Complications of anesthesia

Complications Of Gen. Anesthesia hamed abedalnabi flaifelMarch 2012

1- Respiratory complications2-Cardiovascular complications 3- Gastrointestinal complications

4-Neurological complications5- Complications from posture6-Miscellaneous complications Hazards to medical & nursing staff

Complications of anesthesia1- Respiratory complications a-Upper airway obstruction: causes( soft tissuses, foreign body, laryngeal spasm(endotracheal tube,oxygen supply)

b- Bronchospsm, c-Cough, d-Hiccup, e- Atelactasis f-Aspiration Pneumonitis ( Mendelson Syndrome), g- Pulmonary Barotraumas , h-Sleep apnea , i- DVT&Pulm.Embolism

Cardiovascular complications1- Cardiac dysrhythemias ;causes( cardiac pathology, hypoxia,hypercapnia, malignant hyperthermia, adrenaline,electrolytes disturbances)2- Myocardial infarction, ischemia 3-Stroke (atrial fibrillation, neck rotation causing vertebral artery obstruction )

4- hypertension at immediate postoperative period (pain , full bladder,undiagnosed hypertension)5-air or gass embolism a-surgical(injured veins above heart level)b- therapeutic, diagnostic

Gastrointestinal complications1-postoperative nausea&vomiting PONV factors( patient, anesthetic technique, stomach, operationTreatment & preventionProchloperazine 12.5 mg,im, cyclizine 50 mg ,metoclopromide 10 mg,domperidone 10 mg droperidol 1-5mg ,hyoscine 0.4mg , ,clonidine ,ONDANSETRONE 4-8 mg ;IM,IV

Intraoperativevomiting(active),regurgitation(passive)1-Laryngeal spasm 2-Lung aspiration of gastric contents- results : i-mild (reflex bradycardia/atelactasis /bronchopneumonia/ lung abscess ;onset 2-10 days, x-ray ; patch of consolidation, fluid level treatment ;postural drainage,antibioticii-Moderate-sever- Mendelson syndromeIncrease risk when volume > 25 mls/ pH < 2.5; ONSET immediately -few hours , signs /symptoms (CyanosisDyponea,Bronchospsm,Hypotension,tachycardia,crakles,wheezing,sever plum. Edema ,death / chest x-ray : irregular mottled densities

PREVENTION OF ACID ASPIRATION SYNDROME(MENDELSON SYNDROME)1- avoid heavy preoperative sedation 2-ensure empty stomach (tube,drugs;metoclopromide,apomorphine ) 3- H2 receptor antagonist ranitidine 150 mg P.O ; night + morning of operation . 4-neutralization of gastric acid ;Na-citrate 15-30 mills of 0.33 moles .

5- rapid sequence induction of anesthesia-preoxygination 100 % O2, for at least 3 minutes -IV induction ,suxamethonium, Sellick maneuver;(cricoid pressure40 newtons , extension of the neck with hand support) -endotracheal intubation

6- awake intubations -topical analgesia for upper airways , - fibreoptic endoscopy-extubation in the lateral position

7-reagional block

TREATMENT OF ACID ASPIRATION 1-prevention further aspiration by tilting head downward or turning the patient to one side2 use suction 3 give oxygen, 4-tracheal tube suction5-bronchposcopy 6- bronchodilator7-antibiotic,8- physiotherapy-9- steroid is not recommended

4-NEUROLOGICAL COMPLICATIONS- abnormal muscle twitching & convulsion causes (propofol, halothane),epilepsy, preclampsia

DELAYED RECOVERY DURING ANESTHESIA1-drugs overdose

2 -disturbance of physiology from anesthesia, hypoxia,hypercapnia,electrolytes and acid base disturbances,hypotension,hypothrmia 3-Disturbances from surgery; hemorrhage,fat embolism,air embolism,brain surgery

4- patients diseases Cerebrovascular disease, myocardial ischemia,myxoedema,hypopituiterism,hypoglycemia, hyperglycemic coma,adrenal insufficiency, uremia, liver failure, undiagnosed brain tumour

5- Drugs taken before operationMAOI (MONO AMINNE OXIDASE INHIBITORS) taken before operation interacts with pethidine or sedatives given intra- or postoperatively

6- Central anti cholinergic syndrome after hyoscine . treated by physostigmine 1-2 mg .

7- septicemia presenting early in postoperative period..

5-COMPLICATIONS FROM POSTURETrendelenburg position ; prolong cerebral edema,retinal detachement prone position ; corneal abrasion,retinal artey occlusion &blindness from pressure on eyes lithotomy position; stain on pelvic ligaments ,streching of sciatic nerves by deep flexion of hips

Supine position - ulnar nerve injury at elbow ( pading +supination)-pading of ankles to protect Achillis tendon ,prevent DVT

6- miscellaneous complicationsawareness during GA, hallucinations ,malignant hyperthermia, scoline apnea , halothane hepatitis , anaphylaxis, trauma to the airways ,teeth , thrombophlebitis

Hazards to medical & nursing staff- pollution of air ; abortion, reduced fertility - stress ; suicide, addiction - blood borne viruses hepatitis, AIDS

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