Acute incidents during anaesthesia A small percentage of apparently routine anaesthetics will end in an anticipated or unforeseen acute incident. Edwin W Turton, MB ChB, Dip Pec (SA), DA (SA), MMed Anes, FCA (SA) Head of Cardiothoracic Anaesthesia, Bloemfontein Hospitals Complex, Department of Anaesthesiology, University of the Free State, Bloemfontein Dr Edwin Turton worked as a clinical fellow in cardiac anaesthesia at Glenfield Hospital, Leicester, UK, in 2009. His current fields of interest are adult and paediatric cardiac anaesthesia and peri-operative echocardiography, and focussed assessment through echocardiography in emergency care. Correspondence to: E W Turton (
[email protected]) Anaesthesia is uneventful in the majority Although anaesthesia is a very well- • Antibiotics (2.6%) of cases but in a small percentage of controlled and governed discipline, acute • Benzodiazepines (2%) routine and emergency cases there will incidents do occur. Incidents can occur • Opioids (1.7%) be an anticipated or an unforeseen acute during induction, maintenance and • Other agents (e.g. radio contrast media) incident. These incidents need immediate emergence from anaesthesia. (2.5%). theoretical knowledge and clinical skills to be managed effectively and to The following acute critical incidents are Treatment and management prevent further morbidity and mortality. discussed in this article: • Stop administration of all suspected Therefore all providers of anaesthesia, • Anaphylaxis agents. at different levels of experience, should • Aspiration • Call for help. be able to provide basic and advanced • Laryngospasm • Airway must be secured and 100% cardiopulmonary resuscitation (CPR).1 • High or total (complete) spinal blocks in oxygen given, and ensure adequate obstetric anaesthesia. ventilation. The first death associated with an anaesthetic • Intravenous or intramuscular adrenaline was reported in 1848 in the USA.