Anaes Vivas · Critical incidents & patient safety
No pulse after induction drugs — perioperative arrest viva
A clinical viva on perioperative cardiac arrest: NAP7 epidemiology and outcomes, ERC rhythm-directed therapy, adrenaline by context, ten anaesthesia-specific collapses, CALS re-sternotomy, and maternal arrest with perimortem caesarean.
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Prompt
Two minutes after rocuronium and cefazolin the end-tidal carbon dioxide falls, the saturation drops, there is no pulse, and the peak airway pressure is 45. Talk me through your first minute, your drugs and shocks by rhythm, the theatre causes you name each cycle, and your open-chest and maternal modifications.
Stimulus
Two minutes after rocuronium and cefazolin the end-tidal carbon dioxide falls, the saturation drops, there is no pulse, and the peak airway pressure is 45. Talk me through your first minute, your drugs and shocks by rhythm, the theatre causes you name each cycle, and your open-chest and maternal modifications[1][9].
References10ShowHide
- [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]Lipman S, Cohen S, Einav S, et al. The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy Anesth Analg, 2014.PMID 24781570
- [6]Armstrong RA, Cook TM, Kane AD, et al. Peri-operative cardiac arrest: management and outcomes of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists Anaesthesia, 2024.PMID 37972480
- [7]Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support Resuscitation, 2021.PMID 33773825
- [8]Society of Thoracic Surgeons Task Force on Resuscitation After Cardiac Surgery The Society of Thoracic Surgeons Expert Consensus for the Resuscitation of Patients Who Arrest After Cardiac Surgery Ann Thorac Surg, 2017.PMID 28122680
- [9]Harper NJ, Dixon T, Dugué P, et al. Suspected anaphylactic reactions associated with anaesthesia Anaesthesia, 2009.PMID 19143700
- [10]Glahn KPE, Girard T, Hellblom A, et al. Recognition and management of a malignant hyperthermia crisis: updated 2024 guideline from the European Malignant Hyperthermia Group Br J Anaesth, 2025.PMID 39482150