Crisis management during anaesthesia: tachycardia

Area of Science:

• Anesthesiology
• Cardiology
• Critical Care Medicine

Background:

• Tachycardia during anesthesia is common but can stem from rare causes, posing risks.
• Prompt identification and management are crucial for patient safety.
• Delays in diagnosis and treatment can arise from complex differential diagnoses.

Purpose of the Study:

• To evaluate the "COVER ABCD-A SWIFT CHECK" core algorithm combined with a tachycardia sub-algorithm.
• To assess the algorithm's effectiveness in managing intraoperative tachycardia.

Main Methods:

• Analysis of 123 reports (145 causative events) of tachycardia during anesthesia from the Australian Incident Monitoring Study (AIMS).
• Comparison of algorithm performance against actual management by anesthesiologists.
• Categorization of tachycardia causes based on blood pressure (hypotension, normotension, hypertension, cardiac arrest).

Main Results:

• Tachycardia occurred with hypotension (33%), normotension (27%), hypertension (26%), and cardiac arrest (17%).
• The COVER algorithm alone could diagnose 35% of cases, leading to resolution in 70% of those.
• Combined COVER and tachycardia sub-algorithm use potentially improved recognition and management in four cases.

Conclusions:

• Tachycardia during anesthesia often presents with altered vital signs, necessitating a structured diagnostic approach.
• A tachycardia sub-algorithm, considering blood pressure and heart rhythm, provides systematic guidance.
• This structured approach complements the COVER ABCD algorithm for improved intraoperative tachycardia management.