Intraoperative Circulatory Embolus - Guidelines for Crises in Anaesthesia

Causes: thrombus, fat, amniotic fluid, air/gas.

Signs: hypotension, tachycardia, hypoxemia, decreased ETCO2 Symptoms: dyspnoea, anxiety, tachypnoea. Also consider if sudden unexplained loss of cardiac output.



Box A: THROMBOEMBOLISM

  Consider thrombolysis e.g. alteplase 10 mg i.v. then 90 mg over 2 h (>65 kg)

  Consider surgical removal – consult vascular surgeon

  Consider percutaneous removal – consult radiologist

Box B: FAT EMBOLISM

  • Petechial rash, desaturation, confusion/irritability if patient conscious

  • Supportive measures are mainstay of initial management

Box C: AMNIOTIC FLUID EMBOLISM

  • Supportive measures are mainstay of initial management

  • Monitor the fetus, if undelivered

  • Treat coagulopathy (fresh frozen plasma, cryoprecipitate and/or platelets)

  • Consider plasmaphoresis

Box D: AIR/GAS EMBOLISM

  • “Mill wheel” murmur may be present

  • Discontinue source of air/gas if applicable and discontinue N2O

  • Tell surgeon to flood wound with saline and cover with wet packs

  • Lower surgical field to below level of heart if possible

  • Place patient in left lateral position if possible

  • If central venous catheter in situ, attempt to aspirate air

  • Volume loading and Valsalva manoeuvre may help



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

Quick Reference Handbook - Guidelines for crises in anaesthesia 



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