Postoperative Complications
- Arrhythmias
- Not
uncommon following surgical procedures
- Must R/O
myocardial infarct as source
- Appropriate
meds as needed to return patient to normal rhythm
- Cardiology
consult as needed
- Change in
Mental Status
- Etiology
is varied – hemorrhage, infarction, edema, seizure, infection, metabolic,
hypoxia
- Evaluate
patientand order appropriate tests
- Frequently,
head CT is necessary to R/O structural lesion
- Constipation
- Especially
in poorly mobile patients on narcotics
- Institute
regular bowel regiments (Colace, qod MOM and Dulcolax supp) to keep
bowels moving in those with severe constipation
- Obtain
KUB when indicated
- Decubitus
Ulcers
- Check
skin on bedridden patients several times each week
- Treat
early skin breakdown aggressively
- Deep
Venous Thrombosis
- Must
have high index of suspicion to avoid missing clots
- Suspect
with unexplained episode O2 desaturation, c/o leg discomfort,
low grade fevers without source
- Diagnosis
is by non-invasive Dopplers or venogram
- Diabetes
- Monitor
serum glucose levels in known diabetics closely
- Steroids
frequently induce hyperglycemia
- Sliding
scale regular insulin and finger sticks are generally adequate
- Occasionally,
insulin drip is needed to obtain control
- Gastrointestinal
Ulceration
- Often
arise in stressed patients on steroids
- Treat
heme positive NG output aggressively
- All
patients should be on H2 blockers and/or antacids
- GI
consult as needed
- Hyponatremia
- Most
commonly caused by SIADH
- Monitor
electrolytes closely, especially if the sodium is trending downwards
- Treatment
is fluid restriction
- Rapid
correction can cause central pontine myelinolysis (CPM) – symmetrical demyelination
of the basis pontis resulting clinically in a “locked-in” syndrome
(quadriplegia with normal mental status)
- Myocardial
Infarction
- High
risk patients should routinely have post-op EKG and serial isoenzymes
- Don’t
ignore complaints of chest pain
- Cardiology
consult as needed
- Pancreatitis
- A
potential complication with any surgery as well as steroids
- Suspect
in patients not tolerating po intake, unexplained abdominal distention,
or with unexplained low grade fevers
- Check
amylase and lipase levels for diagnosis
- Treatment
is maintaining patient strict NPO with hyperalimentation until resolution
- Pneumocephalus
- Presence
of intracranial air at operative site
- May
exert mass effect
- Generally
is reabsorbed within several days post-op
- Alternating
room air with 100% O2 may accelerate resolution, q2h
alternation
- Pneumonia
- Common
in elderly patients, or those with prolonged intubation
- Check
daily CXRs on intubated patients
- Aggressive
pulmonary toilet is essential
- Pulmonary
Embolism
- Must
have high index of suspicion to avoid missing
- Suspect
with any unexplained episode of O2 desaturation
- Diagnosis
is by VQ scan or pulmonary angiogram
- Rash
- Most are
drug related – stop all potential agents as soon as possible
- Dilantin
is a frequent source – change to an alternate anticonvulsant
- Stevens-Johnson
syndrome is a rare complication
- Consider
hypoallergenic bedding if no clear drug source
- Seizures
- May be
generalized or focal
- Must be
treated aggressively to avoid brain injury
- See
seizure management section for treatment
- SIADH
(Syndrome of Inappropriate ADH Secretion)
- Frequent
after trauma and surgery
- Urinary
dumping of sodium despite hyponatremia
- Watch
electrolytes for declining sodium levels
- Treatment
is strict FLUID RESTRICTION – usually 1000-1200 cc/day, or less
- Subgaleal
Fluid Collection/Pseudomeningocele
- CSF
escapes through incomplete dural closures into subgaleal compartment
under skin
- Occasionally
heralds post-op hydrocephalus
- May
resolve spontaneously, with aspiration and tight wrap to adhere scalp to
underlying tissue, or require surgical correction
- Urinary
Retention
- Especially
in poorly mobile patients on narcotics
- Elderly
men frequently have retention after Foley removal secondary to BPH
- May be
associated with urinary tract infection
- Always
check UA, culture and sensitivities
- Urology
consult if needed
- Urinary
Tract Infection
- Frequent
complication of catheterization
- Foley
catheters should be removed as soon as possible in all patients
- Wound
Infection
- Fortunately,
only seen in appropriate 1% of cases
- Culture
purulent drainage
- Open and
drain infected wounds and institute appropriate abx