Postoperative Care

After any procedure performed in the operating room, all patients must undergo close observation at least in the recovery room. After larger procedures and for patients who require hospitalization, observation must continue on the surgical ward. The primary intent of this practice is the early detection of postoperative complications. The entire medical team must be vigilant and aware of the patient’s history, the procedure performed, and risk factors for potential complications. Some of the most important things to attend to include monitoring vital signs (which may indicate severe complications such as bleeding), wound and drain care, postoperative pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain control, nausea and vomiting, pulmonary hygiene to prevent atelectasis Atelectasis Atelectasis is the partial or complete collapse of a part of the lung. Atelectasis is almost always a secondary phenomenon from conditions causing bronchial obstruction, external compression, surfactant deficiency, or scarring. Atelectasis, deep vein thrombosis Deep vein thrombosis Deep vein thrombosis (DVT) usually occurs in the deep veins of the lower extremities. The affected veins include the femoral, popliteal, iliofemoral, and pelvic veins. Proximal DVT is more likely to cause a pulmonary embolism (PE) and is generally considered more serious. Deep Vein Thrombosis prophylaxis, and fluid management.

Last update:

Table of Contents

Share this concept:

Share on facebook
Share on twitter
Share on linkedin
Share on reddit
Share on email
Share on whatsapp

Recovery Room

The recovery room is reserved for patients in the immediate postoperative period who have received general anesthesia Anesthesia Anesthesiology is the field of medicine that focuses on interventions that bring a state of anesthesia upon an individual. General anesthesia is characterized by a reversible loss of consciousness along with analgesia, amnesia, and muscle relaxation. Anesthesiology: History and Basic Concepts. Observation usually lasts 6 hours (until they are conscious and their vital signs are stable).

Monitoring airway, breathing, and circulation (the ABCs) and vital signs

  • Monitoring of the ABCs is the priority.
  • The patient may initially remain intubated, even in the recovery room.
  • Following extubation, patients should receive supplemental oxygen and should be encouraged to take frequent deep breaths.
  • Assess the patient’s vital signs:
    • ↑ Temperature: consider atelectasis Atelectasis Atelectasis is the partial or complete collapse of a part of the lung. Atelectasis is almost always a secondary phenomenon from conditions causing bronchial obstruction, external compression, surfactant deficiency, or scarring. Atelectasis, infection  
    • ↑ Pulse rate (PR): consider hemorrhage, pulmonary embolism Pulmonary Embolism Pulmonary embolism (PE) is a potentially fatal condition that occurs as a result of intraluminal obstruction of the main pulmonary artery or its branches. The causative factors include thrombi, air, amniotic fluid, and fat. In PE, gas exchange is impaired due to the decreased return of deoxygenated blood to the lungs. Pulmonary Embolism (PE), MI MI MI is ischemia and death of an area of myocardial tissue due to insufficient blood flow and oxygenation, usually from thrombus formation on a ruptured atherosclerotic plaque in the epicardial arteries. Clinical presentation is most commonly with chest pain, but women and patients with diabetes may have atypical symptoms. Myocardial Infarction, infection, or pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain (most common) 
    • ↓ BP: consider hemorrhage, cardiac dysfunction, infection
    • ↑ RR: consider pulmonary embolism Pulmonary Embolism Pulmonary embolism (PE) is a potentially fatal condition that occurs as a result of intraluminal obstruction of the main pulmonary artery or its branches. The causative factors include thrombi, air, amniotic fluid, and fat. In PE, gas exchange is impaired due to the decreased return of deoxygenated blood to the lungs. Pulmonary Embolism, atelectasis Atelectasis Atelectasis is the partial or complete collapse of a part of the lung. Atelectasis is almost always a secondary phenomenon from conditions causing bronchial obstruction, external compression, surfactant deficiency, or scarring. Atelectasis, infection   
    • ↓ Oxygen saturation: consider PE, MI MI MI is ischemia and death of an area of myocardial tissue due to insufficient blood flow and oxygenation, usually from thrombus formation on a ruptured atherosclerotic plaque in the epicardial arteries. Clinical presentation is most commonly with chest pain, but women and patients with diabetes may have atypical symptoms. Myocardial Infarction, airway obstruction Airway obstruction Airway obstruction is a partial or complete blockage of the airways that impedes airflow. An airway obstruction can be classified as upper, central, or lower depending on location. Lower airway obstruction (LAO) is usually a manifestation of chronic disease, such as asthma or chronic obstructive pulmonary disease (COPD). Airway Obstruction, atelectasis Atelectasis Atelectasis is the partial or complete collapse of a part of the lung. Atelectasis is almost always a secondary phenomenon from conditions causing bronchial obstruction, external compression, surfactant deficiency, or scarring. Atelectasis
    • ↓ Level of consciousness: consider stroke, cerebral hemorrhage, or lingering anesthetic effects
  • Major complications:
    • Airway obstruction
    • MI MI MI is ischemia and death of an area of myocardial tissue due to insufficient blood flow and oxygenation, usually from thrombus formation on a ruptured atherosclerotic plaque in the epicardial arteries. Clinical presentation is most commonly with chest pain, but women and patients with diabetes may have atypical symptoms. Myocardial Infarction
    • Hemorrhage 
    • Respiratory failure Respiratory failure Respiratory failure is a syndrome that develops when the respiratory system is unable to maintain oxygenation and/or ventilation. Respiratory failure may be acute or chronic and is classified as hypoxemic, hypercapnic, or a combination of the two. Respiratory Failure
    • Acute kidney injury Acute Kidney Injury Acute kidney injury refers to sudden and often reversible loss of renal function, which develops over days or weeks. Azotemia refers to elevated levels of nitrogen-containing substances in the blood that accompany AKI, which include BUN and creatinine. Acute Kidney Injury
Timeline of postoperative complications

