A post operative patient can undergo many types of complications following surgical procedures. It is said that most such complications will occur in the 1st to 5th day following a surgery. But, the most dangerous complications will arise in the immediate post operative period, probably within the first 24 hours after the surgery.
It is common practice to monitor a patient who had undergone a major surgery at the theatre for few hours and thereafter depending on the nature of the surgery as well as the patients’ condition to observe in a ward or in an ICU setting. In any instance, the nursing staff as well as the doctors will keep a close eye on the patient to identify early signs of possible complications. The vigilance would be more in the immediate hours after the surgery and we will look at some of the possible complications soon after a surgery.
Bleeding or Hemorrhage
Probably the most common complication in the immediate post operative period is bleeding. To differentiate it from late onset bleeding manifestations, the immediate bleeding complications are known as ‘Primary bleeding’ or ‘Primary Hemorrhage’.
The reason for these bleeding manifestations would be coagulation or clotting defects, continuous bleeding from the wound site or failed hemostasis or even can be an associate injury which went unnoticed during the surgery.
In any instance, the loss of blood will be manifesting according to the volume that is being lost and low blood pressure, rapid pulse, paleness as well as haematoma formation or bruising at the site of the surgery are common signs along with continuously soaking wound dressing.
Once identified, a decision should be made to further observe the patient with adequate resuscitation or else to re-open the wound in order to arrest the bleeding. If the problem lies with clotting defects it should be corrected and at times the patient may need to be transfused blood or blood products such as platelets or fresh frozen plasma.
Breathing problems
There can be several causes for difficulty in breathing following surgery and some of the well known reasons would be atelectasis, effect of anaesthetic agents or pulmonary embolism.
Atelectasis is the collapse of small airways or the alveoli in the base of the lungs and would be the result of increased secretions that is blocking the air passage. The inability by the patient to expel these secretions voluntarily would lead to such complications and almost all instances would involve general anaesthesia patients.
Analgesic agents such as opioids and some times spinal anaesthesia that has gone too high in the spine can also give rise to post operative difficulty in breathing.
Pulmonary embolism is a condition in which a dislodged blood clot, fluid embolus or even an air bubble travels through the blood vessels and lodges in a tiny blood vessel in the lungs and thus results in a section of lung tissues which are deprived of circulation. It’s a dreaded condition which can precipitate as tight chest pain, sudden onset difficulty in breathing as well as collapse and the condition is relatively common with hip surgeries as well as other pelvic surgeries.
Thus, observation of the colour of the patient and monitoring the oxygen saturation of the blood will enable the clinicians to identify the problem and thus maintain adequate oxygen intake till the problem gets sorted out except in situations of pulmonary embolism.
Poor urine output
This can lead to acute renal failure and most often is the result of inadequate fluid replacement following a surgery. It can be secondary to renal damage as well and can be secondary to a condition known as ‘Rhabdomyolysis’ or catabolism of muscle tissues following surgery. Increase blood loss, infection as well as retention of urine can also precipitate low output state in a post op patient.
Most often, these patients will be catheterized and the intake as well as the output will be charted from the time of the surgery. Thus, it’s possible to identify any mismatch between the intake and the output and act accordingly to prevent further complications.
Apart from these complications, there can be other instances which can precipitate a heart attack, acute wheezing episode or else acute organ failure related to vital organs. Thus, close monitoring in the immediate post operative period will assist the clinicians to reduce the occurrence of such complications and save the lives of the patients.
