Anesthesia complications – the unforeseen negative effects arising during the general anesthesia or soon after awakening. Are shown in the form of respiratory insufficiency, violations of blood circulation, excessive oppression of TsNS, vomiting, a regurgitation. After awakening development of psychoses, a hallucinatory syndrome, paresis and paralyzes is possible. In certain cases dynamic impassability of intestines comes to light. The diagnosis is established on the basis of clinical signs, the given hardware monitoring of vital signs, a laboratory research of biological environments of an organism.
Complications of an anesthesia belong to the category of the yatrogenny states resulting from actions of the health worker. Most often are preventable at the sufficient volume of preventive actions and thorough training of the anesthesiologist to surgery. The number of unforeseen problems decreases every year. By data for 1956, the lethality for the reasons connected with the general anesthesia reached 15%. Today this indicator does not exceed 0,02% when using an endotrakhealny method of supply of mix, modern anesthetics, continuous monitoring of a condition of the patient. The quantity of non-lethal problems, statistically for 2014, reaches 2,5%.
Reasons of complications of an anesthesia
The absolute majority of the problems arising during anesthesia is caused by the wrong actions of the anesthesiologist or nurse-anesthetist. Anesthesia complications can be also caused by violation of recommendations of the doctor from the patient. The demonstration of allergic reactions which cannot be provided meets only in 1% of cases of total number of zhizneugrozhayushchy pathology. The malignant hyperthermia – the condition of muscular hyper metabolism developing as reaction to introduction of miorelaksant of the depolarizing action is even less often diagnosed. It is more convenient to consider the reasons of pathology on systems of an organism:
- Hypoventilation. The main complications at an endotrakhealny anesthesia: detachment or excess of contours, wrong ratio of air-gas mix, violation of calibration or mechanical malfunction of the device, development of respiratory metabolic failures. Besides the oxygen listed to insufficient receipt brings accumulation of a phlegm in an intubatsionny tube in the absence of aspiration into an organism. If the patient is not on IVL, respiratory standstill at overdose of the anesthetizing substance is possible.
- Violations of haemo dynamics. Arise at the patients having chronic heart diseases, suffering from GB or hypotonia. All these factors have to be revealed and are as far as possible corrected before intervention. Insufficient inspection – the reason of heavy processes up to shock and death of the patient. Decrease HELL and failures of a warm rhythm also meet at primary coronary weakness, violation of a normal vascular tone, the reduction of OTsK caused by blood loss.
- Oppression of TsNS. It is found mainly at the wrong selection of a dose of medicine. The patients needing mix with the reduced amount of anesthetic suffer. At overdose there is an immersion of the patient in III3 or III4 an anesthesia stage. The reason of complications such – a mistake of the anesthesiologist in the choice of a dosage of medicine.
- Violation of work of intestines. The most frequent kind of similar failures – vomiting. Arises as result of irritation of the emetic center the soaked-up means. For prevention to the patient recommend to refuse meal in 8-12 hours prior to anesthesia. The emergency patient wash out a stomach. The reasons of the vomiting arising during intervention – non-compliance with medical recommendations, a carelessness of the anesthesiologist who did not warn the patient about restrictions of food, insufficiently high-quality washing of a stomach prior to operation.
The mechanism of development depends on anesthesia complication type. At hypoventilation the hypoxia and a giperkapniya is observed, metabolic processes in body tissues are broken, respiratory acidosis takes place. Disorder of the vital reactions is noted. At critical decrease HELL develops a state of shock, blood circulation centralization, fabric perfusion, supply of bodies and systems with oxygen, nutrients decreases. Against the background of insufficiency of blood circulation there occur reversible, and then irreversible changes in structure of tissues of the central nervous system.
At excessive oppression of TsNS there are failures in regulation of work of internals, including hearts, lungs, a liver, kidneys. Vomiting – result of irritation of the relevant center. At an endotrakhealny method of giving of narcotic means does not constitute considerable danger. If the patient is on independent breath, there is a risk of aspiration of emetic masses. Pneumonia, injury of a trachea and bronchial tubes by sour gastric contents becomes complications of aspiration.
