1. Post operative complications
Classification
Specific to operation
General ( Immediate early late)

2. E.G Complication of a Bowel Resection for colon ca
Specific
Intraoperative Haemorrhage
Wound infection
Anastomotic leak
Intra-abd.abscess
Adhesion
Stricture
hernia
General to anaeshesia MI
Anaphylactic Reaction
Pumonary collapse
DVT
Cannula phlebitis
UTI
- PE

3. Common clinical presentation
Low urine output (oligo-anuria)
Urine output is a reflection of GFR which is a reflection of RBF hence hydration
Surgery produces the stress response. Which leads to decreased urine volume.
Other factors can affect GFR not just RBF

4. Min. acceptable urine output is 0.5ml/kg
Important to act on urine output to avoid tubular damage and necrosis hence acute renal failure

5. Patient has oligo-anuria Catheterize ? retention If catheter flush
If real oligo - anuria
Check for low Assess for signs
Cardiac output of hypovolaemia

6. Consider icu support if failed consider
Treat causes of trial of fluid Challenge
Low cardiac output bolus up to 5ml/kg
(e.g arrhythmias)
Consider icu support if failed consider
further challenge
monitored by cvp

7. Advanced therapies Furosemide Dopamine water
Renal support – indication k+
urea (to toxic bwels)
failure to regulate acid-base

8. 2- Confusion (D.A.M HYPOS)
Drugs
- Anaesthetic agents
- Analgesics (opiates)
- Normal drugs being given
- Normal drugs not being given

9. Acute systemic infection
- Wound infection
- Anastomotic leak
- Chest infection

10. Metabolic disturbance
Hypokalaemia / hyper
Na+ Na+
Sugar / sugar
Fluid overload
- Alcohol withdrawal

11. Hypotension
- Occult haemorrhage
Inadequate fluid infusion
Low cardiac output (MI arrhythmias, PE)

12. HYPOXIA
PYREXIA

14. HYPOXIA
Common especially in thoracic + abdominal surgery cause may be multifactorial
Have a low index of suspicion – mild confusion mild hypotension and slight tachycardia may be the only signs -

15. Basic physiology. Adequate analgesia, proper patient positioning, humidified oxygen and physiotherapy
Most post-op respiratory problems are not due to classical pneumonia. Provided the collapse and hypoventilation that underlies many problems is treated, any infectious element usually settles spontaneously.

17. Common or important problems
Anastomotic leak
- Between days 4 – 14 postoperatively
manefist as
Peritonitis
Intra – abdominal abscess
Enteric fistula. (path or least resistance i.e through wound or drain site)

18. 2- Wound complication
Wound infection
Wound dehiscence.
Wound hernia

19. 3- Cannula related sepsis
4- UTI

20. 5- Intestinal obstruction
Mechanical – uncommon as early complication following surgery – late due to adhesion.
Paralytic

21. 6- Fluid and electrolyte imbalance
May occur as a result of.
Inappropriate administration of fluid replacement therapy by the medical staff.
Excessive losses e.g due to NG tubes. High intestinal stoma output , intestinal fistulae, diuretics etc.
Intrinisic renal disease exacerbated by surgery or drugs

22. 7- Thromboembolic disease.
Upto 20% of patients that stay longer than 7 days can develop DVT
Highest in women on ocp + pelvic surgery
Majority will not be clinically apparent .

23. 8- Adhesions Fibrnonos – usually resolve 6-9 weeks
Can become fibrosed dense fibrotic adhesion. In abdomen these bands of tissue may form between or over loops of small bowel in particular. may lead to “kinking” or compression of small bowel loops, causing obstruction and even infarction of the blood supply. Such complication may occur shortly after the adhesions form. Within months of surgery, or many years after.

24. Factors that cause adhesion include:
Genetic
Infection/inflammation at time of surgery
Use of powdered (starch) surgical gloves)
Use of biological suture material
Cooling of intestinal loop.

25. THANK YOU