Post operative complications

Hypotension

Causes:

1. Hypovolemia (most common cause ) it could be due to inappropriate replacement of blood and/or fluids pre and/or post operatively.

2. Decrease systemic vascular resistance (residual effects of anesthetics , sepsis)

3. Arterial hypoxemia.

Causes:

4. Cardia dysrhythmias.

5. Pulmonary embolus.

6. Decreased myocardial contractility (M.I).

7. Pneumothorax.

8. Cardiac tamponade.

Management

• Confirm the accuracy of the blood pressure measurement.

• Oliguria (less than 0.5ml/kg/h) which increase after fluid challenge (200ml).

• Low haematocrit.

• Replacement of fluid properly if not benefit

Put central venous line and measure CVP

-If Bp was low and CVP high it may indicate heart failure (inotropic drugs).

- If Bp was low and CVP low it may indicate hypovolemia (IV fluids).

- If Bp was low and CVP high or low it may indicate sepsis (proper antibiotic).

Hypertension

Causes:

1. Arterial hypoxemia.

2. Enhanced sympathetic nervous system activity (pain, bladder distension).

3. Preoperative hypertension.

4. Hypervolemia.

5. Hypercarbia.

Management

• Confirm the accuracy.

• Correct the cause.

• Use Hypotensive agents (Hydralazine)

Cardiac dysrhythmias

Causes:• Arterial hypoxemia.• Hypovolemia.• Hypothermia.• Hypertension.• Pain.• Myocardial ischemia.• Anticholinesterase.

Causes:

• Electrolyte abnormality:

- Hypokalemia.

- Hypocalcaemia.

• Respiratory acidosis.

• Digitalis toxication.

• Preoperative cardiac dysrhythmia.

Management

• Most cardiac dysrhythmias which occur in post operative period do not require treatment other than correction of the underlying cause.

• Patency of the upper airway and good oxygenation could be enough as a treatment.

• Drug therapies:

- Atropine for treatment of bradycardia.

- Verapamil to decrease heart rate.

- Lidocaine to suppress ventricular ectopics.

• Electrical cardioversion for treatment of hemodynamically significant atrial or ventricular tachydysrhythmias.

Renal dysfunction

• Patients at high risk:1. Co-existing renal disease.2. Major trauma.3. Sepsis.4. Advanced age.5. Multiple intraoperative blood transfusions.6. Prolong intra operative hypotension.7. Cardiac or vascular surgery.8. Biliary tract surgery in presence of obstructive

jaundice.

Management

Put a urinary catheter for early recognition of oliguria ( less than 0.5ml/kg.hr) in high risk patients and treat accordingly.

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