Timeline of postoperative complications
DVT DVT Deep vein thrombosis (DVT) usually occurs in the deep veins of the lower extremities. The affected veins include the femoral, popliteal, iliofemoral, and pelvic veins. Proximal DVT is more likely to cause a pulmonary embolism (PE) and is generally considered more serious. Deep Vein Thrombosis: deep vein thrombosis Deep vein thrombosis Deep vein thrombosis (DVT) usually occurs in the deep veins of the lower extremities. The affected veins include the femoral, popliteal, iliofemoral, and pelvic veins. Proximal DVT is more likely to cause a pulmonary embolism (PE) and is generally considered more serious. Deep Vein Thrombosis

Image by Lecturio. License: CC BY-NC-SA 4.0

Other activities in the recovery room

  • The patient’s symptoms (e.g., dyspnea Dyspnea Dyspnea is the subjective sensation of breathing discomfort. Dyspnea is a normal manifestation of heavy physical or psychological exertion, but also may be caused by underlying conditions (both pulmonary and extrapulmonary). Dyspnea) and concerns (e.g., pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain or nausea) should be addressed.
  • Evaluate symptoms that could be caused by complications:
    • Chest pain Chest Pain Chest pain is one of the most common and challenging complaints that may present in an inpatient and outpatient setting. The differential diagnosis of chest pain is large and includes cardiac, gastrointestinal, pulmonary, musculoskeletal, and psychiatric etiologies. Chest Pain ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Normal Electrocardiogram (ECG) to assess for possible MI MI MI is ischemia and death of an area of myocardial tissue due to insufficient blood flow and oxygenation, usually from thrombus formation on a ruptured atherosclerotic plaque in the epicardial arteries. Clinical presentation is most commonly with chest pain, but women and patients with diabetes may have atypical symptoms. Myocardial Infarction
    • Uncontrolled pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain → evaluate for internal surgical bleeding
  • Serial physical examinations are performed with a focus on ruling out complications:
    • Heart and lung exam
    • Surgical wound exam
  • Based on the procedure performed, the patient’s risks, and the patient’s current status, the surgeon will determine the disposition of the case, which may be:
    • Discharge to home, for healthy patients undergoing minor and/or minimally invasive procedures without worrisome signs/symptoms in recovery
    • Transfer the patient to the inpatient ward for continued, routine postoperative care
    • Transfer the patient to the ICU for more complex care

Surgical Ward

The patient is moved to the surgical ward for continued observation.

Basics of routine surgical care on the ward

All patients should be physically evaluated by a member of the surgical team at least once daily (if not more often).