Division of all possible complications is made on signs of defeat of this or that system. It is accepted to differentiate 5 main groups, each of which includes several kinds of pathological states. Defeat of respiratory system and the blood circulatory system is the most dangerous. Allocate the following types of the negative reactions which are found during the general anesthesia or after it:
- Damage of respiratory organs. Arises most often. It is shown in the form of mechanical asphyxia at a language zapadeniye, a laryngospasm, obstruction of airways by the emetic masses, a phlegm, blood. At intravenous anesthesia without intubation blocking of the respiratory center against the background of excess of an admissible dose of medicines or individual reaction is possible.
- Damage of the blood circulatory system. The main manifestations – tachycardia, premature ventricular contraction, fibrillation of auricles or ventricles. Development of an acute heart failure at which heart ceases to cope with loading is possible. Changes of a vascular tone lead to hypotonia or a hypertension, can be complicated by compensatory reactions, in particular – a takhiaritmiya, a myocardial infarction.
- Defeat of TsNS. Deep injuries of a brain are followed by oppression of independent breath, excessive immersion in an anesthesia that complicates an exit from it. At neurogenetic violation of blood circulation the brain is exposed to a hypoxia that provokes subsequently post-hypoxemic encephalopathy. Specific effects of some medicines – nonsense, hallucinations, psychomotor excitement at an immersion stage in an anesthesia or an exit from it, muscular hyperreactivity. Meet when using ketamine, a propofol, inhalation anesthetics.
- Damage of a GIT. Symptoms are vomiting, postoperative paresis of intestines. Vomiting is easily stopped by introduction of antivomitives. At paresis locks develop, complex medical actions are required. Paresis is most often observed after intestines operations at which the mechanical and medicamentous negative impact on a gastrointestinal tract is combined.
- Allergic reactions. Complications of this kind are not considered as yatrogenny, concern to group of not foreseen incidents. Can be shown in the form of a small tortoiseshell (the rash of red color raised over skin level), angioneurotic hypostasis of airways or other parts of the body of sick, anaphylactic shock. The last is the heaviest reaction to contact with a trigger factor, in the absence of timely diagnostics often leads of the patient to death.
Symptoms of complications of an anesthesia
Respiratory violations are shown in the form of classical symptoms of a hypoxia. Diffusion cyanosis, compensatory tachycardia is found, increase in level of arterial pressure is possible. SpO2 decreases, the giperkapniya accrues. At accumulation of a phlegm rattles, gurgle are heard. The equipment signals about insufficient passability of airways. The volume of a breath decreases. The anesthesia complications caused by defeat of cardiovascular system lead to increase or decrease in pulse rate higher than 90 or lower than 60 beats per minute respectively. When falling HELL skin pale, is covered cold sticky then, mucous bluish color. Increase in pressure in vessels can be followed both hyperaemia, and pallor of skin, arises at a reflex spasm of capillaries.
Defeat of hypermarket at operation is included by violations of haemo dynamics, a warm rhythm. Awakening drags on. Consciousness is restored long, often not completely. Less heavy reversible failures are diagnosed on existence of hallucinosis, inadequate behavior. The patient does not understand where he is that happened to him, obscenely quarrels. There is no critical evaluation of actions. The normal state is restored within several hours. Carry vomiting, nausea, locks or diarrhea, lack of noise of intestines at an auskultation to number of symptoms of damage of a GIT.
Complications of an anesthesia are revealed by the anesthesiologist conducting the patient. Preoperative and post-operational inspection is for this purpose performed. The doctor permanently is in process of intervention in the patient's headboard, watching his state and undertaking measures for correction of the arising violations. The diagnosis is exposed on clinical signs and results of monitoring. Severity of the available failures and feature of their current determine by information obtained by laboratory methods. The list of diagnostic actions includes:
- Fizikalny inspection. Specific signs of this or that violation come to light. Auskultation allows to find extraneous noises and rattles in lungs at aspiration of a phlegm, "mute" sites at obstruction of airways. During operation the excursion of a thorax of the patient is visually controlled. Its termination demonstrates critically small intake of air.
