Atelectasis and pneumonia
Atelectasis is best seen on CT (not CXRs). It starts within minutes of induction, and is partly caused by using 100% O2.
[prescription take]
good pain relief aids coughing. Arrange physio + antibiotics.
Laryngospasm
The cords are firmly shut. Treat with 100% oxygen. Attempt to ventilate. It may be necessary to paralyze and intubate.
Bronchospasm
Ensure oxygenation. If intubated, check tube position (carina stimulation may be the cause: withdraw tube slightly). Check for pneumothorax. (Increase concentration of volatile agent if he is light.) Salbutamol 250 eg by IV, aminophylline hyperventilation with 100% O2. If persistent, give hydrocortisone 100mg IV and consider epinephrine (=adrenaline, 1-10mL up to 0.1mL/kg of 1:10,000 IV).
Shivering hypothermia
Preventable with space blankets, and may be treated by radiant heat and pethidine for shivering (0.3mg/kg slowly IV). Be aware that shivering increases O2 consumption 5-fold.
Scoline apnoea
(Abnormal cholinesterase) ventilate until power returns.
Malignant hyperpyrexia
(Autosomal dominant). Rapidly rising temperature (>2°C/h) is precipitated by eg halothane or suxamethonium. Masseter spasm may be the first indication, then tachycardia, mottling, hypercarbia, hyperkalaemia, arrhythmias, hypoxaemia, and acidosis.
Treatment
- Get senior help; stop all precipitants and stop surgery.
- Hyper- ventilate with O2.
- Active cooling (ice packs, cold IVI).
- Take to ITU
- Dantrolene 1mg/kg IV bolus; repeat as needed till up to 10mg/kg given.
- Mannitol for myoglobinuria.
- Correct acidosis (sodium bicarbonate).
- Treat any hyperkalaemia (OHCM p 825)
- Encourage diuresis
- Insulin
- Steroids, eg hydrocortisone 100mg IV.
- Phenotype relatives (muscle biopsy response to halothane and caffeine).
- Get a Medicalert bracelet, and a letter to give to future anaesthetists.
Awareness
This is most distressing for patients. Neuromuscular blockade makes its diagnosis difficult; the BIS monitor (above) may incidence.
Prevalence
Much less than 1% even in emergency/obstetric anaesthesia (here doses used are minimized, to avoid shock). It is still rarer in other contexts (eg 0.2%).
Advertisements
