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A FRAMEWORK FOR ANAESTHETIC CRISIS MANAGEMENT

Below is an attempt at a comprehensive framework for intraoperative anaesthetic crisis management.

REFLEX

‘This is a crisis situation’

+/- exclude/confirm cardiac arrest by palpating the carotid pulse
+/- commence cardiopulmonary resuscitation as per ALS guidelines

I would immediately

  • Review monitoring & clinical signs to determine severity & aetiology
  • Communicate the problem to the teamĀ 
  • Instruct a nurse to call for helpĀ 
  • Send someone to retrieve [resource]

TARGETED MANAGEMENT

My immediate management would be to

  • Increase inspired oxygen to 100%
  • I would remove [trigger/source] and [deepen/lighten] anaesthesia
  • Institute immediate management of [intervention]

I would treat the most likely cause [cause]

  • However I would consider a broader differential according to [diagnostic model]
  • I would manage [cause] as per [relevant guideline]
  • The mainstay of treatment is [intervention]

I would simultaneously assess and manage the patient in a systematic fashion

  • [Airway management]
  • [Breathing management]
  • [Circulation management], [invasive monitoring]
  • [Disability management], [anaesthesia management]
  • [Environmental management]

SUPPORTIVE CARE

Further supportive management would include [supportive management]

Once the patient has clinically stabilised, I would

  • Discuss with the surgeon the appropriateness of continuing/deferring surgery
  • +/- liaise with ICU for ongoing post-resuscitative care
  • Ensure investigation & confirmation of the aetiology
  • Ensure investigation & management of complications

FOLLOW-UP

Subsequent follow-up would involve

  • Accurate documentation
  • Review & medical care as appropriate +/- follow-up testing
  • Disclosure of events to the patient/NOK
  • Debrief of the team
  • I would notify the relevant institutional & national morbidity/mortality pathways
  • +/- contact medical defence organisation

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