  • Monitor vital signs, urinary output, and mental status.
  • Monitor the state and output of drains and tubes (e.g., Foley catheter, nasogastric tube, chest tube).
  • Manage fluids.
  • Check the surgical site for signs of dehiscence, infection, or bleeding.
  • Help control common postoperative symptoms:
    • Pain
    • Nausea and vomiting
  • Prophylaxis against:
    • Atelectasis
    • Deep vein thrombosis ( DVT DVT Deep vein thrombosis (DVT) usually occurs in the deep veins of the lower extremities. The affected veins include the femoral, popliteal, iliofemoral, and pelvic veins. Proximal DVT is more likely to cause a pulmonary embolism (PE) and is generally considered more serious. Deep Vein Thrombosis)
  • For patients at risk of internal bleeding and/or metabolic issues, order and follow up on basic lab work:
    • CBC (typically within the first 24 hours after surgery); consider transfusion based on Hb levels and blood loss during surgery
    • Consider a basic metabolic panel (BMP).
    • Labs unique to the patient and/or procedure
  • Work toward discharge:
    • Ambulation
    • Tolerating nutrition
    • Normal voiding and appropriate bowel activity
    • Symptoms controlled without IV or IM medications

Drains

  • Drains should be checked and emptied regularly:
    • Lost fluid should be replaced with a fluid of similar characteristics.
    • Continuous blood loss through a drain should be investigated. 
    • Remove as soon as clinically appropriate in order to minimize complication risks.
  • Urinary catheter: for most procedures, typically removed once the patient can ambulate

Wound care

Wound infections can affect either the superficial or the deep incisional spaces. Pressure sores may also develop in immobile patients.

  • Wounds should be examined daily for signs of infection: redness, swelling, drainage
  • Wounds should be covered with a dry dressing, which should be removed when clinically appropriate, often within 48 hours.
  • Superficial infections involve only the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin and subcutaneous tissue near the incision and can present with:
    • Cellulitis Cellulitis Cellulitis is a common infection caused by bacteria that affects the dermis and subcutaneous tissue of the skin. It is frequently caused by Staphylococcus aureus and Streptococcus pyogenes. The skin infection presents as an erythematous and edematous area with warmth and tenderness. Cellulitis
    • Purulent drainage
    • Superficial abscess
  • Deep infections may involve the peritoneal or organ spaces and present with:
    • Pain
    • Fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever
    • Ileus (in GI surgery)
  • Signs of infection should be managed: 
    • Wound swab for Gram staining and culture
    • Antibiotics if clinical infection is apparent on physical exam
    • +/– surgical debridement
  • Pressure sores
    • A result of friction/persistent pressure over soft tissue affecting pressure points (e.g., sacrum)
    • Risk factors:
      • Immobility
      • Malnutrition Malnutrition Malnutrition is a clinical state caused by an imbalance or deficiency of calories and/or micronutrients and macronutrients. The 2 main manifestations of acute severe malnutrition are marasmus (total caloric insufficiency) and kwashiorkor (protein malnutrition with characteristic edema). Malnutrition in children in resource-limited countries
      • Poor peripheral circulation 
      • Diabetes mellitus Diabetes mellitus Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus 
      • Edema
    • Prevention:
      • Early mobilization
      • Adequate nutrition 
      • Regular turning by staff, if immobile 
      • Air filter mattress for high-risk patients 
  • Risk factors for impaired wound healing Wound healing Wound healing is a physiological process involving tissue repair in response to injury. It involves a complex interaction of various cell types, cytokines, and inflammatory mediators. Wound healing stages include hemostasis, inflammation, granulation, and remodeling. Wound Healing:
    • Obesity
    • Smoking
    • Diabetes mellitus Diabetes mellitus Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
    • Peripheral vascular disease

