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Post Operative Complications. Circulatory Complications. Hypertension Arrhythmias Tachycardia Hypotension & Hypovolemia. Hypertension. Hypertension is the most common of the post-operative cardiovascular complications .

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circulatory complications
Circulatory Complications
  • Hypertension
  • Arrhythmias

Tachycardia

  • Hypotension & Hypovolemia
slide4

Hypertension is the most common of the post-operative cardiovascular complications.

defined as a systolic blood pressure greater than 160 mm Hg or a diastolic blood pressure greater than 90 mm Hg.

When the hypertension is severe, it can cause serious problems, such as:

Left ventricular failure

Myocardial infarction

Arrhythmias

Pulmonary edema

Cerebral hemorrhage

Postoperative hypertension occurs most frequently in patients who had pre-existing hypertension.

slide5

CAUSES

Discomfort (eg, pain, anxiety, confusion, a full bladder) can raise a postoperative patient's blood pressure.

Many physiologic abnormalities, such as hypoxemia, hypercapnia, or fluid overload, can also induce hypertension.

Certain surgeries have a higher risk of inducing a hypertensive response, notably:

Abdominal aneurysm repair

Intracranial surgery

The strongest risk factor for postoperative hypertension is a physiologic predisposition as people with atherosclerosis or pre-existing hypertension, even if it had been well controlled, are the most likely patients to develop post-operative hypertension. 

slide6

Recognition And Assessment

Blood pressure is one of the key signs that should be continually monitored .

Postoperative hypertension tends to occur early in a patient's recovery, so blood pressures should be measured more frequently in the first 30 minutes of a patient's stay in the PACU.

Management

The goal in managing postoperative hypertension is to relieve the stressor.

When hypertension occurs, nurses should be certain that they are providing sufficient analgesia and that the patient's bladder is not distended.

Nurses should also check and improve the patient's ventilation, oxygen saturation, and fluid balance.

Relieving discomfort with additional sedation can lower postoperative hypertension.

If these measures do not reduce the patient's blood pressure, then antihypertensive drugs are probably needed.

In the PACU, beta-adrenergic blockers are commonly used to reduce blood pressure.

slide8

Causes

Postoperative tachycardia can be a sign of a wide range of stressors, including pain, hypoxemia, hypercapnia, anemia, hypovolemia, and fever, or it can be component of an Arrhythmia.

Pain and discomfort (eg, from an over distended bladder) are the most common causes of tachycardia.

Recognition And Assessment

Tachycardia is defined as ≥100 heartbeats/minute.

slide9

Management

When a PACU patient develops tachycardia, the nurse checks the patient's airway, oxygen saturation level, vital signs, volume signs (jugular venous fill level, urine output, peripheral pulses, capillary refill time), and bladder size. In addition, the nurse evaluates the patient's cardiac rhythm. And any problems are treated.

Persistent tachycardia can often be slowed with fluids, an opioid analgesic, or a beta-adrenergic blocker. All these measures need the consent of the attending physician.

Tachycardia may also be a component of a newly developed Arrhythmia.

Most Arrhythmias that appear in the PACU are the result of an underlying metabolic or circulatory imbalance.

When the physiologic imbalance is corrected, the Arrhythmia and the tachycardia will usually disappear.

slide11

Mild hypotension is one of the more common circulatory abnormalities seen in the PACU. However, Severe Hypotension is rarely seen.

slide12

CAUSES

Hypovolemia: the most common cause.

Causes of hypovolemia include:

blood loss and evaporation (fluids are lost by evaporation when an operation requires body cavities to be open for long periods).

Urinary losses are sometimes not fully replaced with intravenous fluid.

the body's reaction to the injury of surgery makes local blood vessels more permeable, and body fluids leave the circulation and accumulate in tissue spaces, in the peritoneal space, and even inside the intestine.

Cardiac dysfunction:

Occasionally, cardiac dysfunction is the major cause of postoperative hypotension.

The cardiac dysfunction (heart failure, dysrhythmia, myocardial infarction) can be a new problem caused by the intra-operative drugs or the conditions of surgery.

More often, postoperative heart malfunctions are exacerbations of pre-existing heart problems.

Spinal opioids.

Epidural or intrathecal anesthesia, especially with an opioid, can cause neurogenic hypotension .

slide13

Recognition And Assessment

Hypotension

In the PACU, patients' blood pressures should be checked regularly. 

Mild hypotension means a drop in blood pressure of less than 10% to 15% from the patient's baseline values. 

Significant hypotension means a drop of 20% to 30% in blood pressure values.

Hypovolemia

Hypovolemia in a post-operative patient can usually be recognized clinically by the occurrence of a number of these signs:

Tachycardia

Decreased radial pulse.

Cool extremities

Narrow pulse pressure (pulse pressure is the difference between the systolic and diastolic blood pressure values)

Poor skin turgor

Dry mucous membranes

Concentrated urine

Lethargy

Sometimes we see cyanosis.

slide14

Management

Mild postoperative hypotension is a common finding, and it can usually be managed by regular monitoring.

On the other hand, significant hypotension needs prompt treatment.

Assuming there is clear airway and adequate ventilation, oxygen is administered, fluids are increased, and when possible, the patient is put in the Trendelenburg position. Then the causes of the hypotension must be searched for and treated.

Meanwhile, if fluids do not improve the hypotension, then it may be necessary to administer vasopressors.

An anesthesiologist or critical care physician must be involved in this and all further evaluations and treatments of postoperative hypotension.

urinary complications
Urinary complications
  • Anuria
  • Oliguria
oliguria is the low output of urine it is clinically classified as an output below 300 500ml day

Postoperative oliguria:Patients usually have decrease in urine output after a major operation that may be a normal physiological response to:

1. fluid/ blood loss.

2. decreased glomerular filtration rate secondary to hypovolemia.

3. hypotension as a response of adrenal cortex to stress.

4. increase in aldosterone (Na and water retention) & antidiuretic hormone (ADH) release.

Oliguria :

is the low output of urine, It is clinically classified as an output below 300-500ml/day.

anuria anuria is defined as less than 50ml urine output per day

Same Mechanism of Oligouria!

Postoperative Anuria:Patients usually have decrease in urine output after a major operation that may be a normal physiological response to:

Anuria itself is a symptom, not a disease. It is often associated with other symptoms of kidney failure.

1. fluid/ blood loss.

2. decreased glomerular filtration rate secondary to hypovolemia.

3. hypotension as a response of adrenal cortex to stress.

4. increase in aldosterone (Na and water retention) & antidiuretic hormone (ADH) release.

Anuria :

Anuria is defined as less than 50mL urine output per day.