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Intraoperative Cardiac Arrest: Difference between revisions
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{{Stub Notice}} | '''<u>Incidence of Perioperative Cardiac Arrest (CA):</u>''' | ||
Increase with increased ASA status | |||
Wake Up Safe Registry: 3.3 per 10,000 of arrest were anesthesia related. Aesthesia-related death was 0.36 per 10,000 anesthetics. | |||
Pediatric Perioperative Cardiac Arrest (POCA) Registry: 1.4 +/- 0.45 per 10,000 were anesthesia related. Mortality rate: 26% | |||
Children (<12 year old): 2x more likely to experience CA, infants (<1 year old): 10x, neonates (<1month old): 50x | |||
'''<u>Causes for Pediatric Perioperative Arrest:</u>''' | |||
* CIRCULATORY FAILURE: | |||
** Hypovolemia: Hemorrhage, inadequate/inappropriate volume resuscitation/transfusion (patients < 24 months may not respond to hypotension with increase HR) | |||
** Hyperkalemia: Succinylcholine, TRANSFUSION (pRBC >2 weeks, speed of transfusion), reperfusion, myopathy, or renal insufficiency | |||
** Dysrhythmia: LA toxicity, line placement (safer to use Ultrasound guided vs. landmark technique) | |||
** Anaphylaxis | |||
** Venous Air Embolism | |||
** Malignant Hyperthermia: very rare | |||
* RESPIRATORY FAILURE: | |||
** Airway Obstruction: - Laryngospasm: Upper respiratory infection increases risk - Bronchospasm | |||
** Inadequate ventilation and oxygenation: difficult airway, mucus plug, kinked ETT, inadvertent extubation | |||
** Disordered control of breathing: drug overdose, neuromuscular diseases, apnea | |||
** Aspiration | |||
* SUDDEN CARDIAC COLLAPSE | |||
** Bradycardia or cardiovascular collapse: - Traction, pressure, or insufflation involving the abdomen, eye, neck, or heart - Undiagnosed cardiomyopathy | |||
** Overdose - Weight-based dosing of IV anesthetic on induction in a child with hypovolemia or compensated shock may lead to collapse | |||
'''<u>Important Resuscitation Steps:</u>''' | |||
# Inform team | |||
# Stop surgical stimulation | |||
# Stop anesthetics (gas & sedation gtt) and vasodilatory meds | |||
# 100% Oxygen | |||
# Open fluids and Trendelenburg position | |||
# Chest-compression | |||
# Call for help | |||
# Consider stopping potassium containing solutions (blood or hyperalimentation) | |||
# Ask for ice to head | |||
# Assign roles | |||
'''<u>Resuscitation Algorithm:</u>''' | |||
Source: Shaffner DH, Heitmiller ES, Deshpande JK. Pediatric perioperative life support. Anesth Analg. 2013 Oct;117(4):960-979. doi: 10.1213/ANE.0b013e3182a1f3eb. Epub 2013 Sep 10. PMID: 24023023. | |||
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