Treatment of common complications after general anesthesia

When general anesthesia is applied during the operation, the patient’s body will be stimulated by anesthetics, surgical trauma, etc., coupled with the hyperreflexia and the original pathological and physiological changes, the patient is likely to have different degrees of complications after the operation. Even if the patient is conscious after the operation, it does not mean that the drug effect is completely eliminated, and the body’s protective reflex cannot be restored. At this time, the probability of complications is still high. So, what kind of complications will occur after a patient undergoes general anesthesia and how to deal with it?

Upper airway obstruction
Upper respiratory tract obstruction is mainly caused by mechanical obstruction such as falling of the tongue, oral secretions or foreign body blockage, and laryngeal edema. Under normal circumstances, when patients have incomplete obstruction, the main manifestations are dyspnea, snoring, etc. Patients with complete obstruction are also accompanied by nasal fanning and three-concave sign, and there is strong breathing, but there is no gas exchange. . When the patient’s tongue falls back after surgery, the clinician needs to tilt the patient’s head back in time and drag the patient’s mandible. If necessary, place the entrance pharynx or nasopharyngeal channel. In this process, the patient’s throat must be removed. Department of secretions to eliminate obstructive symptoms. For patients with symptoms of laryngeal edema, because laryngeal edema often occurs in infants or patients with difficulties in endotracheal intubation, surgical traction and stimulation of the larynx will also affect it. Therefore, in actual treatment, it is Mild patients can be treated by intravenous corticosteroids or nebulized adrenaline inhalation, and severe patients need to undergo tracheal intubation or tracheotomy in time.

Lower respiratory tract obstruction
Twisted tracheal tube, long tracheal slope and close to the tracheal wall, and blocked trachea caused by aspiration of secretions can all lead to lower respiratory tract obstruction. Generally speaking, patients with less severe obstruction can only hear the rales in the lungs and nothing else. Symptoms, and severely ill patients will also have difficulty breathing, decreased tidal volume, high airway resistance, and rapid heart rate. If not treated in time, it is likely to endanger the life of the patient. Therefore, before the surgical anesthesia, the tracheal tube must be thoroughly checked. If the tube is too soft or unqualified, it must be replaced in time. The position of the tube must be checked in time during the operation to avoid changes in the patient’s position as much as possible. There is a kinking of the catheter. Moreover, after surgery, clinicians should auscultate the patient’s lungs in time to remove secretions in the respiratory tract.

The most obvious manifestations of such complications are the patient’s shortness of breath, cyanosis, restlessness, tachycardia, and elevated blood pressure. When the anesthesia machine fails and the oxygen supply is insufficient, the oxygen concentration of the patient is too low, the surgeon should correct it in time; when the patient has atelectasis due to excessive secretion or insufficient ventilation, the clinician should use fiber in time The bronchoscope sucks sputum for the patient. Patients with severe symptoms need to be treated with PEEP. In addition, there are often cases of pulmonary inhalation and pulmonary edema in clinical practice. The severity of pulmonary inhalation is mainly determined by the PH value and volume of the inhaled substance. Critically ill patients should be treated with mechanical ventilation. As for pulmonary edema, because the patient has acute left heart failure and increased pulmonary capillary permeability after such complications, treatment should be carried out from the aspects of cardiac strengthening, diuresis, vasodilation, oxygen inhalation, and mechanical ventilation. treatment.

Low blood pressure
Some patients will also have symptoms of hypotension during anesthesia, such as oliguria or metabolic acidosis. Patients with severe symptoms will also experience varying degrees of myocardial ischemia and central nervous system dysfunction. If the anesthesia is too deep, the patient’s blood pressure will drop and the pulse pressure will be narrowed, which will be more obvious in patients with hypovolemia before anesthesia. In this case, clinicians should consider reducing anesthesia and supplementing blood volume according to the actual situation of the patient. If necessary, vasoconstrictor drugs should be used to restore the patient’s vascular tension to avoid hypovolemic shock due to excessive blood loss during the operation. Happening.

For patients with a history of hypertension, fentanyl should be injected intravenously before induction of general anesthesia, and attention should be paid to dose control, which can effectively alleviate the cardiovascular response of patients during tracheal intubation. During the operation, the depth of anesthesia should be appropriately adjusted according to the degree of surgical stimulation. If the patient has stubborn hypertension symptoms, controlled blood pressure reduction measures can be taken to ensure the stability of the patient’s circulatory system.

Some patients will have symptoms of sinus tachycardia and hypertension at the same time. At this time, the surgeon should appropriately deepen the anesthesia. In hypovolemia, anemia, and hypoxia, patients will also experience increased heart rate. Clinicians must provide timely treatment for the patient’s cause. In addition, when visceral traction or cardio-ocular reflex occurs during the operation, patients with mild illness are likely to cause bradycardia due to the vagus nerve reflex, and patients with severe illness may also experience cardiac arrest. At this time, the surgeon should stop related operations immediately, and if necessary, intravenously inject atropine to ensure the stability of the heart rhythm. If the patient has frequent atrial premature beats or even atrial fibrillation, cedilan drugs must be given promptly for treatment.

In short, after general anesthesia, patients are likely to have tongue fall, respiratory obstruction, and circulatory system instability. In this case, clinical anesthesiologists must have accurate basic knowledge and operational skills of anesthesia, clarify the specific causes of complications after general anesthesia, and take effective measures to treat the abnormal conditions of the patients, help the patients recover, and make them healthy. provide assurance.