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 #Tachycardia #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
