Intraoperative  Bradycardia - Guidelines for Crises ...

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.

❸ Airway

 • 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).

❹ Breathing

 • Check chest symmetry, rate, breath sounds, SpO2, measured VTexp, ETCO2.

 • Feel the airway pressure using reservoir bag and APL valve <3 breaths.

❺ Circulation

 • Check rate, rhythm, perfusion, recheck blood pressure.

❻ Depth

 • 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).


 • 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 @

Quick Reference Handbook - Guidelines for crises in anaesthesia 

#Bradycardia #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup #Cardiology
Contributed by

Dr. Gerald Diaz
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG: | Twitter:

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