Respiratory Problems
airway obstruction
The primary reason is the backward escaping of the tongue in the unconscious patient.
hypoventilation
Ventilation efficiency decreases with postoperative pain, muscle spasm and paralysis, or decreased respiratory control due to medication.
hypoxia
The leading causes are hypoventilation, ventilation and perfusion mismatch, and increased pulmonary shunts.
Causes that increase shunt include atelectasis, pneumothorax, diffuse airway collapse, pulmonary edema, aspiration, pulmonary embolism, and tremor.
Diffusion Hypoxia: It develops due to the dilution of alveolar oxygen and carbon dioxide by the nitrous oxide that diffuses from the tissues and leaves the blood rapidly in the patient who starts breathing air while taking oxygen/nitrogen oxide.
Administering pure oxygen for 1-2 minutes after cessation of nitrous oxide will prevent this.
atelectasis
It is the most common postoperative pulmonary complication.
Pain, tight abdominal bandage, inability to expel bronchial secretions cause atelectasis.
There is a fever, tachypnea, tachycardia, and auscultation in the atelectasis area reveals decreased breathing and purring sounds.
Good pain control, early mobilization, coughing, respiratory exercise are helpful in prevention.
Respiratory therapy, postural drainage and expectorant, antibiotics, moist oxygen are given.
Aspiration pneumonia (Mendelson syndrome)
Hypoxia is the earliest and most reliable symptom.
Tachycardia, tachypnea, bronchospasm, cyanosis, hypotension, and cardiovascular collapse may occur.
Irregular densities (especially in the hilar region) are seen on the chest X-ray.
Breathing is supported, oxygenation is provided, and antibiotics are administered.
surgical emphysema
It occurs as a result of excessive distension of the alveoli when pressurized gas is given.
pneumothorax
pulmonary embolism
Heart diseases and carcinomas, septic causes
Difficult and prolonged operations, prolonged bed rest (hip fracture, etc.)
Venous thrombosis in the leg and pelvis veins
It starts with a sudden pain in the chest 2-14 days postoperatively.
Cyanosis, fainting sensation, hemoptysis, pleural pain, dyspnea.
Tachycardia, elevation in central venous pressure, neck vein distension, hypotension
PA chest X-ray; right heart enlargement, diaphragmatic elevation, shadowing of lower membranes
Findings of right heart hypertrophy can be seen on ECG.
In treatment; anticoagulation is administered, sedation and oxygen are given.
air embolism
Operations that damage the neck, thorax, chest and pelvis veins, heart surgeries, uterine curettage
Delivery of air to the peritoneal and pleural space, bladder, uterus and tubes for diagnosis and treatment
It occurs when excessive air suddenly enters the vascular structures.
Sudden cyanosis, hypotension, tachycardia, dilation of neck veins, irregular breathing, tachypnea, hypopnea, cardiac arrest may occur.
The table is placed in the Trendelenburg position.
Oxygen is given and the patient is placed on his left side.
Air is aspirated from the right heart with the catheter.
If necessary, the right thorax is opened, air is aspirated from the heart and cardiac massage is performed.
Postoperative fever
1 day atelectasis
3rd day catheter infection (thrombophlebitis or urinary tract infection)
If wound infection develops in the first 48 hours on the 5th day, beta-hemolytic streptococci,
4-7. gram (-), gram (+) and staphylococci per day
7th day intraabdominal abscess
neurological problems
delayed awakening
• The most common causes are drug effects and cerebral hypoxia.
convulsion
• Hypoxia, cerebral edema, cerebrovascular accident, alkalosis, fever, hypo / hyperglycemia, hypokalemia, uremia, deep ether anesthesia, local anesthetics, eclampsia
Postoperative mental dysfunction
be aware
Postoperative fatigue
Excitation and hallucination after anesthesia
Anxiety
Peripheral nerve injuries
• The ulnar nerve, brachial plexus and lower extremity motor nerves are most commonly affected.
Ischemic spinal injury
• The most important reason is long-term hypotension.
central anticholinergic syndrome
The state of consciousness is normally maintained by continuous stimulation of the cerebral cortex with acetylcholine.
Centrally acting anticholinergics (Atropine) may cause findings such as amnesia, decreased concentration, agitation, dysarthria, and hallucinations.
It is more common in older people, especially those with reduced vision and hearing.
Its treatment is based on increasing acetylcholine in the central nervous system (physostigmine, salicylate).
gastrointestinal problems
Aspiration Pneumonia (See Respiratory Problems)
regulation
Nausea-vomiting
5-6 days after the operation. hours, pyloric stenosis, peritoneal irritation, abdominal distention, blood in the stomach, esophageal and intestinal obstruction, while preventing gastric emptying
Head trauma, labor, pain, stress, general condition disorder and narcotics slow the discharge.
Anticholinergics, antihistamines, phenothiazines, butyrophenones, dopamine antagonists, ondansetron can be used.
Postoperative Gastrointestinal Functions
After general anesthesia, gastric emptying can return to normal after 24 hours, small bowel movements after 1-2 hours, and colonic movements after 48 hours.
Narcotic use delays gastric emptying.
Neostigmine also increases contractions, especially in the ileum.
Regional anesthesia decreases mesenteric blood flow while increasing intestinal blood flow.
Cardiovascular Problems
Vascular complications
Hematoma, most commonly caused by withdrawing the cannula in the vein without applying pressure to the needle
Thrombosis and thrombophlebitis caused by intravenous agents and infusions.
From thrombotic complications; deep vein thrombosis and pulmonary embolism are the most important.
Rhythm disturbances and cardiac arrest Tachycardia
During induction of anesthesia due to excitation and when anesthesia is superficial
Loss of blood during the operation due to shock
Due to the use of atropine in premedication
Hyperthyroidism may occur due to pheochromocytoma.
Bradycardia
Sinus bradycardia, vagal stimulation
Anoxia due to respiratory failure
It occurs as a result of myocardial depression with cardiotoxic drugs.
myocardial infarction
Myocardial infarction is frequently seen on the 3rd day after surgery and is painless in 80% of cases.
Sudden hypotension developing during this period should suggest left heart failure and arrhythmia infarction.
cardiac dysrhythmias
Bradycardia, sinus tachycardia, supraventricular tachycardia, nodal rhythm, atrial and ventricular premature beats.
Hypotension is the most common complication in the early period.
Such as hypovolemia, vasodilator therapy or the effect of anesthetics, deep anesthesia, anoxia, spinal anesthesia, myocardial infarction, hypoxia, pulmonary embolism and pneumothorax, vasovagal reflex and anaphylactic reactions
Hypertension
It may occur due to cyclopropane anesthesia, intracranial lesions, thyrotoxicosis, CO2 retention, position changes or awkward position and pain.
Other issues
Chills: Specific drug meperidine / pethidine in treatment
Ophthalmological problems: Corneal abrasion is the most common.