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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