Intraoperative Tachycardia - Guidelines for Crises in Anaesthesia

Tachycardia in theatre is often due to inadequate depth of anaesthesia / analgesia or alternatively a reflex to hypotension. Tachycardia should not be treated as an isolated variable: remember to tailor treatment to the patient and the situation.



❶ Immediate action: Stop any stimulus, Check pulse, rhythm and blood pressure:

 • If no pulse or impending arrest: use Box A.

 • If narrow complex AND not hypotensive first increase depth of anaesthesia/analgesia.

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, obtain 12-lead ECG if possible.

❻ Consider underlying problems (Box B).

❼ Consider rate control (Box C).

❽ Call for help; consider electrical cardioversion (Box D) if problem not resolving quickly.

❾ Depth: Consider current depth of anaesthesia AND adequacy of analgesia



POTENTIAL UNDERLYING PROBLEMS

• Stimulation with inadequate depth.

• Consider drug error.

• Also consider: central line/wire; hypovolaemia; primary cardiac arrhythmia; myocardial infarction; electrolyte disturbance; local anaesthetic toxicity (→ 3-10); sepsis (→ 3-14); circulatory embolus, gas/fat/amniotic (→ 3-5); anaphylaxis (→ 3-1); malignant hyperthermia crisis (→ 3-8)



By Association of Anaesthetists @ https://twitter.com/AAGBI

Quick Reference Handbook - Guidelines for crises in anaesthesia 



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