The most effective way to deal with anesthetic emergencies is to prevent them and appropriate 1) stabilization of the patient, 2) selection of type and dosage of anesthetic drugs, 3) preparation of anesthetic equipment, 4) pre-, post- and intra-operative support of the patient, and 4) physiologic monitoring, will make the anesthetic episode safer and will decrease the likelihood of anesthetic emergencies.
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What is the best way to deal with anesthetic emergencies?
Aug 01, 2010 · Tamara Grubb, DVM, PhD, DACVAA. The most effective way to deal with anesthetic emergencies is to prevent them and appropriate 1) stabilization of the patient, 2) selection of type and dosage of anesthetic drugs, 3) preparation of anesthetic equipment, 4) pre-, post- and intra-operative support of the patient, and 4) physiologic monitoring, will make the …
What are anesthesia-related emergencies in the operating room?
Anesthesia, sedation, and pain management should be taken seriously in the emergency patient. Proper knowledge of the drugs available and their pharmacokinetics and pharmacodynamics are necessary to administer anesthesia safely to critical patients. A proactive approach regarding monitoring, titration of anesthetic drugs, and anticipation of life-threatening complications …
Is there a newer edition of anesthesia emergencies?
The nature of anaesthesia means that we commonly use agents known to be associated with anaphylactic reactions; these include muscle relaxants, antibiotics and latex. Presentation of anaphylaxis can be heterogeneous, thus a high index of suspicion is necessary to establish the diagnosis and ensure prompt management.
When might a patient require ventilator assistance during general anesthetic?
Abstract. The general principles that guide a pediatric anesthesiologist in the care of a newborn needing urgent and emergent neonatal surgery are reviewed. These include careful evaluation and assessment of the newborn including a detailed prenatal history. A brief review of neonatal physiology including the development of the autonomic ...
What are four steps taken in the case of an anesthetic emergency?
What anesthesia is used for emergency surgery?
What does an anesthesiologist do in an emergency?
Anesthesiologists are also qualified to contribute to emergency medicine, providing airway and cardiac resuscitation and support and advanced life support, as well as pain control. They help stabilize patients and prepare them for surgery.
What type of Anaesthesia is preferred for obstetric emergencies?
What are emergency surgeries?
How is anesthesia given during surgery?
Can anesthesiologist do emergency medicine?
Is Anesthesiology an emergency medicine?
What are the 3 types of anesthesia?
When is general anesthesia indicated for a cesarean section?
What is the role of an anesthesia provider?
An anesthesia provider requires a combination of skills, such as anatomical knowledge of the airway, knowledge of the varied pharmacologic agents used , along with their effects and interactions, drug titrations, ability to manage stress and provide relief to an anxious, often critically ill patient. There can be several anesthesia-related emergencies in the operating room and they can be classified as follows:
Can anesthesia cause cardiac arrest?
Anesthesia agents (e.g. muscle relaxants) and medications (e.g. antibiotics) can lead to anaphylaxis, malignant hyperthermia and hyperkalemic cardiac arrest in the operation room. It is imperative for the anesthesia provider to promptly identify the condition and start treatment. For example, if muscle rigidity is noticed during intubation ...
What is a massive hemorrhage?
Massive hemorrhage. This can occur unexpectedly during a surgical procedure if a blood vessel is accidentally severed or in cases of trauma wherein the patient is brought to the operating room with blunt trauma to the abdomen.
Is cerebral edema a neurosurgical procedure?
Although the exact eti ology of cerebral edema during surgery is not known, it is encountered commonly during neurosurgical procedures. The etiology is believed to be multifactorial with subarachnoid hemorrhage or intraventricular hemorrhage leading to acute intracranial hyperemia and cerebral edema.
Why is intraoperative cardiac monitoring important?
Intraoperative cardiac monitoring helps to detect signs of ischemia and appropriate oxygenation and measures can be instituted to prevent disasters.
Why are drugs administered accidentally?
Before and during the surgical procedure, drugs may be administered accidentally due to wrong labeling, human fatigue/inattention. This can be avoided by repeated checking and confirming the medication labels, avoiding too many unnecessary medications on the anesthesia machine, adequate rest for the providers and watching for miscommunication during hand-offs.
Why do children have laryngospasm?
Laryngospasm. Patients, especially children, are very sensitive to airway manipulation which can lead to laryngospasm. Other causes of laryngospasm are blood, or secretions on the vocal cords, surgical stimulation or failure to provide an anesthetic agent.
Edited by Keith Ruskin and Stanley Rosenbaum
A newer edition of Anesthesia Emergencies is available. Latest edition (2 ed.)
Abstract
This resource contains relevant step-by-step information on how to detect, manage, and treat complications and emergencies during the perioperative period. Concisely written, highlighted sections reinforce essential points for easy memorization while consistent organization and checklists provide ease of learning and clarity.
