Question

Discuss the general post-operative complications following surgery and show how they can be prevented.

Answer 1

1. Hemorrhage
   1. This could be due to slippage of sutures or due to infection
   2. Slippage of sutures usually occurs immediate post operative period.
   3. Infection occurs after some time and leads to slough off of the blood vessel.
   4. Prevention -
      1. Recheck the suture before closure of incision
      2. Keep a watch on patient's temperature, white blood count or pus discharge. This could indicate infection.
      3. Put the patient on prophylatic antibiotics.
2. Allergic reaction to anesthetic drugs or antibiotics
   1. Prevention -
      1. Elicit a through history of drug allergy in the patient.
      2. Avoid any drug that the patient is allergic to.
      3. Administer a test dose of a drug to assess for allergy
      4. Keep adrenaline standy ( as some patient may develop anaphylaxis to the test dose also)
3. Fall in blood pressure ( Hypotension)
   1. This occurs due to loss of blood and fluid from the body.
   2. Prevention:
      1. Maintain adequate hydration.
      2. Give the patient a head low position
      3. Replace the blood loss with blood products.
4. Basal atelectasis -
   1. This occurs due to imobility.
   2. Occur after abdominal surgeries.
   3. Abdominal surgeries impair diaphragmatic function.
   4. This impaires respiratory movements. This leads to reduced clearance of secretions from the lung.
   5. This promotes basal atelectasis
   6. Prevention -
      1. Maintain adequate hydration ( this prevent dessication of respiratory secretions)
      2. Chest physiotherapy
      3. Adequate pain relief - this will help the patient to breath properly and help to expectorate out the secretion.
      4. Avoid sedative analgesia - Seadatives reduces the central respiratory drive. This causes retention od secretion.
      5. Incentive spirometry
5. Deep venous thrombosis and pulmonary embolism:
   1. Immobility causes statis of blood in the leg veins.
   2. Surgery induces inflammation.
   3. This promotes a pro-coagulative state in the body.
   4. This leads to thrombose formation in the leg veins.
   5. One such thrombus might dislodge from the veins and make move into the lung.
   6. This can leads to breathlessness or even death.
   7. Prevention:
      1. Provide pneumatic stocking in the intra-operative period.
      2. Start the patient on prophylactic dose of anticoagulants (low molecular weight heparin)
      3. Initiate early mobilization of the patient in the post operative period.
6. Low urinary output:
   1. This could occur due to
      1. Urinary retention
      2. Blockage of the urinary cathether by debris
      3. Acute kidney injury leading to anuria
   2. Prevention:
      1. Insert a urinary cathether and change it weekly or as requireed.
      2. Flush the catheter.
      3. Maintain adequate hydration.
      4. Maintain normal blood pressure
7. Wound dehisense:
   1. This occurs due to rupture of sutures
   2. If the sutures are too tight
   3. The affected area is not rested adequately
   4. Infection - this could lead to sloughing off of the sutures.
   5. Prevention
      1. Always take suture on healthy edges
      2. Regular dressing of the wound.
      3. Avoid taking tight sutures.
      4. Use interupted sutures - this allows space for edema fluid to leak outside and prevent the build-up of pressure.
8. Infection and septicemia:
   1. There are multiple sites where infection can occur in the post-operative period
      1. Lungs - pneumonia
      2. The site of surgery
      3. Urinary tract infection (catheter related)
   2. Infection from these sites may spreads to various parts of the body via the blood and lead to seeding of infection.
   3. Prevention:
      1. Chest physiotherapy - This prevents the accumulation of secretion in the lungs.
      2. Removal of drains and catheter after they are no longer required.
      3. Put the patient of broad spectrum antibiotics.
      4. Early mobilization
9. Paralytic ileus -
   1. In some patient, in the post-operative period the body movement stops.
   2. This occurs due to paralysis of the enteric nervous system
   3. Prevention:
      1. Keep a watch on the passage of flatus and feces by the patient
      2. Early initiation of entera feed
      3. Monitor electrolytes - Hypokalemia should be corrected with potassium supplementation.
10. Acute confusin:
    1. This occurs in the patient due to mal-adjustment to the new surroundings
    2. This can be prevented by counselling the patient, allowing the patient to talk to his/her relatives
11. Incisional hernial:
    1. Incisions over the abdominal wall leads to rupture of muscle of the abdomen.
    2. This weakens them.
    3. AS a result, abdominal content herniate out of the incision.
    4. Prevention
       1. Avoid cutting abdominal muscle during surgery
       2. Provide adequate rest to the incisional site
       3. Prevent sudden increase intrabdoominal pressure - this can be achieved by
          1. preventing constipation by using laxative
          2. If the patient is an asthmatic or has chronic bronchitis - start the patient on inhalers to reduce the cough.
       4. Abdominal belts also help