Fluid replacement and oral intake

  • Fluid input (fluid intake) and output (sensible and insensible losses) should be balanced.
    • Fluid input sources:
      • Exogenous sources: oral and IV fluid
      • Endogenous sources: water produced by metabolism
    • Fluid output sources:
      • Sensible losses: urine and drains
      • Insensible losses: respiration, feces, sweat
    • Extra losses, such as increased insensible losses due to temperature in tropical climates, must be kept in mind.
    • Maintenance fluid requirements for adults are approximately 1.5–2.5 L daily.
  • Goals of fluid management:
    • Guard against ongoing physiologic fluid loss in patients who cannot or should not eat/drink; these losses may be increased due to: 
      • Drains
      • GI losses: vomiting, diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea
      • Insensible losses: tachypnea, perspiration
    • Support cardiac preload
    • Maintain intravascular volume 
    • Electrolyte balance
  • Provide maintenance fluid:
    • 4 ml/kg/hour (or 100 ml/kg/24 hours) for the 1st 10 kg of body weight
    • 2 ml/kg/hour (or 50 ml/kg/24 hours) for the 2nd 10 kg 
    • 1 ml/kg/hour (or 20 ml/kg/24 hours) for each kilogram after the 20th
  • Nutrition:
    • Enteral nutrition (e.g., oral intake) is preferred and should start as soon as possible as long as there are no contraindications (e.g., intestinal obstruction).
    • Total parenteral nutrition (TPN) may be initiated, if prolonged nil per os (NPO; nothing by mouth) state is anticipated.
  • It is not necessary to replace potassium within the first 24–48 hours after surgery because potassium is released from injured cells.

Pain management Pain Management Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is a subjective experience. Acute pain lasts < 3 months and typically has a specific, identifiable cause. Pain Management

  • Pain should be regularly assessed and addressed.
  • Therapeutic options:
    • Parenteral analgesics:
      • Opioids Opioids Opiates are drugs that are derived from the sap of the opium poppy. Opiates have been used since antiquity for the relief of acute severe pain. Opioids are synthetic opiates with properties that are substantially similar to those of opiates. Opioid Analgesics: morphine, hydromorphone, fentanyl
      • Patient-controlled analgesics: opioids
      • IV NSAIDs
      • IV acetaminophen Acetaminophen Acetaminophen is an over-the-counter nonopioid analgesic and antipyretic medication and the most commonly used analgesic worldwide. Despite the widespread use of acetaminophen, its mechanism of action is not entirely understood. Acetaminophen
      • Ketamine
    • Oral analgesia: opioids, NSAIDs, acetaminophen Acetaminophen Acetaminophen is an over-the-counter nonopioid analgesic and antipyretic medication and the most commonly used analgesic worldwide. Despite the widespread use of acetaminophen, its mechanism of action is not entirely understood. Acetaminophen, gabapentin
    • Regional analgesia: intrathecal opioids, epidural block, peripheral nerve block
  • Use a multimodal approach.
  • Maximize the use of nonopioid analgesics before administering opioids. 
  • Typical example regimen:
    • NSAID NSAID Nonsteroidal antiinflammatory drugs (NSAIDs) are a class of medications consisting of aspirin, reversible NSAIDs, and selective NSAIDs. NSAIDs are used as antiplatelet, analgesic, antipyretic, and antiinflammatory agents. Nonsteroidal Antiinflammatory Drugs + acetaminophen Acetaminophen Acetaminophen is an over-the-counter nonopioid analgesic and antipyretic medication and the most commonly used analgesic worldwide. Despite the widespread use of acetaminophen, its mechanism of action is not entirely understood. Acetaminophen (scheduled)
    • Opioid as needed or opioid by patient-controlled analgesia
    • Additional measures:
      • Consider adjuvant analgesia (e.g., gabapentin) and/or regional analgesia
  • Start with IV forms and transition to oral as tolerated.
  • Stay alert: Uncontrolled pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain may indicate a complication, such as internal hemorrhage or infection.

Postoperative nausea and vomiting

  • Risk factors:
    • Patient-specific:
      • Women
      • Nonsmokers 
      • Previous history of postoperative nausea and vomiting
      • Motion sickness  
    • Procedure-specific:
      • Volatile anesthetic agents (e.g., nitrous oxide)
      • Postoperative opioids 
      • Type of surgery (e.g., cholecystectomy Cholecystectomy Cholecystectomy is a surgical procedure performed with the goal of resecting and extracting the gallbladder. It is one of the most common abdominal surgeries performed in the Western world. Cholecystectomy is performed for symptomatic cholelithiasis, cholecystitis, gallbladder polyps > 0.5 cm, porcelain gallbladder, choledocholithiasis and gallstone pancreatitis, and rarely, for gallbladder cancer. Cholecystectomy: Approaches and Technique
  • Major complications may result from postoperative nausea and vomiting, including:
    • Wound dehiscence and bleeding 
    • Dehydration
    • Prolonged hospital stay
    • ↑ Intracranial pressure (a concern for neurosurgical patients)
  • Postoperative nausea and vomiting treatment:
    • Antiemetic agents:
      • Serotonin 5-hydroxytryptamine-3 receptor antagonists: ondansetron
      • Dopamine antagonists: metoclopramide, prochlorperazine
    • May combine agents from different classes

