Postoperative

Complications and
management
by
Dr.Mustafa Usama Abdul
Mageed
General laparscopic and
bariatric surgery
 Specific
postoperative
complications
Respiratory complications

an oxygen saturation of less than 90 percent

Post-operative hypoxia
Hypoxia is defined as an oxygen saturation of less than 90
per cent.
Hypoxia may present as shortness of breath or agitation or
as upper airway obstruction (absence of air movement,
seesaw motion of chest, suprasternal recession) or cyanosis
or as a combination
of any of the above.
In obese patients ,smokers or in those with acute or
chronic lung disease, hypoxia develops more quickly.
Causes :-
1. Upper airway obstruction
2. Laryngeal oedema
3. Hypoventilation
4. Atelectasis
5. Pulmonary eodema
6. Pulmonary embolism
Clinical features

Shortness of Upper airway

breath cyanosis obstruction
Management

Head tilt, chin lift Suctioning of any

maneuver blood or secretions

Administer
oxygen at 15
L/min, using a
non-rebreathing
insertion of an manual ventilation
mask
oropharyngeal airway with ambu bag
Cardiac system
 Clinical features

Cold clammy tachycardia Low urine output

extremities
Gastrointestinal tract

Paralytic
ileus
Clinical features

nausea anorexia pain

vomiting obstipation distension No bowel sound

Investigations
Management

Gastrointestinal
distension Oral intake
decompression by restriction Water electrolytes
nasogastric suction balance
Renal and urinary system
Acute kidney injury
 According to national guidance (National
Institute for Health and Care Excellence,
NICE) based on several definitions,
 acute kidney injury can be detected by
the following criteria :
 ●● a rise in serum creatinine of 26 μmol/L
or greater within 48 hours;
 ●● a ≥50% rise in serum creatinine known
or presumed to have occurred within the
past 7 days;
 ●● a fall in urine output to less than 0.5
mL/kg/h for more than 6 hours in adults
and more than 8 hours in children and
young people;
 ●● a ≥25% fall in estimated glomerular
filtration rate in children and young
people within the past 7 days.
Urinary system
Clinical features of UTI

Fever tiredness Suprapubic

pain

urgency frequency Burning micturition

Sings of UTI

Hematuria Pyuria
Investigations

Urine dipstick test Blood test Urine culture

Management

Proper bladder
Adequate
drainage
hydration
URINARY SYSTEM

Urinary retention
 Clinical features

No urine is passed Suprapubic pain

for several hours.
management

catheterization
Central nervous system
Postoperative delirium
 With an increasingly frail and elderly
population presenting for elective surgery,
 the incidence of postoperative delirium
(POD) is increasing.
 POD is frequently recognised late and has
significant postoperative sequelae
 Theoverall incidence of POD is 5–50%. It
occurs more frequently in the elderly
orthopaedic patient and those
undergoing emergency surgical
procedures
 There are two types of delirium
 – hyperactive (restlessness, incoherent
speech, agitation, hallucinations) and
 hypoactive (withdrawn, poorly responsive
to the environment, depressed
 Preoperative risk factors for POD include
 pre-existing cognitive impairment,
 dementia,
 frailty,
 Parkinson’s disease,
 severe illness,
 renal impairment
 and depression.
 intraoperative administration of narcotics
and benzodiazepines,
 change of medications, electrolyte and
fluid abnormalities,
 constipation, catheterisation and an
unfamiliar
 environment
TREATMENT

 Correcting any reversible cause, involving

relatives or friends whom the patient
knows and pain control can all contribute
to reducing the impact and duration of
delirium.
 As a last option, haloperidol may be
given in titrated doses according to local
protocols.
POSTOPERATIVE
NAUSA AND VOMITING
 Risk factors for PONV include
 female gender
 , nonsmoking,
 and a history of PONV, motion sickness or
migraine.
 Use of volatile anaesthetic agents, opioids
and nitrous oxide
 add to the risk. Duration and type of surgery
also affect the incidence of PONV.
 Treatment of PONV includes
 adequate treatment of pain,anxiety, hypotension
and dehydration.
Antiemetics can be
 administered both prophylactically and for
treatment.
 A multimodal pharmacological approach, using
drugs that work at different sites, such as HT3
receptor antagonists (e.g. ondansetron),
 steroids (e.g. dexamethasone), phenothiazines (e.g.
prochlorperazine) and antihistamines (e.g. cyclizine), is
the most effective.
Drains
 Drainsshould be removed as soon as
possible and certainly once the drainage
has stopped or become less than 25
mL/day.
DISCHARGE OF PATIENTS
Thank for lessening