Bibliographic Information
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Abstract
This resource contains relevant step-by-step information on how to detect, manage, and treat complications and emergencies during the perioperative period.
Bibliographic Information
The link was not copied. Your current browser may not support copying via this button.
Edited by Keith Allman, Andrew McIndoe, and Iain Wilson
A newer edition of Emergencies in Anaesthesia is available. Latest edition (3 ed.)
Abstract
This essential reference deals with many of the emergency situations which occur during anaesthesia practice. It describes the presentation, differential diagnosis, investigations and immediate actions for a range of problems.
Bibliographic Information
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What is the role of paramedics in medical emergencies?
Medications give paramedics the power to make drastic changes to a patient’s physiology within seconds. But, with great power comes great responsibility. Administration of a medication always comes at a cost. That cost could be a minor side effect, like headache, or a serious life-threatening side effect, like cardiac arrhythmias. This is why it is important to understand not only the indications for a drugs use, but also the contraindications and adverse effects. The management of most medical emergencies involves administration of medications by the paramedic. Some of these emergencies may be the direct result of drugs that the patient intentionally or unintentionally ingested. As you will see, the route of administration can have major effects on how the drug works. This emphasizes the point that drug dosing is dependent on route of administration (Vanden Hoek et al, 2010). Epinephrine is one example where the intramuscular and subcutaneous doses are about the same and are administered in a 1:1000 concentration (1mg/mL). For intravenous administration, the dose is significantly less than other routes and the concentration is 1:10,000 (0.1mg/mL). Accidental administration of the wrong epinephrine concentration would be ten-times more epinephrine than planned! The goal of this chapter is to provide you with a detailed overview of the common medications used for paramedic emergencies. It is not as important to memorize the exact onset time of a drug, for instance, as it is to know in general how fast the drug will work. Understanding the drug’s mechanism of action can help you remember the scenarios where it will be the most effective. Most importantly, contraindications to the use of each drug need to be remembered as administration of these drugs in the wrong circumstance can have dire consequences. The Institute for Safe Medication Practices (ISMP) has a list of high-alert medications for the acute care setting. These medications have the potential for serious patient harm if used in error. Mistakes with these medications are not necessarily more common than with other drugs, but the consequences can be devastating. The majority of the medications discussed in this chapter are considered high alert. Please check all medications with an up-to-date resources or drug reference. The ISMP has several error-reducing strategies for managing these medications.
What is the mnemonic for EMS?
Initial EMS care for acute coronary syndrome is remembered by the mnemonic MONA: morphine, oxygen, nitroglycerin, aspirin. Although this is a standard regimen, one must know about the contraindications and details of each of these medications. Morphine has some contraindications and cautions, as previously mentioned. Oxygen is used in acute coronary syndrome only if the patient is dyspneic, has signs of heart failure, or has SpO2 < 94%. Aspirin contraindications will be discussed later in this chapter. However, aspirin should always be used when appropriate as it can reduce mortality by 25% in AMI and by 50% in unstable angina. Some add a B to the MONA mnemonic (MONA-B) to recall that ß-blockers are useful in the management of acute coronary syndrome, especially since beta-blockers can reduce mortality. Several antianginal agents exist and are typically divided into nitrates, beta blockers, and calcium channel blockers. Nitrates, such as nitroglycerin, have the largest effect on preload thus should be used cautiously in patients who depend on their cardiac preload (e.g. hypovolemia, right ventricular injury). Patients at risk for cardiac ischemia may be on nitrates at home and are typically instructed to call for EMS if their pain is either unrelieved or increased after a single rescue dose.
What is the ACS syndrome?
A toxidrome is a syndrome (collection of signs and symptoms) seen with drug toxicity from a specific class of medications. Anticholinergic syndrome (ACS) can occur with inadvertent overdose or intentional overdose of anticholinergic medications. The signs and symptoms associated with this syndrome are the same, though to a lesser degree, as the signs and symptoms seen with use of anticholinergic medications. They include skin flushing, dry skin, dry mucous membranes, mydriasis (dilated pupils), altered mental status, and fever. These signs are recalled with the mnemonic “red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare.” Tachycardia may be seen as well as hypertension and urinary retention. Bronchodilator effects can occur and are exploited to cause bronchial smooth muscle relaxation in patients with asthma and other bronchospastic disease.
What are the effects of corticosteroids on the airway?
