Trouble Shooting Anaesthesia

Question 1

Blood Pressure Trending Down (Hypotension?)

<60 MBP
<90 Systolic

Answer 1

• Too deep = decrease anaesthesia
• Any blood loss?
• Fluid bolus 5-10ml/kg?
• Check pulses
• True reading from machine? = move cuff or use doppler
• Dopamine CRI
• Packed red blood cells

Question 2

Decreased Temperature (Hypothermia)

Answer 2

• Check BAIR hugger for temp, turn up if poss
• Bubble wrap body/feet
• Add another blanket
• Hotties placed on patient
• Coming out of surgery soon? = Warm up cage

Question 3

Painful

Answer 3

• When was last methadone (q4-8h)/butorphanol injection
• Fentanyl CRI? = Start or increase
• Another CRI? = Add Ketamine

Question 4

Light

Answer 4

• Increase Isoflurane
• Pain response?
• Alfaxan top up?

Question 5

Deep

Answer 5

• Decrease Isoflurane?
• A few only O2 breaths?
• Decrease CRI’s?

Question 6

Hypoventilation

Answer 6

• Reduction of air entering the pulmonary alveoli
• Earliest indicator is increased CO2 levels, then decreased RR
• Can lead to acidosis, hypotension and cardiac arrest
• Caused by CNS depression, upper airway obstruction, traumatic injuries, atelectasis (lung collapse)
• Provide ventilation, decrease ISO, check airway

Question 7

Cardiac Arrest

Answer 7

• Follow CPR protocol
• Caused by hypovolaemia, sepsis, drug overdose, hypoxia, hypercapnia, acidosis, arrhythmias
• Clinical signs include absent HR/RR, cyanosis, collapsed and unresponsive