Mental status changes

  • Delirium Delirium Delirium is a medical condition characterized by acute disturbances in attention and awareness. Symptoms may fluctuate during the course of a day and involve memory deficits and disorientation. Delirium or confusion may occur postoperatively.
  • Rule out stroke with history, exam, and potentially brain imaging.
  • Presentation:
    • Anxiety 
    • Incoherent speech
    • Decreased level of consciousness
    • Destructive behavior (e.g., pulling out drains)
  • Risk factors:
    • Older age
    • Preexisting dementia
    • Alcohol withdrawal 
    • Benzodiazepine/opioid use 
    • Electrolyte disturbances 
    • Infection
  • Treatment:
    • Treat the underlying cause. 
    • Haloperidol in severe agitation
  • Anxiety, disorientation, and minor changes in behavior or appearance can be early manifestations of complications.

Prophylaxis

  • DVT DVT Deep vein thrombosis (DVT) usually occurs in the deep veins of the lower extremities. The affected veins include the femoral, popliteal, iliofemoral, and pelvic veins. Proximal DVT is more likely to cause a pulmonary embolism (PE) and is generally considered more serious. Deep Vein Thrombosis prophylaxis:
    • Mechanical methods, which are used in almost all patients:
      • Elastic stockings 
      • Intermittent pneumatic compression 
      • Early ambulation
    • Pharmacologic methods:
      • Used for moderate- to high-risk patients (e.g., bariatric, orthopedic, or cancer patients) 
      • Typically use low-molecular-weight heparin or unfractionated heparin
  • Atelectasis prophylaxis:
    • Referred to as “pulmonary hygiene”
    • Atelectasis can result in decreased oxygenation, poorer wound healing Wound healing Wound healing is a physiological process involving tissue repair in response to injury. It involves a complex interaction of various cell types, cytokines, and inflammatory mediators. Wound healing stages include hemostasis, inflammation, granulation, and remodeling. Wound Healing, and respiratory infections.
    • Techniques used:
      • Early mobilization
      • Deep breathing and/or incentive spirometry
      • Adequate analgesia (prevents shallow breathing due to pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain)
      • Continuous positive airway pressure (CPAP)

Outpatient Care after Discharge

Patients are typically ready for discharge when they meet the following criteria:

  • Stable vital signs and exam
  • Able to ambulate and provide basic self-care (or have help in doing so) 
  • Able to tolerate nutrition and hydration
  • Pain controlled on oral medications
  • Voiding and defecating appropriately for their clinical situation

Review all restrictions and instructions with patients prior to discharge:

  • Include any limitations to work/school (e.g., no heavy lifting for 6 weeks).
  • Teach patient how to care for their incisions.
  • Explain what to expect in terms of recovery.
  • Explain what requires more immediate evaluation.
  • Provide phone numbers and resources so patients know who to call or where to go in case of concerns.
  • Provide documentation (“doctor’s note”) for work/school as needed. 

Ensure patient is set up with:

  • Appropriate rehabilitation/physical therapy (may be required depending on the patient and/or procedures)
  • Required medical equipment and/or supplies

Most patients should have a postoperative appointment around 7–14 days after discharge:

  • Assess surgical wound healing Wound healing Wound healing is a physiological process involving tissue repair in response to injury. It involves a complex interaction of various cell types, cytokines, and inflammatory mediators. Wound healing stages include hemostasis, inflammation, granulation, and remodeling. Wound Healing.
  • Assess functional status, pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain, and symptoms.
  • Review pathology/findings and next steps in the plan of care. 

Clinical Relevance: General Surgical Complications

The following conditions include common complications that can occur in any patient undergoing a surgical procedure that requires general anesthesia Anesthesia Anesthesiology is the field of medicine that focuses on interventions that bring a state of anesthesia upon an individual. General anesthesia is characterized by a reversible loss of consciousness along with analgesia, amnesia, and muscle relaxation. Anesthesiology: History and Basic Concepts.

