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Post operative complications
Hypotension
Causes:
2. Hypovolemia (most common cause ) it could be due to inappropriate replacement of blood and/or fluids pre and/or post operatively.
3. Decrease systemic vascular resistance (residual effects of anesthetics , sepsis)
4. 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:
2. Arterial hypoxemia.
3. Enhanced sympathetic nervous system activity (pain, bladder distension).
4. Preoperative hypertension.
5. Hypervolemia.
6. 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:2. Co-existing renal disease.3. Major trauma.4. Sepsis.5. Advanced age.6. Multiple intraoperative blood transfusions.7. Prolong intra operative hypotension.8. Cardiac or vascular surgery.9. 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.
Thank You