Intraoperative Bradycardia - Guidelines for Crises in Anaesthesia
Bradycardia in theatre should not be treated as an isolated variable: remember to tailor treatment to the patient and the situation. Follow the full steps to exclude a serious underlying problem.
❶ Immediate action: Stop any stimulus, check pulse, rhythm and blood pressure:
• If no pulse OR not sinus bradycardia OR severe hypotension: use Box A.
• If pulse present AND sinus bradycardia: use Box B.
❷ Adequate oxygen delivery
• Check fresh gas flow for circuit in use AND check measured FiO2.
• Visual inspection of entire breathing system including valves and connections.
• Rapidly confirm reservoir bag moving OR ventilator bellows moving.
• Check position of airway device and listen for noise (including larynx and stomach).
• Check capnogram shape compatible with patent airway.
• Confirm airway device is patent (consider passing suction catheter).
• Check chest symmetry, rate, breath sounds, SpO2, measured VTexp, ETCO2.
• Feel the airway pressure using reservoir bag and APL valve <3 breaths.
• Check rate, rhythm, perfusion, recheck blood pressure.
• Consider current depth of anaesthesia AND adequacy of analgesia.
❼ Consider underlying problem (Box C).
❽ Call for help if problem not resolving quickly.
❾ Consider transcutaneous pacing (Box D).
POTENTIAL UNDERLYING PROBLEMS
• Consider whether you could have made a drug error.
• Consider known drug causes (eg. remifentanil, digoxin etc).
• Surgical stimulation with inadequate depth.
• Also consider: high intrathoracic pressure; pneumoperitoneum; local anaesthetic toxicity (→ 3-10); beta-blocker; digoxin; calcium channel blocker; myocardial infarction, hyperkalaemia, hypothermia, raised intra-cranial pressure.
By Association of Anaesthetists @ https://twitter.com/AAGBI
Quick Reference Handbook - Guidelines for crises in anaesthesia
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