Post Operative Complications

Post Operative
Complications
Circulatory Complications
• Hypertension
• Arrhythmias
Tachycardia
• Hypotension & Hypovolemia
Hypertension
 Hypertension is the most common of the post-operative
cardiovascular complications.
 defined as a systolic blood pressure greater than 160 mm Hg or
a diastolic blood pressure greater than 90 mm Hg.
When the hypertension is severe, it can cause serious problems,
such as:
 Left ventricular failure
 Myocardial infarction
 Arrhythmias
 Pulmonary edema
 Cerebral hemorrhage
 Postoperative hypertension occurs most frequently in patients
who had pre-existing hypertension.
CAUSES
 Discomfort (eg, pain, anxiety, confusion, a full bladder) can
raise a postoperative patient's blood pressure.
 Many physiologic abnormalities, such as hypoxemia,
hypercapnia, or fluid overload, can also induce hypertension.
 Certain surgeries have a higher risk of inducing a hypertensive
response, notably:
Abdominal aneurysm repair
Intracranial surgery
 The strongest risk factor for postoperative hypertension is a
physiologic predisposition as people with atherosclerosis or preexisting hypertension, even if it had been well controlled, are
the most likely patients to develop post-operative hypertension.
Recognition And Assessment
Ω Blood pressure is one of the key signs that should be continually monitored .
Ω Postoperative hypertension tends to occur early in a patient's recovery, so blood
pressures should be measured more frequently in the first 30 minutes of a patient's stay
in the PACU.
Management
♥ The goal in managing postoperative hypertension is to relieve the stressor.
♥ When hypertension occurs, nurses should be certain that they are providing sufficient
analgesia and that the patient's bladder is not distended.
♥ Nurses should also check and improve the patient's ventilation, oxygen saturation, and
fluid balance.
♥ Relieving discomfort with additional sedation can lower postoperative hypertension.
♥ If these measures do not reduce the patient's blood pressure, then antihypertensive
drugs are probably needed.
♥ In the PACU, beta-adrenergic blockers are commonly used to reduce blood pressure.
Causes
∆ Postoperative tachycardia can be a sign of a wide
range of stressors, including pain, hypoxemia,
hypercapnia, anemia, hypovolemia, and fever, or it can
be component of an Arrhythmia.
∆ Pain and discomfort (eg, from an over distended
bladder) are the most common causes of tachycardia.
Recognition And Assessment
Tachycardia is defined as ≥100
heartbeats/minute.
Management
∆ When a PACU patient develops tachycardia, the nurse checks the
patient's airway, oxygen saturation level, vital signs, volume signs
(jugular venous fill level, urine output, peripheral pulses,
capillary refill time), and bladder size. In addition, the nurse
evaluates the patient's cardiac rhythm. And any problems are
treated.
∆ Persistent tachycardia can often be slowed with fluids, an opioid
analgesic, or a beta-adrenergic blocker. All these measures need
the consent of the attending physician.
∆ Tachycardia may also be a component of a newly developed
Arrhythmia.
∆ Most Arrhythmias that appear in the PACU are the result of an
underlying metabolic or circulatory imbalance.
∆ When the physiologic imbalance is corrected, the Arrhythmia
and the tachycardia will usually disappear.
Mild hypotension is one of the more common
circulatory abnormalities seen in the PACU.
However, Severe Hypotension is rarely seen.
CAUSES
1. Hypovolemia: the most common cause.
Causes of hypovolemia include:
∆ blood loss and evaporation (fluids are lost by evaporation when an operation
requires body cavities to be open for long periods).
∆ Urinary losses are sometimes not fully replaced with intravenous fluid.
∆ the body's reaction to the injury of surgery makes local blood vessels more
permeable, and body fluids leave the circulation and accumulate in tissue
spaces, in the peritoneal space, and even inside the intestine.
Cardiac dysfunction:
∂ Occasionally, cardiac dysfunction is the major cause of postoperative
hypotension.
∂ The cardiac dysfunction (heart failure, dysrhythmia, myocardial infarction)
can be a new problem caused by the intra-operative drugs or the conditions
of surgery.
∂ More often, postoperative heart malfunctions are exacerbations of preexisting heart problems.
Spinal opioids.
Epidural or intrathecal anesthesia, especially with an opioid, can cause
neurogenic hypotension .
Recognition And Assessment
Hypotension
 In the PACU, patients' blood pressures should be checked regularly.
 Mild hypotension means a drop in blood pressure of less than 10% to 15% from the
patient's baseline values.
 Significant hypotension means a drop of 20% to 30% in blood pressure values.
Hypovolemia
Hypovolemia in a post-operative patient can usually be recognized clinically by the
occurrence of a number of these signs:
 Tachycardia
 Decreased radial pulse.
 Cool extremities
 Narrow pulse pressure





(pulse pressure is the difference between the systolic and diastolic blood
pressure values)
Poor skin turgor
Dry mucous membranes
Concentrated urine
Lethargy
Sometimes we see cyanosis.
Management
 Mild postoperative hypotension is a common finding, and it
can usually be managed by regular monitoring.
 On the other hand, significant hypotension needs prompt
treatment.
 Assuming there is clear airway and adequate ventilation,
oxygen is administered, fluids are increased, and when
possible, the patient is put in the Trendelenburg position. Then
the causes of the hypotension must be searched for and
treated.
 Meanwhile, if fluids do not improve the hypotension, then it
may be necessary to administer vasopressors.
 An anesthesiologist or critical care physician must be involved
in this and all further evaluations and treatments of
postoperative hypotension.
Urinary complications
•Anuria
•Oliguria
Oliguria :
is the low output of urine, It is clinically classified as
an output below 300-500ml/day.
Postoperative oliguria:
Patients usually have decrease in urine output after a
major operation that may be a normal physiological
response to:
1. fluid/ blood loss.
2. decreased glomerular filtration rate secondary to
hypovolemia.
3. hypotension as a response of adrenal cortex to stress.
4. increase in aldosterone (Na and water retention)
& antidiuretic hormone (ADH) release.
Anuria :
Anuria is defined as
less than 50mL urine
output per day.
Anuria itself is a
symptom, not a disease.
It is often associated
with other symptoms of
kidney failure.
Same Mechanism of
Oligouria!
Postoperative Anuria:
Patients usually have decrease in
urine output after a major
operation that may be a normal
physiological response to:
1. fluid/ blood loss.
2. decreased glomerular
filtration rate secondary to
hypovolemia.
3. hypotension as a response of
adrenal cortex to stress.
4. increase in aldosterone (Na
and water retention)
& antidiuretic
hormone (ADH) release.
Thank you