Asthma is a disease that has three effects on the airway: bronchospasm, mucus production, and inflammation. Corticosteroids act to reduce systemic inflammation and cause immunosuppression. The major acute complications of steroid therapy are hyperglycemia, increased intraocular pressure, and mania. Steroids have a slow onset of action and therefore are not first line therapy for pulmonary emergencies. Daily inhaled steroids are used in inflammatory pulmonary conditions as part of maintenance therapy. Oral dosing for steroids is common in the clinic and hospital setting. For patients with acute issues, intravenous dosing is more appropriate as it avoids the need for the patient to swallow while dyspneic. Intravenous formulations also have a quicker onset of action. Corticosteroids used in asthma include dexamethasone, hydrocortisone, methylprednisolone. Other corticosteroid options include prednisolone and prednisone. Steroid dosing can be converted between types by using the following equipotent dosing chart. As an example, 4mg of IV dexamethasone would be equivalent to about 100mg IV hydrocortisone or about 20mg IV methylprednisolone.
What are the effects of xanthine?
Xanthines are chemical compounds with bronchodilating effects. They also oppose the action of adenosine, which leads to alertness and stimulant effects. The most widely used xanthine derivative is caffeine. Other xanthine derivatives include aminophylline and theophylline.
What is a RAAS?
The renin-angiotensin-aldosterone system (RAAS), also known as the renin-angiotensin system (RAS), is a mechanism in the body for maintaining blood pressure. The kidneys sense a low blood pressure then release renin, which begins the complex pathway toward increased blood pressure. ACE inhibitor (ACE-I) agents block this pathway, which makes them useful agents for hypertension. Their primary indication in the acute setting is for patients after myocardial infarction (Hazinski et al, 2010). ACE inhibitors reduce mortality and improve left ventricular dysfunction in patients who have had a myocardial infarction. They are indicated, in oral form, within 24 hours after AMI. They are also indicated for clinical signs of AMI with left ventricular dysfunction and for left ventricular ejection fraction < 40%. Therapy should start with low-dose oral administration, though IV doses are available in some preparations. Generally, they are not started by EMS or in the ED, but instead are started after coronary reperfusion therapy has been completed and blood pressure is stable. Since PO dosing is preferred and no more than a single dose would be given by an EMS provider, pharmacokinetics will not be discussed.
What is the purpose of beta blockers?
Beta-adrenergic antagonists are primarily used to reduce heart rate. Heart rate is mediated by ß1 adrenergic receptors. Some of the beta-adrenergic antagonists are specific to ß1 receptors. However, some are mixed blockers of both ß1 and ß2 receptors. These mixed medications can cause undesirable effects from ß2 blockade, such as bronchoconstriction and wheezing. As a general rule, beta blockers that start with the letter A-M are ß1-specific and those starting with N-Z are mixed ß1 and ß2. Labetalol, as well as carvedilol, are exceptions to the rule. These two-medication block ß1 receptors, ß2 receptors, and α1 receptors. Blockade of both ß1 and α1 receptors makes labetalol a useful medication for patients with severe hypertension.
What is the goal of an anesthesiologist?
Anesthesiologists prefer their patients to have a gentle transition from the anesthetized state into the awake state. The desired goal is “smooth emergence. ”. When the general anesthetic requires an endotracheal tube, an issue is how to awaken the patient with minimal patient coughing and bucking while the tube remains in the trachea.
Who is Richard Novak?
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
Classification of Emergencies in The Operation Room
Drug-Induced Emergencies
- Anesthesia agents (e.g. muscle relaxants) and medications (e.g. antibiotics) can lead to anaphylaxis, malignant hyperthermia and hyperkalemic cardiac arrest in the operation room. It is imperative for the anesthesia provider to promptly identify the condition and start treatment. For example, if muscle rigidity is noticed during intubation accompan...
Patient Related Emergencies
- Difficult airway
A difficult airway should be anticipated in patients who are obese, have a short, broad neck, medical co-morbidities or upper airway tumors or maxillofacial fractures/deformities. In all such cases, a preoperative plan for alternative airwayin an emergency like tracheal intubation/cricothy… - Aspiration
A patient without adequately functioning airway reflexes due to a recent meal (inadequate starvation period), delayed gastric emptying (bowel obstruction, pregnancy, pain or opiates) can regurgitate gastric contents into the airway and lungsduring induction of anesthesia. It is impera…
Iatrogenic Emergencies
- Incorrect drug administration
Before and during the surgical procedure, drugs may be administered accidentally due to wrong labeling, human fatigue/inattention. This can be avoided by repeated checking and confirming the medication labels, avoiding too many unnecessary medications on the anesthesia machine, ade… - Incorrect dose administration
This can be a disastrous complication, especially in the case of drugs whose doses are weight dependent or in pediatric/elderly patients or patients with renal or hepatic disease.
Checklist to Minimize Different Emergencies in The Or
- Although certain emergencies are sudden and without apparent cause, the anesthesia provider can pro-activelydo the following to minimize nasty operating room surprises: Evaluate the patient pre-operatively with a thorough history and physical examination. A detailed history will provide information about medications taken by the patient currently, current medical conditions, previo…