Respiratory complications

  • DVT DVT Deep vein thrombosis (DVT) usually occurs in the deep veins of the lower extremities. The affected veins include the femoral, popliteal, iliofemoral, and pelvic veins. Proximal DVT is more likely to cause a pulmonary embolism (PE) and is generally considered more serious. Deep Vein Thrombosis: formation of a clinically important intravascular thrombus in the deep venous plexus of the lower limbs.
  • PE: when a clot becomes lodged within the pulmonary circulation. A pulmonary embolism Pulmonary Embolism Pulmonary embolism (PE) is a potentially fatal condition that occurs as a result of intraluminal obstruction of the main pulmonary artery or its branches. The causative factors include thrombi, air, amniotic fluid, and fat. In PE, gas exchange is impaired due to the decreased return of deoxygenated blood to the lungs. Pulmonary Embolism obstructs gas exchange Gas exchange Human cells are primarily reliant on aerobic metabolism. The respiratory system is involved in pulmonary ventilation and external respiration, while the circulatory system is responsible for transport and internal respiration. Pulmonary ventilation (breathing) represents movement of air into and out of the lungs. External respiration, or gas exchange, is represented by the O2 and CO2 exchange between the lungs and the blood. Gas Exchange and may be life-threatening.
  • Pneumonia Pneumonia Pneumonia or pulmonary inflammation is an acute or chronic inflammation of lung tissue. Causes include infection with bacteria, viruses, or fungi. In more rare cases, pneumonia can also be caused through toxic triggers through inhalation of toxic substances, immunological processes, or in the course of radiotherapy. Pneumonia: infection of the pulmonary parenchyma, most commonly by bacterial pathogens. 
  • Aspiration pneumonitis: Patients who vomit while intubated may aspirate the vomitus and develop inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation of the pulmonary parenchyma due to the gastric contents.
  • Respiratory failure Respiratory failure Respiratory failure is a syndrome that develops when the respiratory system is unable to maintain oxygenation and/or ventilation. Respiratory failure may be acute or chronic and is classified as hypoxemic, hypercapnic, or a combination of the two. Respiratory Failure: inability to maintain normal PO2 and PCO2 in arterial blood, rendering the body unable to support systemic metabolic requirements. Respiratory failure Respiratory failure Respiratory failure is a syndrome that develops when the respiratory system is unable to maintain oxygenation and/or ventilation. Respiratory failure may be acute or chronic and is classified as hypoxemic, hypercapnic, or a combination of the two. Respiratory Failure can be due to inadequate oxygenation of blood or inadequate ventilation.
  • Acute respiratory distress syndrome Acute Respiratory Distress Syndrome Acute respiratory distress syndrome is characterized by the sudden onset of hypoxemia and bilateral pulmonary edema without cardiac failure. Sepsis is the most common cause of ARDS. The underlying mechanism and histologic correlate is diffuse alveolar damage (DAD). Acute Respiratory Distress Syndrome: severe inflammatory reaction of the lung that is characterized by the presence of pulmonary infiltrates due to alveolar fluid accumulation, without evidence suggestive of a cardiogenic etiology.
  • Pleural effusion Pleural Effusion Pleural effusion refers to the accumulation of fluid between the layers of the parietal and visceral pleura. Common causes of this condition include infection, malignancy, autoimmune disorders, or volume overload. Clinical manifestations include chest pain, cough, and dyspnea. Pleural Effusion: accumulation of fluid within the pleural space, which can be due to a multitude of causes.
  • Pneumothorax Pneumothorax A pneumothorax is a life-threatening condition in which air collects in the pleural space, causing partial or full collapse of the lung. A pneumothorax can be traumatic or spontaneous. Patients present with a sudden onset of sharp chest pain, dyspnea, and diminished breath sounds on exam. Pneumothorax: potentially life-threatening condition in which air is trapped in the pleural space and there is complete or partial collapse of the lung. Pneumothorax Pneumothorax A pneumothorax is a life-threatening condition in which air collects in the pleural space, causing partial or full collapse of the lung. A pneumothorax can be traumatic or spontaneous. Patients present with a sudden onset of sharp chest pain, dyspnea, and diminished breath sounds on exam. Pneumothorax may arise because of procedural complications or increased pulmonary pressures during mechanical ventilation.

