Australian Incident Monitoring Study Research Articles

Bradycardia as an early warning sign for cardiac arrest during routine laparoscopic surgery.

The aim of this study was to identify clinical patterns of occurrence, management and outcomes surrounding cardiac arrest during laparoscopic surgery using the Australian Incident Monitoring Study (AIMS) database to guide possible prevention and treatment. The AIMS database includes incident reports from participating clinicians from secondary and tertiary healthcare centres across Australia and New Zealand. The AIMS database holds over 11 000 peri- and intraoperative incidents. The primary outcome was to characterize the pattern of events surrounding cardiac arrest. The secondary outcome was to identify successful management strategies in the possible prevention and treatment of cardiac arrest during laparoscopic surgery. Fourteen cases of cardiac arrest during laparoscopic surgery were identified. The majority of cases occurred in 'fit and healthy' patients during elective gynaecological and general surgical procedures. Twelve cases of cardiac arrest were directly associated with pneumoperitoneum with bradycardia preceding cardiac arrest in 75% of these. Management included deflation of pneumoperitoneum, atropine administration and cardiopulmonary resuscitation with circulatory restoration in all cases. The results imply vagal mechanisms associated with peritoneal distension as the predominant contributor to bradycardia and subsequent cardiac arrest during laparoscopy. Bradycardia during gas insufflation is not necessarily a benign event and appears to be a critical early warning sign for possible impending and unexpected cardiac arrest. Immediate deflation of pneumoperitoneum and atropine administration are effective measures that may alleviate bradycardia and possibly avert progression to cardiac arrest.

Residual anaesthesia drugs in intravenous lines – a silent threat?

Residual anaesthesia drugs in intravenous lines – a silent threat?

Contemporary simulation education for undergraduate paramedic students

In recent years there has been an emphasis on the reduction of medical errors in patient management, especially in the hospital setting. There is no identified reporting structure for the...

Crisis management during anaesthesia: awareness and anaesthesia

Background: Patient awareness during general anaesthesia has considerable potential for severe emotional distress in the patient as well as professional, personal, and financial consequences for the anaesthetist. Objectives: To examine...

Crisis management during anaesthesia: the development of an anaesthetic crisis management manual

Background: All anaesthetists have to handle life threatening crises with little or no warning. However, some cognitive strategies and work practices that are appropriate for speed and efficiency under normal...

Crisis management during anaesthesia: embolism

Background: Embolism with gas, thrombus, fat, amniotic fluid, or particulate matter may occur suddenly and unexpectedly during anaesthesia, posing a diagnostic and management problem for the anaesthetist. Objectives: To examine...

Crisis management during anaesthesia: problems associated with drug administration during anaesthesia

Background: Modern anaesthetic practice relies upon the administration of a wide range of potent drugs given by a variety of routes, at times in haste or under conditions of stress....

Crisis management during anaesthesia: hypertension

Background: Hypertension occurs commonly during anaesthesia and is usually promptly and appropriately treated by anaesthetists. However, its recognition is dependent on correctly functioning and calibrated monitors. If it is not...

Crisis management during anaesthesia: pneumothorax

Background: Pneumothorax is a potentially dangerous condition which may arise unexpectedly during anaesthesia. The diagnosis is one of exclusion, as initial changes in vital signs (cardiorespiratory decompensation and difficulty with...

Crisis management during anaesthesia: obstruction of the natural airway

Background: Obstruction of the natural airway, while usually easily recognised and managed, may present simply as desaturation, have an unexpected cause, be very difficult to manage, and have serious consequences...

Crisis management during anaesthesia: water intoxication

Background: Irrigation of closed body spaces may lead to substantial perioperative fluid and electrolyte shifts. A syndrome occurring during transurethral resection of prostate (TURP), and a similar syndrome described in...

Crisis management during anaesthesia: laryngospasm

Background: Laryngospasm is usually easily detected and managed, but may present atypically and/or be precipitated by factors which are not immediately recognised. If poorly managed, it has the potential to...

Crisis management during anaesthesia: hypotension

Background: Hypotension is commonly encountered in association with anaesthesia and surgery. Uncorrected and sustained it puts the brain, heart, kidneys, and the fetus in pregnancy at risk of permanent or...

Crisis management during anaesthesia: pulmonary oedema

Background: Pulmonary oedema may complicate the perioperative period and the aetiology may be different from non-operative patients. Diagnosis may be difficult during anaesthesia and consequently management may be delayed. Objectives:...

Crisis management during anaesthesia: regurgitation, vomiting, and aspiration

Background: Regurgitation, vomiting and aspiration may occur unexpectedly in association with anaesthesia. “Aspiration/regurgitation” was ranked fifth in a large collection of previously reported incidents that arose during general anaesthesia. These...

Crisis management during anaesthesia: sepsis

Background: Anaesthesia with concurrent sepsis is risky, and involves consideration of possible organ dysfunctions—respiratory, cardiovascular, renal, and haematological—as well as ensuring that appropriate antibiotics are given after taking the necessary...

Crisis management during anaesthesia: bradycardia

Background: Bradycardia in association with anaesthesia may have many potential causes and associated conditions, some rare and/or obscure. A prompt appropriate response is important as some homeostatic mechanisms may be...

Crisis management during anaesthesia: bronchospasm

Background: Bronchospasm in association with anaesthesia may appear as an entity in its own right or be a component of another problem such as anaphylaxis. It may present with expiratory...

Crisis management during anaesthesia: desaturation

Background: Desaturation occurs for many reasons under anaesthesia, some rare and obscure, and many potentially life threatening. The rapidity with which the cause is determined and appropriate management is instituted...

Crisis management during anaesthesia: anaphylaxis and allergy

Background: Anaphylactic and anaphylactoid reactions during anaesthesia are a major cause for concern for anaesthetists. However, as individual practitioners encounter such events so rarely, the rapidity with which the diagnosis...