The amount of discomfort you have after surgery depends on many things, including the type of surgery. Typical discomforts may include:
Nausea and vomiting from general anesthesia
Sore throat caused by the tube placed in the windpipe for breathing during surgery
Soreness, pain, and swelling around the incision site or minor pain around IV sites
Restlessness and sleeplessness
Thirst
Constipation and gas
What complications may occur after surgery?
Complications can sometimes occur after surgery. The most common complications include:
Shock
Shock is a severe drop in blood pressure that causes a dangerous slowing of blood flow throughout the body. Shock may be caused by blood loss, infection, spine injury, or metabolic problems. Treatment may include any or all of the following:
Stopping any blood loss
Helping with breathing. This might be with a breathing machine.
Reducing heat loss
Giving IV fluids or blood
Giving extra oxygen
Prescribing medicines to help raise blood pressure.
Bleeding
Rapid blood loss from the site of surgery, for example, can lead to shock. Treatment of rapid blood loss may include:
IV fluids or blood plasma
Blood transfusion
More surgery to control the bleeding
Wound infection
When bacteria enter the site of surgery, an infection can happen. Infections can delay healing. Wound infections can spread to nearby organs or tissue, or to distant areas through the bloodstream. Treatment of wound infections may include:
Antibiotics
Surgery or procedure to clean or drain the infected area
Deep vein thrombosis
A deep vein thrombosis is a blood clot in a large vein deep inside a leg, arm, or other part of the body. Symptoms are pain, swelling, tenderness, and skin redness in a leg, arm, or other area. If you have these symptoms, call your healthcare provider. In some cases, the clot can break off and travel to the lungs or brain. This can cause a pulmonary embolism or a stroke. Compression stockings are often used for treatment. They can also prevent DVTs.
Pulmonary embolism
The clot can break away from the vein and travel to the lungs. This clot is called a pulmonary embolism. In the lungs, the clot can cut off the flow of blood. This is a medical emergency and may cause death. If you have the following symptoms, call 911 or get emergency help right away. Symptoms are chest pain, trouble breathing, coughing [may cough up blood], sweating, very low blood pressure, fast heartbeat, light headedness, and fainting. Treatment depends on the location and size of the blood clot. It may include:
Blood-thinner medicines [anticoagulants] to prevent more clots
Thrombolytic medicines to dissolve clots
Surgery or other procedures to remove the clot
Lung problems
Sometimes lung problems happen because you don’t do deep breathing and coughing exercises within 48 hours of surgery. They may also happen from pneumonia or from inhaling food, water, or blood into the airways. Symptoms may include wheezing, chest pain, shortness of breath, fever, and cough. Getting up and walking around, deep breathing, and coughing often can help reduce the chances for these problems. Treatment depends on the lung problem and the cause.
Urinary retention
This means you aren’t able to empty your bladder. This may be caused by the anesthesia or certain surgeries. It is often treated by using a thin tube [catheter] to drain the bladder. This is kept in place until you have regained bladder control. Sometimes medicines to stimulate the bladder may be given.
Reaction to anesthesia
This is rare, but it does happen. Symptoms can range from mild to severe. Treatment of allergic reactions includes stopping specific medicines that may be causing the reaction. You may also be given other medicines to treat the allergy. Tell your healthcare team about any allergies you have before the surgery to minimize this risk. If an allergic reaction does occur, ask what caused the allergy so you can stay away from it for any future surgery.
Correspondence: Dr Marcin Karcz, Department of Anesthesiology, University of Rochester, 601 Elmwood Avenue, Rochester, New York 14642, USA. Telephone 585-764-4099, e-mail ude.retsehcor.cmru@zcrak_nicram
Copyright © 2013 Canadian Society of Respiratory Therapists. All rights reserved
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Abstract
General anesthesia and mechanical ventilation impair pulmonary function, even in normal individuals, and result in decreased oxygenation in the postanesthesia period. They also cause a reduction in functional residual capacity of up to 50% of the preanesthesia value. It has been shown that pulmonary atelectasis is a common finding in anesthetized individuals because it occurs in 85% to 90% of healthy adults. Furthermore, there is substantial evidence that atelectasis, in combination with alveolar hypoventilation and ventilation-perfusion mismatch, is the core mechanism responsible for postoperative hypoxemic events in the majority of patients in the postanesthesia care unit [PACU]. Many concomitant factors also must be considered, such as respiratory depression from the type and anatomical site of surgery altering lung mechanics, the consequences of hemodynamic impairment and the residual effects of anesthetic drugs, most notably residual neuromuscular blockade. The appropriate use of anesthetic and analgesic techniques, when combined with meticulous postoperative care, clearly influences pulmonary outcomes in the PACU. The present review emphasizes the major pathophysiological mechanisms and treatment strategies of critical respiratory events in the PACU to provide health care workers with the knowledge needed to prevent such potentially adverse outcomes from occurring.
Keywords: Alveolar hypoventilation, Atelectasis, Postanesthesia care unit, Pulmonary shunt, Respiratory complications, Ventilation-perfusion mismatch
Résumé
L’anesthésie générale et la ventilation mécanique nuisent à la fonction pulmonaire, même chez des personnes en santé, et entraînent une diminution de l’oxygénation pendant la période postanesthésique. Elles provoquent également une réduction de la capacité fonctionnelle résiduelle pouvant atteindre 50 % de la valeur obtenue avant l’anesthésie. Il a été démontré que l’atélectasie pulmonaire est courante chez les personnes anesthésiées. En effet, elle se produit chez 85 % à 90 % des adultes en santé. De plus, il est clairement démontré que l’atélectasie, associée à l’hypoventilation alvéolaire et à la discordance entre la ventilation et la perfusion, est le principal mécanisme responsable d’événements hypoxémiques postopératoires chez la majorité des patients de l’unité de soins postanesthésiques [USPA]. Il faut également tenir compte de nombreux facteurs concomitants, tels que la dépression respiratoire causée par le type et le foyer anatomique des mécaniques pulmonaires modifiées par chirurgie, les conséquences d’une atteinte hémodynamique et les effets résiduels des médicaments anesthésiques, notamment le blocage neuromusculaire résiduel. Le recours pertinent aux techniques anesthésiques et analgésiques, associé à des soins postopératoires méticuleux, influe clairement sur les issues pulmonaires à l’USPA. La présente analyse fait ressortir les principaux mécanismes physiopathologiques et stratégies thérapeutiques d’événements respiratoires critiques à l’USPA pour transmettre aux dispensateurs de soins les connaissances nécessaires en vue d’éviter la survenue d’issues indésirables.
Respiratory complications in the postanesthesia period are an important area of concern because they are a major cause of morbidity and mortality. A critical respiratory event in the postanesthesia care unit [PACU] is the complex of major unanticipated ventilation problems, including hypoxemia [hemoglobin oxygen saturation 21 mg/dL]
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Table adapted from reference 8. ASA American Society of Anesthesiologists; BUN Blood urea nitrogen
The most important of the patient-related risk factors identified in the ACP guideline are increasing age and increasing American Society of Anesthesiologists classification of comorbidity [8]. The effect of advanced age becomes particularly notable at approximately 60 years of age and worsens from there [8]. Of note, smoking and COPD were only minor risk factors in the ACP analysis [8].
A serum albumin level