- Hardware inspection. The main method – connection of the patient to the cardiomonitor for all the time of intervention. Such parameters as level HELL, blood saturation percent by oxygen, a warm rhythm, body temperature are measured. Increase or decrease HELL, uneven pulse – symptoms of haemo dynamic violations, reduction of SpO2 in combination with tachycardia – manifestations of respiratory insufficiency. Damage of a brain is determined at an electroencephalography by easing or total absence of signs of activity. Uncontrollable growth of body temperature gives the grounds to assume development of a malignant hyperthermia. Paresis of intestines is diagnosed at a postoperative stage by means of ultrasonography of an abdominal cavity (lack of a vermicular movement).
- Laboratory inspection. Is auxiliary. At a hypoxia pH less than 7,35, increase in concentration of carbon dioxide find decrease. The sharp myocardial infarction leads to growth of troponin, LDG, KFK, KFK MV. At ZG in blood products of destruction of cross-striped muscles appear.
Treatment of complications of an anesthesia
Therapy is carried out taking into account the reasons which caused a pathological state. At respiratory violations correction of structure and volume of air-gas mix, sanitation of an endotrakhealny tube by means of an electrosuction is carried out. If completely it is not possible to clear airways, call endoscopic crew on duty for carrying out the emergency bronkhoskopiya. Apply to knocking over of a laryngospasm narcotic analgetics, atropine, spazmolitik, adrenomimetik. For O2 blood saturation the device is exposed in the mode of the strengthened oxygenation (100%). Maintenance of somnolence is provided at the expense of intravenous anesthetics.
Violations from CCC treat posimptomno. At bradycardia introduction of atropine, adrenaline is required. Decrease HELL against the background of weakening of warm activity – the indication for transfer of the patient to introduction of pressor amines via the syringe pump. Decrease in a dose of anesthetic can be required. Arrhythmias stop with use of a kordaron, amiodaron, novokainamid, lidocaine. The fibrillation which is not giving in to chemical influence demands carrying out an electric defibrillation. At increase HELL anti-hypertensive means are entered, at decrease – hypotonic medicines, infusion solutions for completion of OTsK, steroid hormones.
Knocking over of short-term postoperative psychoses medicamentous means is not carried out. At the expressed psychomotor excitement appointment of neuroleptics, narcotic analgetics is allowed. Long-term violations of work of TsNS demand therapy with application of nootrop, antioxidants, the all-strengthening means (polyvitaminic complexes, adaptogens). The tone of intestines is usually restored independently in 1-2 days. At the long course of paresis it is entered .
The malignant hyperthermia is the indication for introduction of a datrolen – the miorelaksant capable to block rianodinovy receptors. Besides, appoint medicines of symptomatic treatment, physical ways of decrease in temperature (ice on large vessels, wetting of a sheet and the patient's body cold water, ventilit a shouting). At allergic reactions pour in antihistaminic medicines, glucocorticosteroids, symptomatic medicines. Heavy manifestations demand an obligatory intubation of a trachea, transfer to IVL if it was not made earlier.
Forecast and prevention
The forecast for the majority of complications favorable at their timely detection. Medical actions allow to stop the phenomena of respiratory and cardiovascular insufficiency without the delayed consequences. The long hypoxia (post-hypoxemic encephalopathy or death of a brain), ischemia of a myocardium (OIM) leads to irreversible changes. In the form of aspiration pneumonia inhalation of emetic masses can have serious consequences. In the absence of the help the forecast adverse. The death of the patient comes from suffocation, fibrillation of auricles, shock.
It is possible to prevent anesthesia complications at careful collecting the anamnesis. The expert finds out whether allergic reactions to narcotic means, episodes of a malignant hyperthermia were noted at the patient or his relatives. The patient is informed on the ban on the use of any food in 10 hours prior to receipt to the operating room. During anesthesia the anesthesiologist supports adequate ventilation of lungs of the patient, dream depth, traces the main vital signs and operation of the equipment.