Cardiovascular complications

  • MI MI MI is ischemia and death of an area of myocardial tissue due to insufficient blood flow and oxygenation, usually from thrombus formation on a ruptured atherosclerotic plaque in the epicardial arteries. Clinical presentation is most commonly with chest pain, but women and patients with diabetes may have atypical symptoms. Myocardial Infarction: ischemia and subsequent injury of the myocardial tissue due to severely reduced blood flow to a coronary artery. MI MI MI is ischemia and death of an area of myocardial tissue due to insufficient blood flow and oxygenation, usually from thrombus formation on a ruptured atherosclerotic plaque in the epicardial arteries. Clinical presentation is most commonly with chest pain, but women and patients with diabetes may have atypical symptoms. Myocardial Infarction is diagnosed on the basis of an increase in cardiac enzymes Enzymes Enzymes are complex protein biocatalysts that accelerate chemical reactions without being consumed by them. Due to the body's constant metabolic needs, the absence of enzymes would make life unsustainable, as reactions would occur too slowly without these molecules. Basics of Enzymes and ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Normal Electrocardiogram (ECG) changes suggestive of ischemia. 
  • Heart failure: inability of the heart to supply the body with a normal cardiac output sufficient to meet metabolic demands.
  • Atrial fibrillation Atrial fibrillation Atrial fibrillation (AF or Afib) is a supraventricular tachyarrhythmia and the most common kind of arrhythmia. It is caused by rapid, uncontrolled atrial contractions and uncoordinated ventricular responses. Atrial Fibrillation: supraventricular arrhythmia produced by chaotic atrial depolarization, characterized on ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Normal Electrocardiogram (ECG) by absent P waves and an “irregularly irregular” ventricular rhythm.

Urinary complications

  • Urinary tract Urinary tract The urinary tract is located in the abdomen and pelvis and consists of the kidneys, ureters, urinary bladder, and urethra. The structures permit the excretion of urine from the body. Urine flows from the kidneys through the ureters to the urinary bladder and out through the urethra. Urinary Tract infection ( UTI UTI Urinary tract infections (UTIs) represent a wide spectrum of diseases, from self-limiting simple cystitis to severe pyelonephritis that can result in sepsis and death. Urinary tract infections are most commonly caused by Escherichia coli, but may also be caused by other bacteria and fungi. Urinary Tract Infections): infection of the urinary system most commonly caused by Escherichia coli Escherichia coli The gram-negative bacterium Escherichia coli is a key component of the human gut microbiota. Most strains of E. coli are avirulent, but occasionally they escape the GI tract, infecting the urinary tract and other sites. Less common strains of E. coli are able to cause disease within the GI tract, most commonly presenting as abdominal pain and diarrhea. Escherichia coli. In the postoperative patient, UTI UTI Urinary tract infections (UTIs) represent a wide spectrum of diseases, from self-limiting simple cystitis to severe pyelonephritis that can result in sepsis and death. Urinary tract infections are most commonly caused by Escherichia coli, but may also be caused by other bacteria and fungi. Urinary Tract Infections is most commonly due to use of an indwelling Foley catheter.
  • AKI AKI Acute kidney injury refers to sudden and often reversible loss of renal function, which develops over days or weeks. Azotemia refers to elevated levels of nitrogen-containing substances in the blood that accompany AKI, which include BUN and creatinine. Acute Kidney Injury (acute renal failure): characterized by increases in serum creatinine and reductions in urinary output and glomerular filtration Glomerular filtration The kidneys are primarily in charge of the maintenance of water and solute homeostasis through the processes of filtration, reabsorption, secretion, and excretion. Glomerular filtration is the process of converting the systemic blood supply into a filtrate, which will ultimately become the urine. Glomerular Filtration. This condition may be due to periods of intraoperative hypotension Hypotension Hypotension is defined as low blood pressure, specifically < 90/60 mm Hg, and is most commonly a physiologic response. Hypotension may be mild, serious, or life threatening, depending on the cause. Hypotension leading to ischemia either caused by blood loss and/or effects of anesthesia Anesthesia Anesthesiology is the field of medicine that focuses on interventions that bring a state of anesthesia upon an individual. General anesthesia is characterized by a reversible loss of consciousness along with analgesia, amnesia, and muscle relaxation. Anesthesiology: History and Basic Concepts, use of nephrotoxic drugs, or embolic events.

Infectious complications

  • Sepsis Sepsis Organ dysfunction resulting from a dysregulated systemic host response to infection separates sepsis from uncomplicated infection. The etiology is mainly bacterial and pneumonia is the most common known source. Patients commonly present with fever, tachycardia, tachypnea, hypotension, and/or altered mentation. Sepsis and Septic Shock: life-threatening syndrome resulting in multiorgan dysfunction caused by an unregulated and disproportionate host response to infection.

