Intraoperative Cardiac Arrest: Difference between revisions

no edit summary
No edit summary
No edit summary
Line 82: Line 82:
* 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>'''  
10

edits