Post-op complications
1. Post-op haemorrhage
- 1° - immediate
- Reactionary – within first 24 hours
- 2° - up to 10 days post-op
 confusion/agitation (from cerebral hypoxia); pallor, sweaty, tachycardia,
tachypnoea, hypotension
- Resuscitation
 Direct compression
 Crystalloid
 Crossmatch
 Catheterise and fluid balance chart
- Wound haematoma
2. Wound emergencies
- Wound infection
 Skin flora – staph aureus, staph epidermidis  flucloxacillin
 From inside viscera – e.coli, pseudomonas (green pigment)
 If patient immunocompromised or very unwell  cefuroxime +
metronidazole
- Wound dehiscence
 Can be partial thickness or full thickness (includes fascia, bone)
 Most secondary to wound infection
3. Cardiac complications
- Chest pain
 Dull central ache  myocardial ischaemia, gastric distension
 Central pain radiating through to back  aneurism/dissection,
PUD, oesophagitis, pancreatitis
 Pain on movement  musk/sk, chest drains
 Pleuritic  infection/empyema, PTX/haemothorax/effusion,
chest drain in situ, PE
- Myocardial ischaemia
 Sx can trigger it by:
1. stress response – catecholamine release by anxiety, pain
2. post-op fluid overload
3. profound hypotension
4. failure to restart anti-anginal meds post-op
 Make patient is on aspirin 75mg and LMWH, GTN, all the usual
stuff
4. Respiratory
- Common!! Due to GA, pain, and immobility
- Pneumonia – good analgesia important to help patient to cough. Physio.
Abx – ciprofloxacin has good gram neg and pos cover until sensitivities
known. CPAP can be used to improve basal collapse. If aspiration
pneumonia – IV cefuroxime and IV metronidazole
- Exacerbation of COPD – postop nebs
5. Renal
- Renal failure
- Hyperkalaemia
- Hypokalaemia
6. Urinary
- Oligurea
 UO <0.5ml/kg/hour
 UO is an indicator of GFR, which is an indicator of renal
perfusion. Hence UO is an indirect measure of renal, and hence
systemic BF, as well as renal function
 Management
1. Basic measures – check that Foley catheter OK
2. CVP if doesn’t respond
3. Is patient overloaded or underloaded? Maintain CVP of 1416mmHg
4. Furosemide?
 Problems associated with oligurea: Pulmonary and cerebral
oedema, CCF, Hyperkalaemia, Acidosis, Drug toxicity
- Acute urinary retention
- UTI
A note on diuretics:
 Loops: inhibit NaKCl exchange in ascending Loop of Henle – hence
decrease osmolality in the medulla – hence decrease water reabsorption
 Spironolactone: Aldosterone antagonist – reduce Na resorption and H+
secretion in the distal tubule
 Thiazides
 Osmotic diuretics: Mannitol – increase the osmotic oressure and hence
reduce water reabsorption
 Alcohol – inhibits ADH release
7. Gastrointestinal
- Paralytic Ileus – this is cessation of GIT motility.
 Could just be due to prolonged surgery/handling of bowel
 due to electrolyte disturbances
 opiates
 Tx: NG, but encourage small volumes of oral; IVF – adequate
hydration; correct electrolytes; reduce opiates
- Mechanical SBO
- Nausea and Vomiting
 Predisposes to: more bleeding, incisional hernia, aspiration
pneumonia, decreased absorption of oral meds, poor nutrition,
hypokalaemia
 Causes:
1. the surgery: long, post op ileus or bowel obstruction
2. the anaesthesia: drugs, CPAP (causes gastric dilatation)
3. electrolyte disturbance: hyponatraemia
-
4. drugs
5. sepsis
 Antiemetics
1. Anti-dopaminergic – prochlorperazine, metoclopramide
2. Anti-serotonergics - ondansetron
3. Anti-histamines – cyclizine
4. Anti-cholinergics – hyoscine
Constipation
Diarrhoea
8. Neurological
9. Haematological
10. DVT and PE