References

  1. Lal, P. (2018). Postoperative care and complications. In: Garden, O. James et al. Principles and practice of surgery (pp. 128–136). Retrieved June 8, 2021, from https://www.clinicalkey.es/#!/content/3-s2.0-B9780702068591000091
  2. James, Mollie M.,D.O., M.P.H., & Beilman, G. J., M.D. (2012). Mechanical ventilation. Surgical Clinics of North America, The, 92(6), 1463-1474. http://dx.doi.org/10.1016/j.suc.2012.08.003
  3. Ferri, Fred F. ,M.D., F.A.C.P. (2014). Pulmonary and critical care. In Ferri, Fred F., MD, FACP (Ed.), Ferri’s Practical Guide: Fast facts for patient care. Elseverier, pp. 340–371. Retrieved June 8, 2021, from https://www.clinicalkey.es/#!/content/3-s2.0-B9781455744596000118
  4. Thompson, B. T., Chambers, R. C., & Liu, K. D. (2017). Acute respiratory distress syndrome Acute Respiratory Distress Syndrome Acute respiratory distress syndrome is characterized by the sudden onset of hypoxemia and bilateral pulmonary edema without cardiac failure. Sepsis is the most common cause of ARDS. The underlying mechanism and histologic correlate is diffuse alveolar damage (DAD). Acute Respiratory Distress Syndrome. N Engl J Med 377:562–572. doi:10.1056/NEJMra1608077
  5. Quick, Clive R.G. et al. (2020). Complications of surgery. In Quick, Clive R.G. et al., Essential Surgery: Problems, Diagnosis, and Management. Elsevier, pp. 170–184. Retrieved June 8, 2021, from https://www.clinicalkey.es/#!/content/3-s2.0-B9780702076312000122
  6. Goldstein, L. B. (2020). Ischemic cerebrovascular disease. In L. Goldman MD, & A. I. Schafer MD (Eds.), Goldman-Cecil medicine (pp. 2396-2407.e3). Retrieved June 8, 2021, from https://www.clinicalkey.es/#!/content/3-s2.0-B9780323532662003799
  7. Ko S. B. (2018). Perioperative stroke: pathophysiology and management. Korean Journal of Anesthesiology Anesthesiology Anesthesiology is the field of medicine that focuses on interventions that bring a state of anesthesia upon an individual. General anesthesia is characterized by a reversible loss of consciousness along with analgesia, amnesia, and muscle relaxation. Anesthesiology: History and Basic Concepts 71:3–11. https://doi.org/10.4097/kjae.2018.71.1.3
  8. Alexander JW, Solomkin JS, Edwards MJ. (2011). Updated recommendations for control of surgical site infections Surgical site infections Surgical site infection (SSI) is a type of surgical infection that occurs at or near a surgical incision within 30 days of the procedure or within 90 days if prosthetic material is implanted. Surgical site infections are classified according to the depth of involvement as superficial, deep, or organ/space. Surgical Site Infections. Ann Surg 253:1082–1093. 
  9. Barbul A, Efron DT, Kavalukas SL. (2014). Wound healing. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz’s Principles of Surgery, 10th ed. New York: McGraw-Hill. 
  10. Beilman GJ, Dunn DL. (2014). Surgical infections Surgical infections An infection is the proliferation of microorganisms within tissues, body cavities, or spaces, which induces an immune response and overwhelms the body's natural defenses. In surgical patients, these infections are frequently caused by the translocation of commensal organisms into deeper tissues, combined with the impairment of host defenses due to surgical injury or stress. Surgical Infections. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz’s Principles of Surgery, 10th ed. New York: McGraw-Hill. 
  11. Culver DH, Horan TC, Gaynes RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial.

Learn even more with Lecturio:

Complement your med school studies with Lecturio’s all-in-one study companion, delivered with evidence-based learning strategies.

Study on the Go

Lecturio Medical complements your studies with evidence-based learning strategies, video lectures, quiz questions, and more – all combined in one easy-to-use resource.

¡Hola!

Esta página está disponible en Español.

🍪 Lecturio is using cookies to improve your user experience. By continuing use of our service you agree upon our Data Privacy Statement.

Details