PERIOPERATIVE COMPLICATIONS

Respiratory complicationBy/Asmaa Eisa Ghazy Mohamed MaraeeALEXANDRIA FACULTY OF MEDICIN 6th year

Complication of a major surgery can be classified as those

Due to anesthesiaDue to surgery

Anesthetic complications depend on the mode (General or Local) and types of anesthetic agent used (anesthetic agent toxicity).

Perioperative Complications Postoperative complications Immediate/early complications Late

PERIOPERATIVE COMPLICATIONSRefers to problems arising during surgery

DUE TO SURGERY

COMMON COMPLICATIONS OF G.A.Direct trauma to the mouthSlow recovery from anesthesia due to drug

interactions or inappropriate choice of drug dosage.

Hypothermia due to long operations with extensive fluid replacement/cold blood transfusion.

Allergic reaction to anesthetic agent Minor effect: post-op nausea & vomitingMajor effect: CVS collapse, respiratory

depression

Due to anesthesia

1) Complications of laryngoscopy and intubation

2) Respiratory obstruction3) Hypoxemia4) Hypercapnia and hypocapnia5) Hypoventilation6) Aspiration pneumonia

Respiratory complications

1. Errors of ETT positioning

a. Esophageal intubationb. Endobronchial intubationc. Position of the cuff in the larynx

mild or severe injury caused by rough and inexperienced use

of laryngoscopes.

These include minor damage to the soft tissues within the

throat which causes a sore throat after the operation to major

injuries to the larynx and pharynx causing permanent

scarring, ulceration and abscesses if left untreated.

Additionally, there is a risk of causing tooth damag

I- Complications of laryngoscopy and intubation

2. Airway trauma:a. Tooth damage.b. Dislocated mandible.c. Sore throat.d. Pressure injury on trachea.e. Edema of glottis or trachea.f. Post intubation granuloma of vocal cords

3. Physiologic responses to airway instrumentationa. Sympathetic stimulationb. Laryngospasmc. Bronchospasm

4. ETT malfunction:a. Risk of ignition during

laser surgery b. ETT obstructionc. Cuff perforation

Signs

1. Inadequate tidal volume.

2. Retraction of the chest wall and of thesupraclavicular,

infraclavicular and suprasternalspaces.

3. Excessive abdominal movement.

4. Use of accessory muscles of respiration.

5. Noisy breathing (unless obstruction is absolute andcomplete).

6. Cyanosis.

7. The natural heave of the chest and abdomen becomesreplaced

by an indrawing of the upper chest and anoutpushing of the

abdomen because of strongdiaphragmatic action.

At the lips. By the tongue Above the glottis At the glottis: laryngeal spasm,

relaxed vocalcords and FB. Bronchospasm Faults of apparatus: Kink or

obstruction of ETT

Sites of obstruction

II- Respiratory obstruction

Upper airway obstruction in PACUinclude incomplete anesthetic recovery,

laryngospasm, airway edema, wound hematoma, and vocal cord paralysis.

Airway obstruction in unconscious patients is most commonly due to the tongue falling back against the posterior pharynx.

Laryngospasm and laryngeal edemaA. DefinitionLaryngospasm is a forceful involuntary spasm of the

laryngeal musculature caused by sensory stimulation of the superior laryngeal nerve.

Triggering stimuli include pharyngeal secretions extubating in stage 2.

The large negative intrathoracic pressures generated by the struggling patient in laryngospasm can cause pulmonary edema

B.Treatment of laryngospasm initial treatment includes 100%oxygen, anterior mandibular displacement, and gentle CPAP (maybe applied by face mask). If laryngospasm persists and hypoxia develops,

succinylcholine (0.25-1.0 mg/kg; 10-20 mg).Treatment of glottic edema and subglottic

edemaadminister humidified oxygen by mask, inhalation of racemic epinephrine,repeated

every 20 minutes, hydrocortisone IV may be considered.Reintubation with a smaller tube may be helpful

PaO2 less 60 mmHg or SaO2 less 90%

Causes:1. Decreased FiO22. Hypoventilation3. V/Q mismatch4. Increased O2 utilization by tissues5. Tissue hypoxiaClinical signs of hypoxia(sweating, tachycardia, cardiac

arrhythmias,hypertension, and hypotension) are nonspecific; bradycardia,hypotension, and cardiac arrest are late signs

Treatment  oxygen therapy with or without positive airway

pressure. Additionally, treatment of the cause

III- Hypoxemia

PaCO2 or ETCO2 > 40 mmHg.Causes:1-Increased FiCO22-Hypoventilation3-Increased dead space4-Increased CO2 production by tissues

Treatment:of the cause

IV) Hypercapnia

 A. Causes 1- Respiratory obstruction 2- Factors affecting the ventilatory drive

a. Respiratory depressant drugs b. Hypothermia c. CV stroke

3- Peripheral factors

a. Muscle weakness b. Pain c. Decreased diaphragmatic movement. d. Pneumo or hemothorax. e. Decreased chest wall compliance e.g. kyphoscoliosis.

B. Hypoventilation in the PACU is most commonly caused by residual depressant effects of anesthetic agents on respiratory drive or persistent

neuromuscular blockade.

C.Treatment 

should be directed at the underlying cause. Marked hypoventilation may require controlled ventilation until contributory

factors are identified and corrected.

V) Hypoventilation