Discuss the Aetiology, Pathology and

Management of post Operative Pyrexia

By
Dr. Akinniyi
NOH-Dala

Outline

Introduction
Temprature Patterns
Time Scale of Post Operative Pyrexia
Aetiology
Pathogenesis
Management
Conclusion

Introduction

Definition: Elevation of body temperature above

normal base line value(37.2+0.50C) in the post
operative period.
T0C=4hrly,
38.3, 41.0, 430C
Exclusion: Ongoing pathologic process with
associated pyrexia
Indicator
Problems: Non specific index
Aim: Early identification of cause
Prompt definitive Rx.

Temperature Patterns

Normal(36.6-37.2+0.40C)
Constitutional hyperthermia
Abnormal: subnormal, hypothermia, pyrexia
Temperature Charts
Persistent, Intermittent, Remittent
Quotidian, Quartan, Tertian, Erb Stein

Time scale of post operative pyrexia

First 24hrs
Systemic response to trauma
Drug Rxns
Transfusion Rxns
Pre-existing infection/septicaemia
24-72hrs
Pulmonary atelectasis
Chest infection
3-7 days
Chest infection
SWI
Intraperitoneal sepsis

UTI
Anastomotic leak
7-10 days
DVT
Pulmonary embolus

Aetiology

Metabolic response to trauma

Transfusion Rxns
Infestation
Infection: uti, swi, rti, iv-devices
Ongoing pathologic process
Surgical complications
Anastomotic leak
Thyroid crisis
Anaesthetic complications: Malignant hyperthermia
Drug Rxns

Pathogenesis
A: Metabolic response to trauma
Neuroendocrine response to afferent visceral
stimulation
Path ways
Chemical mediators cutaneous nociceptors
brainstem autonomic afferent
endocrine/metabolic Xnges
Pain somatic/association areas hypothalamus
hypothalamic/pituitary rls
Hypovolaemia;dehydration;fasting- brain stem
baro/ chemoreceptors(area postrema)
Anxiety/change in sleep pattern alteration in
circardian rythm

Endocrine responses:
- catabolic hormones-cortisol/adrenalin, - anabolic hormones-GH, insulin, LH, FSH
*T3/T4

B: Alteration in hypothalamic thermoregulatory

function
Endotoxins/ Pyrogens

Inflammatory Cell Activation

Endogenous pyrogens
(IL-1,IL6,TNF,IFN,IFN)

Circumventricular organ (OVLT)

Hypothalamus (Preoptic area)

>>synthesisPGE2

C: Abnormal metabolism of skeletal muscle

Ryanodine receptor defect

Alteration in intracellular Ca2+ metab

Management

Hx: complain: fever/cold sensation/rigor

Time of onset
Pattern/periodicity
Complication; convulsion, altrd sensorium
Constitutional symptoms
Possible aetiology
Preoperative diagnosis
Extent/Nature of surgery
Comorbidity (D/M,HIV,Scdx,Asthma,COPD, etc)
Review of systems (Resp,Git,Genito/uri,cvs,cns)

Examination:
General:palor,icterus,hydratn,petechiae..
Vital signs(T0C Vs charts)
Systems
Resp,Cvs,Git,Genito/urinary,Cns,Mss
Dressings,drains
Observation charts(pre,intra,post op)
Rxt Charts

Investigations:
Fbc+Esr, Blood film, septic work-up,Euc
Ecg,Echo,CXR,Blood gas analysis, urinalysis,Rbs/Fbs
Septic work-up
-Throat swab
-Sputum
-Blood
-Urine
-Lumbar puncture
-Wound swab

Treatment

Palliative/Conservative
Light colthing+aeration
Tepid sponge
Warm bath
NSAIDS
(pcm,dypirone,ibuprrofen,asa)
IVF
Nutritional rehabilitation

Defitive
Based on identified cause
Metabolic response
Plasmodiasis
Transfusion Rxn
Septacaemia
Anastomotic leaks
Thyroid crisis
DVT/microembolism
Malignant hypertermia
monitoring

Conclusion

Post operative pyrexia is of variable

aetiology. Hence the need for the
attending clinician to identify clearly
possible cause and institute appropriate
treatment.
THANKS