Post-Operative Complicationspart 2
د. صباح نوري السعدM.B.Ch.B, D.A,F.I.M.S, C.A.B.A & I.C5-Central Nervous System: 1- Delayed Recovery: Causes:Relative sensitivity to anaesthetic agentsRelative overdose of drugs as opioidsRarely delayed recovery is a manifestation of more sinister event, e.g. stroke, myocardial infarction.May be the first sign of an endocrine disorder such as Diabetes mellitus, thyroid under- or over-activityHypoxiaShock state
2-Intra-Operative Awareness: although occur during surgery, but obviously present post-operatively.3-Convulsions: Causes:EclapmsiaStrokeMetabolic causes such as hypoglycaemia, hyperpyrexia.Management: Follow the same principles as that for convulsion in any situation; supportive treatment including airway maintenance.Treat hypoglycaemiaAnticonvulsants (benzodiazepines)
4-Ocular Complication:Especially in prone and lateral positions when the eyes are left openedDiplopia may persist for up to two days when muscle relaxants have been used.5-Problems of Temperature Control:A fall in core temperature of 1 єC or so in almost unavoidable during anaesthesia.Neonates are a particular problemAccidental hypothermia (if < 32 єC) → cardiac arrestRe-warming of hypothermic patient → increase oxygen consumption (hypoxia) and increase cardiac output (stressing the ischemic or failing heart).
6-Minor post-operative complications (Aches, Pains and Trauma): Minor is a dismissive term since these problems may be very distressing to the patient.Sore Throat: occurs after up to 50% of general anaesthetics, caused by:Endo-Tracheal Tube (ETT)Breathing dry gasesUsually resolves within 24 hoursHeadache: Occurs after 15-20% of general anaestheticsCause is unknownNormally resolves within a few hours
Laryngeal Granuloma: if hoarseness persists for longer than about a week after anaesthetic involving endotracheal tube (ETT).Trauma to Teeth: rarely occurs if endotracheal intubation and airway maintenance are performed properly.
Acute Pain Managenet Labour pain: Features of this pain:It gets worse not better with timeNon-pathologicalAssociated with happy outcomeIts relief must not result in compromise to the babyIdeal pain relief must be very potent, very safe, and does not have any depressant effect upon central nervous system.Technique: Epidural block via catheter (bolus and top up dosing)Drug of choice: Bupivacaine 0.125% or 0.25%
Acute Post-Operative Pain: The most common pain met by the anaesthetist and best dealt by preventing it happening in the first place (pre-emptive analgesia). Mild Pain: may be relieved by :Oral: Paracetamol + Codeine (500mg+30mg/1000mg+60mg) 4 times per dayNon-steroidal Anti-inflammatory drugs (NSAIDs):Diclofenac : intramuscular, slow intravenous infusion, suppositoriesKetorolac: Intravenous, intramuscularN.B: Both groups of drugs can be used together if one group proved not effective.
Moderate-Severe Pain: Opioids are the main stay of treatmentMorphine intramuscularly every 3-4 hours ORPethidine intramuscularly every 3-4 hoursORIntermittent boluses of morphine 1-2mg/5 minutes
Paracetamol (Perfalgan®) vial 1g can be used (as intravenous infusion) with each of the above regimens to enhance the effect.
Patient-Controlled Analgesia: achieved by filling a syringe with a large amount of morphine and connecting it to an intravenous cannula. The patient is given a button which when pressed → delivers a fixed small dose of morphine. The machine lock-out for a short time (5 minutes) to give the dose a chance to achieve its effect. The patient then may take another dose.Typically: 1mg morphine each 5 minutes, usual maximum dose 12mg/h