Post operative
complications and
their management
Purpose of post operative
management
• Quick
• Painless
• Safe
Recovery from surgery
Reduces physical, psychological ,
strategical and financial cost of surgery
Commonly encountered post
operative complications
General complications and their
management
Pain
• Post op. pain management is essential because it can lead to delayed
recovery, unsatisfied patient and various other multiple problems
such as:
• In childbirth surgery mother’ pain might hinder bonding with the new born
child , breast feeding and care of newborn.
• In case of joint surgeries pain might affect with the mobility function resulting
in contractures etc as in hand injury procedures.
• A day care surgery might extend to a unplanned hospital admission.
Factors contributing to
it are anesthetic
effects, past h/o NV,
post op. pain
hypotension etc
Delirium and Emergence
Delirium
• Delirium is an altered state of
consciousness, characterized by
episodes of confusion, that can
develop over hours or days.
• Emergence Delirium is an acute
confusional state when
recovering from effects of
anesthesia.ED is usually short
(average, 5-20 minutes).
Fever
40 % patient develop pyrexia after surgery
Management : investigate cause and treat accordingly plus antipyretics
Shivering and hypothermia
Post op nutritional
problems
• Might not eat b/c of N,V and
abdominal cramps etc although
increased requirements after
surgery.
• Management : appropriate
nutritional support
Complication of blood
transfusion
• Management :
• Stop transfusion
• Infections can be prevented by
proper screening
• Severe allergic reaction may
Hypo or
require steroids and anti
hyperthermia histamines
Immobilization
• Increases risk for
• DVT, PE
• URINARY RETENTION
• ATELACTASIS
• PRESSURE SORES
• CONSTIPATION
• Management : mobilize pt ASAP
• Pt should be encouraged to sit out in chair even on the first day
Wound dehiscence
• Usually occur between 5th to 8th day post op. as strength of wound is
weakest during this time.
• Most commonly seen in abdominal surgeries.
• Risk factors include
• General factors e.g DM, obesity, malnourishment, sepsis, cancer, steroids etc
• Local factors e.g poor closure of wound, poor local wound healing e.g b/c
infections etc and increased intra abdominal pressure e.g b/c excessive cough,
constipation etc
• Management: according to principles of wound healing and dressings
Complications associated with the infusion/
monitoring system
• Air embolism may occur if more than 15 ml of air is accidently introduced
during or after insertion of venous catheter.
• Managed by proper nursing techniques
• Phlebitis may be related to time of needle / catheter placement, nature of
fluids infused and infection.
• Managed by rx of infection and changed of cannula every 72 hrs.
• Finger necrosis may occur in patient who require continuous monitoring
of pulse, BP and ABG through arterial lines.
• Management by checking patency of arterial lines before inserting
Specific post operative
complications
Respiratory complications
• E.g ….Dyspnea most commonly caused by alveolar collapse or
atelectasis other causes include MI, HF, PE, exacerbation of asthma
and COPD, chest infections etc.
• Respiratory complications can be reduced by
• Using adequate analgesia including epidurals and using analgesia that
depresses respiration carefully e.g opiods
• Administering oxygen using face mask or nasal prongs
• Regular physiotherapy
Cardiovascular complications
• Hypotension caused by bleeding, insufficient fluid replacement, MI,
epidural anesthesia (vasodilation of veins),septic shock, opioid overdose.
• Management : increase in fluid input and administration of high flow oxygen.
• Hypertension usually relates to inadequate pain relief and anxiety and is
relieved with appropriate analgesia.
• Special care is needed for patients with IHD and CVD as in these patient HTN can
precipitate MI and stroke
• DVT risk factors are old age, immobility, cancer, oral contraceptives,
smoking, trauma, obesity etc
• Can be prevented by early mobilization, compression stockings, heparin etc
Renal compliations
Oliguria/ anuria
• Commonest cause is reduced renal perfusion resulting from perioperative
hypotension or inadequate fluid replacement.
• Can lead to acute renal failure
• Management :
• urine output monitoring
• Serum urea, creatinine and electrolytes monitoring
• Adequate fluid replacement
• Avoiding nephrotoxic drugs
• Preventing infections
Quick safe painless recovery
