More than 32 million Americans underwent a surgical procedure in 2007, according to a report compiled by the medical information company Medtech Insight. Most surgeries prove successful and patients recover without significant complications. Surgery and anesthesia, however, are never risk-free. Potential complications may arise due to anesthetic medications, direct effects of the operative procedure or indirect effects on the body. Early recognition and treatment prove essential in minimizing the consequences of surgical or anesthetic complications.
Malignant Hyperthermia
Malignant hyperthermia is an inherited disorder in which the voluntary muscles react to certain types of anesthesia with a drastically increased metabolic rate. The reaction leads to dramatic increases in body temperature, heart rate and respiratory rate. The accelerated metabolic rate in the muscles also causes a marked increase in oxygen consumption and carbon dioxide production. This elevates the acid level in the bloodstream and precipitates a breakdown of muscle tissue.
In a 2007 article published in "Orphanet Journal of Rare Diseases," Dr. Henry Rosenberg and colleagues report that malignant hyperthermia can be triggered by the anesthetic gases sevoflurane, halothane and desflurane. The muscle relaxant succinylcholine, which is commonly used during general anesthesia, can also provoke a hyperthermic reaction.
Blood Loss
Significant blood loss may occur with surgery, although the level of risk varies broadly depending on the type of surgery performed. Surgeries involving the manipulation or repair of blood vessels are likely to necessitate transfusions to replace lost blood. Bone surgeries, such as hip replacement, also commonly involve substantial blood loss.
Significant blood loss during surgery may cause postoperative problems with low blood pressure and heart rhythm abnormalities, reports The Merck Manual of Health & Aging. Additionally, patients who sustain significant blood loss during surgery may be at increased risk for postoperative confusion.
Deep Vein Thrombosis
Surgery is a significant risk factor for the development of blood clots of the deep veins, also known as deep vein thrombosis, reports the National Heart, Lung and Blood Institute. Deep vein clots most commonly occur in the legs, but may also develop in the arms.
Patient-related factors that increase the risk for a postoperative blood clot include advancing age, smoking, obesity and limited mobility. The American College of Chest Physicians reports that patients undergoing hip or knee replacement surgery, cancer patients and those undergoing surgery related to major trauma are at high risk for postoperative deep vein thrombosis.
Infections
Postoperative infections remain an important potential complication for nearly all surgical procedures. Infections may occur within the surgical incision or in an organ or tissue exposed during a procedure. In a 2006 article published in the journal "BMC Infectious Diseases," Dr. Robert Rubin notes that patient-related factors that increase the risk for surgical infection include obesity, advanced age, malnutrition, cancer and diabetes mellitus. Surgeries involving more than two hours of operative time are also associated with an increased risk for infection, notes Rubin.
References
- Medtech Insight: U.S. Surgical Procedure Volumes, February 2007
- "Orphanet Journal of Rare Diseases"; Malignant Hyperthermia; Dr. Henry Rosenberg, et al.; April 2007
- The Merck Manual of Health & Aging: Some Potential Complications of Surgery
- National Heart, Lung and Blood Institute: Deep Vein Thrombosis
- "Chest"; Prevention of Venous Thromboembolism, The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy; Dr. William H. Geerts., et al.; September 2004
