morphine with caution
 Dopamine has no long-term practical use in renally impaired patients, though it may be able
to preserve renal function.

PERI-OPERATIVE VISUAL DYSFUNCTION:

Up to 4% of patients reported blurred vision lasting at least 3 days, and of these up to 25% will have
permanent blurred vision requiring treatment. The majority of these are due to corneal abrasions,
and are best avoided with careful taping of the eye closed during general anaesthesia. Visual loss or
blindness after non-cardiac surgery is very rare (1:250,000) although more common in cardiac
surgery (0.1-2%).

HEPATIC COMPLICATIONS:

Impaired liver function gives rise to effects directly attributable to the failing liver itself and also to
indirect effects expressed via other organ systems. Effects directly attributable include
hypoglycaemia, lactic acidosis, hypermetabolism, azotemia and impaired urea synthesis. Jaundice
appears when serum bilirubin exceeds 35 µmol/l and defects in cholesterol metabolism together
with intra-hepatic cholestasis may lead to production of poor quality bile and malabsorbtion of fat
and fat-soluble vitamins. There is reduced synthesis of proteins such as albumin, clotting factors,
thyroid binding globulin and pseudo-cholinesterase. Impaired hormone biotransformation, reduced
production of modulator proteins and reduced protein binding lead to increased circulating levels of
hormones such as insulin, thyroxine, T3 , aldosterone and oestrogen. Impaired hormone modulation,
failure to clear by-products of metabolism, activation of cytokines and release of vasoactive
substances from the damaged liver result in patho-physiological changes in many organ systems.
These indirect effects include; cardiovascular changes, pulmonary changes, electrolytes and renal
changes, neurological problems, haematological problems, susceptibility to infection and altered
drug disposition.