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Intraoperative Cardiac Arrest: Difference between revisions
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* Avoid hypoglycemia | * Avoid hypoglycemia | ||
* Avoid hyperventilation (unless herniating) | * Avoid hyperventilation (unless herniating) | ||
'''<u>Special Considerations:</u>''' | |||
'''LARYNGOSPASM:''' | |||
* On induction, 100% FiO2, deepen anesthetics | |||
* IM atropine 0.02 mg/kg (0.1 mg minimum dose) and | |||
* IM succinylcholine 4 mg/kg (maximum dose 150 mg). | |||
* If the patient has IV or IO access, then a lower dose of succinylcholine should be used to break laryngospasm (0.3–1.0 mg/kg) | |||
* Of note, don’t need to aspirate before IM injection | |||
'''VP SHUNT:''' | |||
During chest compressions: | |||
* Without increased ICP: one-third of the intrathoracic pressure generated may be transmitted to the ICP via the vertebral veins and CSF | |||
* With increased ICP much higher percentage of intrathoracic pressure during chest compressions is transmitted to ICP, significantly decreasing cerebral perfusion pressure. | |||
Neurosurgeon should immediately tap the VP shunt to remove cerebrospinal fluid (CSF) and reduce ICP. | |||
'''VENOUS AIR EMBOLUS:''' | |||
Administering 100% inspired oxygen | |||
Discontinuing nitrous oxide and inhaled drugs | |||
Stopping air entry: | |||
* Flood field with fluid | |||
* Lower field to promote venous filling | |||
* Trap air in right atria (right side up) | |||
Aspirating air from the central line | |||
CPR and vasopressor administration may be needed | |||
'''HYPERKALEMIA''' | |||
The acute resuscitation to drive potassium into cells and reduce cardiotoxicity includes (Mnemonic: C-B-I-G) | |||
Calcium CaCl2 20 mg/kg or Calcium Gluconate 60 mg/kg IV or IO | |||
Bicarb: NaHCO3 1–2 mEq/kg IV or IO | |||
Insulin/Glucose: D25 W 2 mL/kg and regular insulin 0.1 U/kg | |||
Alkalosis Hyperventilation (can see immediate decrease in T waves) | |||
'''LOCAL ANESTHETICS TOXICITY''' | |||
Seizure: immediate treatment with benzodiazepine | |||
Cardiac arrest: chest compressions should be started and Epi at low initial doses (1 μg/kg based on adult recommendations). | |||
Antiarrhythmic drugs: amiodarone (avoid lidocaine and procainamide) | |||
Intralipid: | |||
1.5 mL/kg bolus of 20% intralipid over 1 minute | |||
If HDS, infusion at 0.25 mL/kg/min for 10 minutes | |||
If still unstable: additional 1.5 mL/kg bolus, then infusion rate at 0.5 mL/ kg/min | |||
Max total dose 10 mL/kg of lipid emulsion over 30 minutes | |||
'''ANAPHYLAXIS:''' | |||
Remove the likely allergens | |||
Administering 100% oxygen | |||
Epinephrine: | |||
10 μg/kg/dose IM up to 0.5 mg/dose q 20 minutes or IV infusion | |||
IVF (boluses of 20 mL/kg) | |||
Trendelenburg positioning | |||
Histamine blockers, Albuterol and corticosteroids | |||
Serum tryptase level is a useful indicator that mast cell degranulation occurred. The test for serum tryptase is time sensitive and needs to be obtained within 3 hours | |||
'''<u>Critical Event Resources:</u>''' | '''<u>Critical Event Resources:</u>''' | ||