anesthesia

2.  Due to anesthesia
 Due to surgery
 Anesthetic complications depend on the
mode (General or Local) and types of
anesthetic agent used (anesthetic agent
toxicity).

3. DUE TO SURGERY
 Perioperative
 Complications Postoperative
complications Immediate/early
complications Late
 PERIOPERATIVE COMPLICATIONS
Refers to problems arising during surgery

4. Due to anesthesia
COMMON COMPLICATIONS OF G.A.
 Direct trauma to the mouth
 Slow 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 & vomiting
 Major effect: CVS collapse, respiratory depression

5. Respiratory complications
1) Complications of laryngoscopy and intubation
2) Respiratory obstruction
3) Hypoxemia
4) Hypercapnia and hypocapnia
5) Hypoventilation
6) Aspiration pneumonia

6. I- Complications of laryngoscopy
and intubation
1. Errors of ETT positioning
 a. Esophageal intubation
 b. Endobronchial intubation
 c. 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

7. 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

8. 3. Physiologic responses to airway
instrumentation
 a. Sympathetic stimulation
 b. Laryngospasm
 c. Bronchospasm
4. ETT malfunction:
 a. Risk of ignition during laser
surgery
 b. ETT obstruction
 c. Cuff perforation

9. 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.

10. II- Respiratory obstruction
Sites of obstruction
 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

11. Upper airway obstruction in PACU
 include 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.

12. Laryngospasm and laryngeal
edema
A. Definition
Laryngospasm
 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

13. 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 edema
 administer 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

14. III- Hypoxemia
 PaO2 less 60 mmHg or SaO2 less 90%
Causes:





1. Decreased FiO2
2. Hypoventilation
3. V/Q mismatch
4. Increased O2 utilization by tissues
5. Tissue hypoxia
Clinical 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

15. IV) Hypercapnia
 PaCO2 or ETCO2 > 40 mmHg.
Causes:
 1-Increased FiCO2
 2-Hypoventilation
 3-Increased dead space
 4-Increased CO2 production by tissues
Treatment:
 of the cause

16. V) Hypoventilation
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.