Watterson L M, Morris R W, Williamson J A, Westhorpe R N
Sydney Medical Simulation Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Qual Saf Health Care. 2005 Jun;14(3):e10. doi: 10.1136/qshc.2002.004432.
Tachycardia during anaesthesia is a common event. In most cases the cause is easily identified and the problem promptly resolved. However, in some the cause may be rare or obscure. Under such circumstances, attempting to initiate appropriate supportive therapy and to consider a large differential diagnosis in a comprehensive manner may lead to delays which can put a patient at risk.
To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for tachycardia, in the management of tachycardia developing in association with anaesthesia.
The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.
There were 145 causative events identified in 123 reports of tachycardia during anaesthesia which were extracted and studied from the first 4000 incidents reported to AIMS. Subgroups were identified based on blood pressure at the time of presentation. Of the 145 causes, tachycardia was associated with hypotension (33%), normotension (27%), hypertension (26%), and cardiac arrest (17%). For simplicity it is recommended that other cardiovascular sub-algorithms are followed when the blood pressure is also abnormal. This includes cardiac arrest and hypotension. In hypotensive states the tachycardia sub-algorithm should be followed until the cardiac rhythm is diagnosed. Sinus tachycardia and hypotension should be managed as hypotension. It was considered that, correctly applied, the core algorithm COVER would have diagnosed 35% of cases and led to resolution in 70% of these. It was estimated that completion of COVER followed by the sub-algorithm for tachycardia would have led to earlier recognition of the problem and/or better management in four cases when compared with actual management reported.
Tachycardia during anaesthesia is frequently associated with a simultaneous change in other monitored vital signs. The differential diagnosis is large. Addressing it in a comprehensive fashion requires a structured approach. A specific sub-algorithm treatment for tachycardia based on the associated blood pressure and on the prevailing heart rhythm in the case of hypotension offers a systematic guide which complements the benefits obtained by employing the core algorithm COVER ABCD.
麻醉期间心动过速是常见情况。多数情况下病因易于识别，问题能迅速解决。然而，有些情况下病因可能罕见或不明。在此类情形下，试图启动适当的支持性治疗并全面考虑广泛的鉴别诊断可能导致延误，从而使患者处于危险之中。
探讨先前描述的核心算法“COVER ABCD - A SWIFT CHECK”，辅以心动过速特定子算法，在处理与麻醉相关的心动过速中的作用。
将这种结构化方法应用于向澳大利亚事件监测研究（AIMS）报告的前4000例相关事件中每例事件的潜在表现，与参与的麻醉医生报告的实际处理情况进行比较。
从向AIMS报告的前4000例事件中提取并研究了123例麻醉期间心动过速报告中的145个病因事件。根据出现心动过速时的血压确定了亚组。在这145个病因中，心动过速与低血压（33%）、血压正常（27%）、高血压（26%）和心脏骤停（17%）相关。为简化起见，建议当血压也异常时遵循其他心血管亚算法。这包括心脏骤停和低血压。在低血压状态下，应遵循心动过速亚算法直至诊断出心律。窦性心动过速和低血压应按低血压处理。据认为，正确应用核心算法COVER可诊断35%的病例，并使其中70%得到解决。据估计，与报告的实际处理情况相比，完成COVER算法后再采用心动过速子算法，在4例病例中可更早识别问题和/或实现更好的处理。
麻醉期间心动过速常与其他监测到的生命体征同时变化相关。鉴别诊断范围广泛。以全面方式处理需要结构化方法。基于相关血压以及低血压情况下的主导心律的心动过速特定子算法治疗提供了一种系统指南，补充了采用核心算法COVER ABCD所获得的益处。
