Intraoperative Cardiac Ischaemia - Guidelines for Crises in Anaesthesia If the patient is unconscious, signs of cardiac ischaemia primarily include: • ST elevation or depression • T wave flattening or inversion • Arrhythmias, particularly ventricular • Other haemodynamic abnormalities (hypo- or hypertension, tachy- or bradycardia) • New or evolving regional wall motion abnormalities if echocardiography is used If the patient is conscious, symptoms may include chest pain, breathlessness, dizziness, nausea and vomiting. Have a high index of suspicion in patients with a pre-existing history or risk factors for cardiac ischaemia ❶ Call for cardiac arrest trolley and 12-lead ECG machine. ❷ Ensure adequate oxygenation and anaesthesia/analgesia. ❸ Treat haemodynamic instability (Box A). ❹ Apply CM5 continuous ECG monitoring (Box B). Obtain a 12-lead ECG as soon as possible. ❺ If ischaemia does not resolve: • Call for help. Inform theatre team of problem. Stop or rapidly complete the surgery. • Start glyceryl trinitrate (GTN) (Box C). • EXTREME CAUTION with GTN if the patient is hypotensive. ❻ Consider invasive arterial blood pressure monitoring. ❼ Treat electrolyte abnormalities particularly potassium, magnesium and calcium. ❽ Treat anaemia aiming for haematocrit >30%. • CAUTION – beware volume overload especially in heart failure. ❾ If persistent ST elevation is present, consider need for anticoagulation, anti-platelet therapy and revascularisation in consultation with cardiology and surgical teams. By Association of Anaesthetists @ https://twitter.com/AAGBI Quick Reference Handbook - Guidelines for crises in anaesthesia #Cardiac #Ischemia #Ischaemia #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup
