Postoperative Complications - Cardiovascular:

1. Post-operative hypertension

Definition: Systolic BP >190 or diastolic BP > 100 on 2 consecutive readings after surgery

Etiology: Pre-existing hypertension, inadequately controlled pain, hypercapnia, hypoxia, volume overload, sympathomimetic drugs, Malignant Hyperthermia, tumours like pheochromocytoma

Clinical picture: Depends on underlying etiology; may have abnormalities in other vital signs.

Treatment: Check other vital signs. Treat underlying etiology. If minimal improvement, can consider medications such as metoprolol, labetalol, or hydralazine.


2. Hypotension

Definition: Systolic BP < 90 mmHg, MAP < 65, or 40 mmHg drop from baseline.

Etiology:

  • Hypovolemic: Blood or fluids (this is the most common cause).
  • Cardiogenic: Ischemia, arrhythmia, cardiomyopathy, valvular disease.
  • Distributive:Anaphylaxis, residual anesthetic agents, sepsis, spinal cord trauma.
  • Obstructive: PE, tension pneumothorax, cardiac tamponade.

Clinical picture: Depends on underlying etiology; potentially tachycardia, decreased mental status.

Treatment: Give fluids. Workup may include CBC, EKG, CXR. Treat underlying cause.


3. Arrhythmia

Definition: Abnormal heart rhythm.

Etiology: Broadly two categories - bradycardia and tachycardia. Can further be divided into stable versus unstable.

Clinical picture: Dyspnea, hypotension, chest pain/tightness.

Treatment: Follow ACLS algorithm for bradycardia or tachycardia. (See section on resuscitation.)


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