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). 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 #Bradycardia #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup #Cardiology
