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Anesthesia for emergency surgery after cardiac arrest or traumatic cardiac injury

Authors
Nadia Blakemore Hensley, MD
Charles W Hogue, MD
Section Editor
Roberta Hines, MD
Deputy Editor
Nancy A Nussmeier, MD, FAHA

INTRODUCTION

Urgent surgery is sometimes necessary in patients presenting to the emergency department with unstable cardiac status, despite the increased risk of perioperative morbidity or mortality. This topic reviews anesthetic management of patients who have suffered a cardiac arrest with resuscitation, and patients with traumatic cardiac injury. The initial critical interventions in post-cardiac arrest management and the initial management of traumatic cardiac injuries are reviewed elsewhere. (See "Post-cardiac arrest management in adults" and "Evaluation of the survivor of sudden cardiac arrest" and "Cardiac injury from blunt trauma" and "Cardiac tamponade" and "Initial evaluation and management of penetrating thoracic trauma in adults".)

GENERAL CONSIDERATIONS

Hemodynamic monitoring — Hemodynamic monitoring in patients with recent cardiac events or injury includes the following general considerations:

Electrocardiography (ECG) – Continuous electrocardiography (ECG) monitoring is necessary to detect arrhythmias and/or myocardial ischemia.

Computerized ST-segment trending is superior to visual clinical interpretation in the identification of ST-segment changes [1-4] and multiple-lead monitoring is more sensitive than single-lead monitoring, although the ECG is a relatively insensitive method for intraoperative detection of myocardial ischemia [5,6].

Intra-arterial catheter Invasive measurement of arterial blood pressure should be used when moment-to-moment blood pressure changes are anticipated and rapid detection is vital. These conditions apply to patients with preexisting hemodynamic instability, as well as those undergoing surgical procedures that are likely to cause rapid blood loss or large fluid shifts. If possible, an intra-arterial catheter is inserted prior to induction of anesthesia.

                                  

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Literature review current through: Nov 2016. | This topic last updated: Tue Aug 30 00:00:00 GMT+00:00 2016.
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