Anesthesia 5th year, 11th lecture (Dr. Aamir)

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The lecture has been given on May 3rd, 2011 by Dr. Aamir.
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  • 1. Post operative complications
  • 2. Hypotension <ul><li>Causes: </li></ul><ul><li>Hypovolemia (most common cause ) it could be due to inappropriate replacement of blood and/or fluids pre and/or post operatively. </li></ul><ul><li>Decrease systemic vascular resistance (residual effects of anesthetics , sepsis) </li></ul><ul><li>Arterial hypoxemia. </li></ul>
  • 3. <ul><li>Causes: </li></ul><ul><li>4. Cardia dysrhythmias. </li></ul><ul><li>5. Pulmonary embolus. </li></ul><ul><li>6. Decreased myocardial contractility (M.I). </li></ul><ul><li>7. Pneumothorax. </li></ul><ul><li>8. Cardiac tamponade. </li></ul>
  • 4. Management <ul><li>Confirm the accuracy of the blood pressure measurement. </li></ul><ul><li>Oliguria (less than 0.5ml/kg/h) which increase after fluid challenge (200ml). </li></ul><ul><li>Low haematocrit. </li></ul><ul><li>Replacement of fluid properly if not benefit </li></ul><ul><li>Put central venous line and measure CVP </li></ul>
  • 5. <ul><li>-If Bp was low and CVP high it may indicate heart failure (inotropic drugs). </li></ul><ul><li>If Bp was low and CVP low it may indicate hypovolemia (IV fluids). </li></ul><ul><li>If Bp was low and CVP high or low it may indicate sepsis (proper antibiotic). </li></ul>
  • 6. Hypertension <ul><li>Causes: </li></ul><ul><li>Arterial hypoxemia. </li></ul><ul><li>Enhanced sympathetic nervous system activity (pain, bladder distension). </li></ul><ul><li>Preoperative hypertension. </li></ul><ul><li>Hypervolemia. </li></ul><ul><li>Hypercarbia. </li></ul>
  • 7. Management <ul><li>Confirm the accuracy. </li></ul><ul><li>Correct the cause. </li></ul><ul><li>Use Hypotensive agents (Hydralazine) </li></ul>
  • 8. Cardiac dysrhythmias <ul><li>Causes: </li></ul><ul><li>Arterial hypoxemia. </li></ul><ul><li>Hypovolemia. </li></ul><ul><li>Hypothermia. </li></ul><ul><li>Hypertension. </li></ul><ul><li>Pain. </li></ul><ul><li>Myocardial ischemia. </li></ul><ul><li>Anticholinesterase. </li></ul>
  • 9. <ul><li>Causes: </li></ul><ul><li>Electrolyte abnormality: </li></ul><ul><li>Hypokalemia. </li></ul><ul><li>- Hypocalcaemia. </li></ul><ul><li>Respiratory acidosis. </li></ul><ul><li>Digitalis toxication. </li></ul><ul><li>Preoperative cardiac dysrhythmia. </li></ul>
  • 10. Management <ul><li>Most cardiac dysrhythmias which occur in post operative period do not require treatment other than correction of the underlying cause. </li></ul><ul><li>Patency of the upper airway and good oxygenation could be enough as a treatment. </li></ul>
  • 11. <ul><li>Drug therapies: </li></ul><ul><li>Atropine for treatment of bradycardia. </li></ul><ul><li>Verapamil to decrease heart rate. </li></ul><ul><li>Lidocaine to suppress ventricular ectopics. </li></ul><ul><li>Electrical cardioversion for treatment of hemodynamically significant atrial or ventricular tachydysrhythmias. </li></ul>
  • 12. Renal dysfunction <ul><li>Patients at high risk: </li></ul><ul><li>Co-existing renal disease. </li></ul><ul><li>Major trauma. </li></ul><ul><li>Sepsis. </li></ul><ul><li>Advanced age. </li></ul><ul><li>Multiple intraoperative blood transfusions. </li></ul><ul><li>Prolong intra operative hypotension. </li></ul><ul><li>Cardiac or vascular surgery. </li></ul><ul><li>Biliary tract surgery in presence of obstructive jaundice. </li></ul>
  • 13. Management <ul><li>Put a urinary catheter for early recognition of oliguria ( less than 0.5ml/kg.hr) in high risk patients and treat accordingly. </li></ul>
  • 14. <ul><li>Thank You </li></ul>
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