APS Complications

8/6/2019 APS Complications

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POSSIBLE COMPLICATIONS

Related to drugs used

OpioidsNSAIDS

Local anaesthetics

Related to techniques used

Intravenous drug administration

Epidural


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Minor complications Nausea and vomiting

Headache

Giddiness

Urinary retention

Ileus Pruritus

Backache


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Major complications

Respiratory depression

Systemic toxicity from local anaesthetic

Epidural haematoma

Epidural abscess

High epidural block


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COMPLICATIONS

RELATED TO DRUGS

OPIOIDS

Respiratory depression Oversedation

Nausea and vomiting

Urinary retention

Ileus

Pruritus


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COMPLICATIONS

RELATED TO DRUGSNSAIDS GIT bleeding

Coagulopathy Acute renal failure

Allergic reactions

Local Anaesthetics Hypotension

Motor block

Systemic toxicity


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COMPLICATIONS

RELATED TO TECHNIQUES

Due to epidural

Epidural abscess

Epidural haematoma

Backache

Headache (accidental dura puncture)

Catheter migration and knotting


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COMPLICATIONS

RELATED TO TECHNIQUES

PCA

Due to drugs used

opioid side effects

Due to IV line

thrombophlebitisaccumulation of opioid in IV line

(need to use anti-reflux valve)


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RESPIRATORY DEPRESSION

Pre-disposing conditions

Extremes of age (neonate, elderly)

Concomitant use of other CNS depressantdrugs

Morbidly obese

Patient sensitivity to opioid

Poor pulmonary function


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WARNING SIGNS

Patient not arousable when called Respiration shallow and slow

Pinpoint pupils

Cyanosis (late sign)


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MANAGEMENT

Call for help

Stop PCA or epidural

Give oxygen

Ask patient to breathe

Give IV/IM naloxone 0.1mg stat andrepeat at 2-3min interval until 0.4mg


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NAUSEA AND VOMITING

Postoperative nausea and vomiting (PONV)

High incidence (20-30%)

More common in:

female patients

paediatric patients

obese patientshistory of motion sickness

history of previous PONV


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NAUSEA AND VOMITING

Causes:

Effects of general anaesthetics

Perioperative opioids Inhalational agents

Induction agents

Related to surgery

Gynaecological procedures Laparoscopic surgey

Bowel surgery

ENT


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NAUSEA AND VOMITING

Prophylaxis and treatment Avoid excessive movements esp. during

transportation Avoid emetic triggering agent

For APS patients on opioids

reduce bolus dose

administer opioid slowly

stop background infusion

give anti-emetic


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NAUSEA AND VOMITING

ANTI-EMETIC AGENTS

Metoclopropamide (maxolon)

10mg in adult (0.15mg/kg)

Droperidol

0.25mg in adult (50mcg/kg)

Ondansetron

4mg in adult

NB: maxolon can be given by ward nursesdroperidol and ondansetron given by APS

doctors


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HYPOTENSION

Numerous causes, often not related to APS

Must rule out surgical problems esp.

immediate postoperative periodbleeding, hypovolaemia

Management

run in fluids (eg Hartmans) 200-500mlscall ward/APS doctors

stop PCA or epidural


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REDUCED GIT MOTILITY

Common problem after abdominal surgery

May not be due to APS

Consider surgical related causes

May be due to inadequate pain relief

Management

delay oral intakeinsert nasogastric tube

laxatives


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URINARY RETENTION

Incidence difficult to determine (40% APSpatients have indwelling urinary catheter)

Maybe due to opioid or local anaesthetic Rule out acute renal failure

Management

reassure, coaxcatheterise


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PRURITUS

Incidence 2%

More with morphine than pethidine

Esp common with epidural or spinal morphine Management:

reassurance

calamine lotion

change to pethidine or other technique

caution with anti-histamine eg piriton

Documents

APS Complications