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Type: Journal article
Title: Crisis management during anaesthesia: myocardial ischaemia and infarction
Author: Ludbrook, G.
Webb, R.
Currie, M.
Watterson, L.
Citation: Quality and Safety in Health Care, 2005; 14(3):e13/WWW 1-WWW 4
Publisher: British Med Journal Publ Group
Issue Date: 2005
ISSN: 1475-3898
Statement of
G L Ludbrook, R K Webb, M Currie and L M Watterson
Abstract: Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK" supplemented by a specific sub-algorithm for myocardial ischaemia and infarction in the management of myocardial ischaemia and/or infarction occurring in association with anaesthesia. Methods: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. Results: Of the 125 incidents retrieved from the 4000 reports, 40 (1%) were considered to demonstrate myocardial infarction or ischaemia. The use of the structured approach described in this paper would have led to appropriate management in 90% of cases, with the remaining 10% requiring other sub-algorithms. It was considered that the application of this structured approach would have led to earlier recognition and/or better management of the problem in 45% of cases. Conclusion: Close and continuous monitoring of patients at risk of myocardial ischaemia during anaesthesia is necessary, using optimal ECG lead configurations, but sensitivity of this monitoring is not 100%. Coronary vasodilatation with glyceryl trinitrate (GTN) should not be withheld when indicated and the early use of beta blocking drugs should be considered even with normal blood pressures and heart rates.
Keywords: Humans; Myocardial Ischemia; Myocardial Infarction; Emergencies; Intraoperative Complications; Monitoring, Intraoperative; Anesthesia; Task Performance and Analysis; Anesthesiology; Algorithms; Risk Management; Australia; Manuals as Topic
Description: © 2005 BMJ Publishing Group
RMID: 0020050649
DOI: 10.1136/qshc.2002.004416
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Appears in Collections:Anaesthesia and Intensive Care publications

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