Postoperative Complications - Neurological:
1. Motor weakness
DDx: Residual neuromuscular blockade, electrolyte imbalance, hypothermia, stroke.
Clinical picture: Somnolence, shallow breathing, uncoordinated movements, agitation. Potentially desaturations and hypercapnia secondary to hypoventilation.
Treatment: Treat underlying cause. Residual neuromuscular blockade may be treated with neostigmine and glycopyrrolate or Sugammadex.
2. Post-operative nausea/vomiting (PONV)
Risk factors:
- Patient factors: Female, non-smoker, history of PONV or motion sickness.
- Anesthesia factors: Use of volatile anesthetics, nitrous oxide, use of intraoperative and postoperative opioids.
- Surgical risk factors:Duration of surgery, type of surgery (laparoscopy, ENT, breast, neurosurgery, strabismus, laparotomy, plastic surgery).
Prevention:
- Intraop: Total intravenous anesthesia (TIVA), pharmacologic prophylaxis (dexamethasone, ondansetron), multimodal analgesia to decrease opioid use, adequate hydration.
Treatment: Pharmacological treatment includes dimenhydrinate, dexamethasone, ondansetron, metoclopramide, low-dose haloperidol.
3. Delayed recovery
Definition: Unconsciousness persisting >15 minutes of discontinuing anesthetic agents.
Etiology:
- Drugs: Residual intravenous (ex opioids, benzos) or volatile anesthetics.
- Patient factors: Extremes of age, obesity, poor baseline physical status.
- Metabolic: Hypoxia, hypercapnia, hypoglycemia, ketoacidosis, electrolyte imbalance.
- Neurological: Intracranial hemorrhage, cerebral ischemia, seizures, CVA.
Treatment: Directed towards underlying cause. Most likely causes should be investigated and treated first.
4. Post-operative delirium
Definition: Transient mental dysfunction that can result in increased morbidity, delayed functional recovery, and prolonged hospital stay; commonly seen in the elderly.
Prevention: Identify and treat underlying medical issues, avoid precipitating medications, optimize fluid status, treat pain, tranquil post-operative care setting.
DDx: Drugs, withdrawal, infection, metabolic disturbances (especially hypoglycemia), structural causes like cerebral hemorrhage or ischemia.
Treatment: Ensure pain is treated and any potential underlying causes are treated. After, may consider pharmacological intervention like benzodiazepines (avoid in elderly as may cause paradoxical reaction) and antipsychotics like haloperidol.