Post operative complications

1. Upper airway obstruction

2. Arterial hypoxemia
3. Hypoventilation
4. Hypotension
5. Hypertension
6. Cardiac dysrthymia
7. Oliguria
8. Bleeding
9. Decreased body temperature
10. Agitation (emergence delirium)
11. Delayed awakening
12. Nausea and vomiting
13. Pain
 Upper airway obstruction

1. Occlusion of the pharynx by the tongue.

2. Laryngeal obstruction
• Laryngospasm
• Laryngoedema
Signs and symptoms:

• Flaring of the nares

• Retraction at the suprasternal notch
(tracheal tug)
• Retraction of intercostal and subcostal
spaces
• Vigorous diaphragmatic and abdominal
contractions
:Treatment

• Elimination upper airway obstruction due

to occlusion of the pharynx by the tongue,
by head tilt-jaw thrust method, this
maneuver stretches muscles attached to
the tongue serving to pull the tongue away
from the posterior pharyngeal wall.
• If not beneficial a nasopharyngeal or
oropharyngeal airway can be inserted (the
nasopharyngeal airway is better tolerated
by patients awakening from general
anesthesia
Laryngospasm
• In complete laryngospasm treated by extension
of the head and anterior displacement of the
mandible plus application of positive airway
pressure with bag and mask delivering pure
oxygen.
• Complete laryngospasm that persist despite
these maneuvers should be treated by IV
succinylcholine, laryngoscopy and intubation of
the trachea with cuffed tube. If intubation was
impossible do cricothyrotomy which will provide
temporary oxygenation until tracheostomy can
be performed.
Laryngeal odema treated by:

• Humidifying the inhaled gases

• Administering nebulized epinephrine

• Dexamethasone ??
 Arterial hypoxemia
(PaO2<60mmHg)
Factors leads to post operative arterial
hypoxemia:
2. Right-to-left intrapulmonary shunt (atelectasis)
3. Mismatch of ventilation to perfusion
4. Decreased cardiac output
5. Alveolar hypoventilation (residual effects of
anesthetics and/or muscle relaxants)
6. Inhalation of gastric contents (aspiration)
7. Pulmonary embolism
8. Pulmonary edema
Pneumothorax
Posthyperventilation hypoxia
Increased oxygen consumption (shivering)
Advanced age
Obesity
Smoking
Lung disease
Diagnosis:
2. Clinical (cardiac dysrthmias, agitation,
cyanosis)
3. Pulseoximeter (arterial hemoglobin
oxygen saturation)
4. Measurement blood gas
(PaO2<60mmHg)
Treatment:
2. Oxygen supplementation
3. Eliminate the cause of hypoxia:
• If due to residual effects of muscle relaxants
(may be not enough dose of neostigmine
given)
• If due to residual effect of opioids give
naloxone
• If due to pneumothorax insert chest tube (if
circulatory depression accompanies a tension
pneumothorax, emergency treatment is
placement a 12-14 gauge needle into the 2nd
anterior intercostal space
• If oxygenation alone was not benefit incubate
at once and put the patient on ventilator
 Hypoventilation
Factors leading to postoperative hypoventilation
2. Drug induced CNS depression (volatile
anesthesia, opioids)
3. Residual effects of muscle relaxants
4. Suboptimal ventilatory muscle mechanics
(patient position, obesity, gastric dilation, site
of surgical incision)
5. Increased production of CO2 (hyperthermia)
6. Co-existing chronic obstructive pulmonary
disease
Diagnosis:
• Clinical (signs of CO2 retention such as
tachycardia, hypertension)
• Capnograph (PaCO2>45mmHg)
• Blood gas measurement
(PaCO2>45mmHg)
Treatment:
• Clear airway and ventilate the patient
• If due to residual effect of opioids give
naloxone
• If due to residual effects of muscle
relaxants (not enough dose of
neostigmine, succinylcholine apnea,
myasthenia gravis, any potentiation of
Nondepolarizing muscle relaxants like
ABs, Mg, respiratory acidosis,
hypokalemia----etc. Treat accordingly)
Thank you