Vomiting, regurgitation

One of the complications is vomiting. At the beginning of anesthesia, vomiting may be associated with the nature of the underlying disease (pyloric stenosis, intestinal obstruction) or with the direct effect of the drug on vomiting center. Against the background of vomiting, aspiration is dangerous - the ingress of gastric contents into the trachea and bronchi. Gastric contents, which have a pronounced acid reaction, getting on the vocal cords, and then, penetrating into the trachea, can lead to laryngospasm or bronchospasm, resulting in a breathing disorder followed by hypoxia - the so-called Mendelssohn's syndrome, manifested by cyanosis, bronchospasm, tachycardia.

Dangerous regurgitation - passive throwing of gastric contents into the trachea and bronchi. This occurs, as a rule, against the background of deep mask anesthesia with relaxation of the sphincters and stomach overflow or after the administration of muscle relaxants (before intubation).

If it enters the lungs during vomiting or regurgitation of acidic gastric contents, it leads to severe pneumonia, often fatal.

To prevent vomiting and regurgitation, it is necessary to remove its contents from the stomach with a tube before anesthesia. In patients with peritonitis and intestinal obstruction, the probe is left in the stomach during the entire anesthesia, while a moderate Trendelenburg position is recommended. Before the onset of anesthesia, to prevent regurgitation, you can use the Celica technique - pressure on the cricoid cartilage posteriorly, which causes compression of the esophagus.

If vomiting occurs, you should immediately remove the gastric contents from the oral cavity using a swab and suction; in case of regurgitation, the gastric contents are removed by suction through a catheter inserted into the trachea and bronchi.

Vomiting followed by aspiration can occur not only during anesthesia, but also upon awakening the patient. To prevent aspiration in such cases, it is necessary to put the patient horizontally or in the Trendelenburg position, turn his head to one side. Observation of the patient is necessary.

Breathing complications

Respiratory complications can be associated with airway obstruction. This may be due to a malfunction of the anesthesia apparatus, therefore, before starting anesthesia, it is necessary to check the operation of the apparatus, its tightness and the permeability of gases through the breathing hoses.

Airway obstruction can occur as a result of tongue retraction during deep anesthesia (the third level of the surgical stage of anesthesia - III 3 ). During anesthesia, solid foreign bodies (teeth, dentures) can enter the upper respiratory tract. To prevent this, it is necessary, against the background of deep anesthesia, to push and support the patient's lower jaw. Before anesthesia, the dentures should be removed, the patient's teeth should be examined.

Complications of tracheal intubation, carried out by direct laryngoscopy, can be grouped as follows: 1) damage to the teeth by the blade of the laryngoscope; 2) damage to the vocal cords; 3) the introduction of the endotracheal tube into the esophagus; 4) introduction of an endotracheal tube into the right bronchus; 5) exit from the trachea of ​​the endotracheal tube or its kink.

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The described complications can be prevented with a clear mastery of the intubation technique and control of the position of the endotracheal tube in the trachea over its bifurcation (with the help of auscultation of the lungs).

Complications from the circulatory system

Arterial hypotension - a decrease in blood pressure both during the period of introduction into anesthesia and during anesthesia - can occur under the influence of drugs on the heart or the vascular-motor center. This happens with an overdose of drugs (more often halothane). Arterial hypotension can appear in patients with low circulating blood volume (BCC) at the optimal dosage of drugs. To prevent this complication, before anesthesia, it is necessary to compensate for the BCC deficiency, and during an operation accompanied by blood loss, transfuse blood substitute solutions and blood.

Cardiac arrhythmias (ventricular tachycardia, extrasystole, ventricular fibrillation) can occur due to a number of reasons: 1) hypoxia and hypercapnia arising from prolonged intubation or insufficient mechanical ventilation during anesthesia; 2) overdose of narcotic substances - barbiturates, halothane; 3) the use of epinephrine against the background of halothane.

To determine the rhythm of cardiac activity, ECG control is required.

Treatment depends on the cause of the complication, it includes the elimination of hypoxia, a decrease in the dose of the drug, the use of drugs of the quinine series.

Cardiac arrest (syncope) is the most serious complication of anesthesia. It is most often caused by an incorrect assessment of the patient's condition, errors in the technique of anesthesia, hypoxia, hypercapnia.

Treatment consists of immediate cardiopulmonary resuscitation.

Complications from the nervous system

During general anesthesia, a moderate decrease in body temperature is often observed due to the effect of drugs on the central mechanisms of thermoregulation, as well as due to cooling of the patient in the operating room.

The body of patients with hypothermia after anesthesia tries to normalize body temperature due to increased metabolism. Against this background, at the end of anesthesia and after it, chills occur. Chills most often occur after halothane anesthesia.

For the prevention of hypothermia, it is necessary to monitor the temperature in the operating room (21-22 C), cover the patient, if necessary, infusion therapy, pour solutions warmed up to body temperature, inhale warm moistened drugs, control the patient's body temperature.

Edema of the brain is a consequence of prolonged and deep hypoxia during anesthesia. Treatment should be started immediately, observing the principles of dehydration, hyperventilation, and local cooling of the brain.

Peripheral nerve damage. This complication appears a day or more after anesthesia. The nerves of the upper and lower extremities and the brachial plexus are more often damaged. This occurs when the patient is placed improperly on the operating table (abduction of the arm more than 90 degrees from the body, placing the arm behind the head, fixing the arm to the arc of the operating table, laying the legs on the holder without a pad). The correct position of the patient on the table eliminates the tension of the nerve trunks.

Treatment is carried out by a neurologist and a physiotherapist.