Anaes · Perioperative cardiac arrest
Perioperative cardiac arrest
Also known as Perioperative cardiac arrest · Intraoperative cardiac arrest · Intraoperative CPR · NAP7 · Anaesthesia-related arrest · 4 Hs 4 Ts · Perimortem caesarean
Exam-exhaustive perioperative cardiac arrest: NAP7 epidemiology, theatre-modified ALS, 4 Hs and 4 Ts with anaesthesia-specific differentials (anaphylaxis, MH, LAST, embolism, haemorrhage, high spinal), adrenaline dosing, open-chest CPR after cardiac surgery, and maternal arrest with perimortem caesarean.
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13 MCQs with explanations
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Meet the patient
A 65-year-old man arrests two minutes after induction with rocuronium and cefazolin for an elective hip replacement. ETCO2 falls, SpO2 drops, there is no pulse, and the peak airway pressure is 45. The single decision in front of you — is this anaphylaxis, and where is the adrenaline — runs in parallel with the CPR you have already started.[1]
Two questions frame every perioperative arrest: is there a reversible cause that exists only because this patient is anaesthetised? and have I modified the algorithm for the chest and the womb? Hold those two and the theatre script slots into place.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Anaesthesia fellowship atlas.
References5Show ledgerHide ledger
- [1]Armstrong RA, et al. Peri-operative cardiac arrest: epidemiology and clinical features of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists Anaesthesia, 2024.PMID 37972476
- [2]Neal JM et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017 Reg Anesth Pain Med, 2018.PMID 29356773
- [3]Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults Br J Anaesth, 2015.PMID 26556848
- [4]Donaldson AJ et al. Bone cement implantation syndrome Br J Anaesth, 2009.PMID 19059919
- [5]Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics Anaesthesia, 2015.PMID 26449292