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Can J Anesth/J Can Anesth (2012) 59:586603
DOI 10.1007/s12630-012-9699-3
SPECIAL ARTICLE
Anesthesia advanced circulatory life support Ranimation circulatoire avance en anesthsie
Vivek K. Moitra, MD Andrea Gabrielli, MD
Gerald A. Maccioli, MD Michael F. OConnor, MD
Received: 21 October 2011 / Accepted: 14 March 2012 / Published online: 21 April 2012 The Author(s) 2012. This article is published with open access at Springerlink.com
AbstractPurpose The constellation of advanced cardiac life support (ACLS) events, such as gas embolism, local anesthetic overdose, and spinal bradycardia, in the perioperative setting differs from events in the pre-hospital arena. As a result, modication of traditional ACLS protocols allows for more specic etiology-based resuscitation.
Principal ndings Perioperative arrests are both uncommon and heterogeneous and have not been described or studied to the same extent as cardiac arrest in the community. These crises are usually witnessed, frequently anticipated, and involve a rescuer physician with knowledge of the patients comorbidities and coexisting anesthetic or surgically related pathophysiology. When the health care provider identies the probable cause of arrest, the practitioner has the ability to initiate medical management rapidly.
Conclusions Recommendations for management must be predicated on expert opinion and physiological understanding rather than on the standards currently being used in the generation of ACLS protocols in the community. Adapting ACLS algorithms and considering the differential diagnoses of these perioperative events may prevent cardiac arrest.
RsumObjectif Le grand ensemble dvnements lis la ranimation cardiaque avance (ACLS) tels que les embolies gazeuses, les surdosages danesthsiques locaux et la bradycardie sinusale dans un contexte priopratoire est diffrent des vnements que lon observe lextrieur de lhopital. En consquence, une modication des protocoles traditionnels dACLS permet une ranimation plus spcique, en fonction de ltiologie. Constatations principales Les arrts cardiaques en priode priopratoire sont la fois rares et htrognes; ils nont pas t dcrits ou tudis avec la mme ampleur que les arrts cardiaques survenant hors de lhpital. Ces crises sont habituellement vcues en direct, souvent anticipes et impliquent lintervention dun mdecin connaissant les comorbidits du patient ainsi que la physiopathologie en rapport avec lintervention et les anesthsiques utiliss. Lorsque le professionnel de la sant identie la cause probable de larrt cardiaque, le praticien a la possibilit dentreprendre rapidement une prise en charge mdicale.
Conclusions Des recommandations pour...