1. Anaesthetic Complications
4th year anaesthesia tutorial
MBChB

2. How to avoid! Thorough assessment
Adequate planning …. Anaesthetist’s motto: “be prepared”
Referral

3. ‘Minor’ complications

4. Sore throat
Muscular pain
Post-operative nausea & vomiting (PONV)
Damage to teeth
Corneal damage
Nerve damage

5. PONV
Risk factors
Patient: young, female, history of PONV or motion sickness, non-smokers
Anaesthetic: opioids, etomidate, NO
Surgical: strabismus, laparoscopy, ear, orchidopexy, gynae
Post-op: pain, opiates, hypotension, forced early feeding
Prophylaxis
Avoid risk factors
Pharmacological
Non-pharmacological

6. Nerve Damage Positioning Neuraxial and regional blockade
Hypoperfusion spinal cord

7. Central Venous Lines Early Pneumothorax / haemothorax, nerve damage
Dysrhythmia
Air embolism
Late
Sepsis and endocarditis
Thrombosis
Tamponade

8. Major complications

9. Ultimately due to HYPOXIA
DEATH !
1: (in the 1st world) vs
1: 280 (in rural SA!!!)
Ultimately due to HYPOXIA

10. Risk Factors for Complications
Patient
Anaesthetic
Surgical

11. Patient
Comorbidity
ASA status
Surgical condition
Age

12. Surgical Type and extent of surgery Emergency or elective
Skill and knowledge surgeon
Mishaps

13. Anaesthetic Intubation Equipment failure Aspiration Anaphylaxis
Cardiac
Pharmacogenetic disease
Postop respiratory depression
Awareness

14. Difficult Airway Recognised - management plan ‘Don’t burn bridges’
Unrecognised – failed intubation drill

15. Failed Intubation Reposition Get help Difficult airway trolley
Ventilate between attempts

16. Dislodged ETT
Obstructed ETT

17. Equipment failure Machine failure Hypoxic gas mixture
Ventilator disconnection

18. Aspiration Chemical pneumonitis Small particles are problematic
At risk – full stomach, hiatus hernia, pregnant, obese, trauma
Rapid sequence induction

19. Cardiac complications MI and arrest
Patient – IHD, CCF, valvular disease, dysrhythmia, PVD, hypovolaemia
Anaesthetic – hypo/hypertension, tachycardia, hypoxia
Surgical – Major risk – intrathoracic, major abdominal, major arterial & emergency

20. Oxygen delivery
DO2 = CO x CaO2
= (HR x SV) x ((Hb x sats) + PaO2))

21. Anaphylaxis Muscle relaxants, latex, antibiotics
Final pathway is degranulation of mast cells or basophils
CVS collapse, bronchospasm, skin changes
Supportive management: ABC’s
ADRENALINE
Serum tryptase
Postop testing and Medic alert bracelet

22. Malignant Hyperthermia
Inherited Ryanodine receptor (calcium receptor) abnormality with calcium dysregulation
Hypermetabolic state
Triggers: volatiles and / or suxamethonium
Tachydysrhythmia, hypercapnia, increased 02 extraction, tachypnoea, cyanosis, muscle rigidity, hyperthermia
Renal and hepatic failure, coagulopathy, cerebral oedema and death

23. Management MH Discontinue trigger Call for help Hyperventilate 100% O2
Dantrolene 2,5 mg kg-1 initial bolus
Cool and supportive management
ICU

24. Halothane Hepatitis 1 : 35 000 Commoner after repeat exposure
Immune mediated
Spectrum includes fatal fulminant hepatic failure

25. Scoline Apnoea Abnormal or absent pseudocholinesterase enzyme
Prolonged paralysis after one dose of sux
Supportive management
Ventilate
Sedate
FFPs (if necessary – NOT first-line therapy)
Medic Alert Bracelet

26. Porphyria Defect in synthesis of haem – porphyrin accumulation
Precipitation acute attack: Barbiturates, pain, infection, starvation, dehydration
Can be delayed by 5 days
Clinical: Abdominal pain, vomiting, motor/ sensory neuropathy, autonomic dysfunction, seizures, coma and death
List of safe drugs

27. Postop Respiratory Failure
Underlying disease: pulmonary, myasthenia gravis, neurological, muscular
Hypokalaemia, hypoglycaemia
Aspiration, PE
Drug complications – opioids and muscle relaxants

28. Awareness Explicit or Implicit Clinical judgement of depth anaesthesia
Objective measures: processed EEG
Agent analyzer
Benzodiazepines