Thoracics

In this chapter on life-threatening thoracic problems in anaesthesia, the authors offer their guidance and expertise on the best-practice methods of dealing with each of these. These problems include tracheal/bronchial obstruction, inhaled foreign body, tracheal injury or laceration, bronchopleural fistula, hypoxia/pneumothorax/high airway pressure during one-lung ventilation, dynamic hyperinflation, cardiac herniation postpneumonectomy, major airway bleeding, and bleeding during mediastinoscopy. In addition, the definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each potential thoracically related situation are given and elaborated upon. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.

Obstetrics

This chapter covers emergency management for obstetric crises including maternal collapse, severe haemorrhage, amniotic fluid embolus, pre-eclampsia and eclampsia, total spinal, accidental dural puncture, cord prolapse, failed intubation, ruptured ectopic, retained placenta, and placenta praevia. The authors give guidance on how to perform intrauterine resuscitation and conduct anaesthesia for a category I Caesarean section. In addition, the definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each potential obstetric-related situation are given. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.

Practical procedures

The final chapter provides instructions for practical procedures which support advice given in other sections. Techniques for managing difficult airways are explored including front of neck access (by surgical or needle cricothyroidotomy), intubating laryngeal mask insertion, awake fibreoptic intubation, lightwand-assisted airway management, and retrograde intubation. Meanwhile, techniques for chest drain insertion and one-lung ventilation are described. Methods of administering bronchodilators by in-circuit nebulization or metered dose inhaler are offered. Advanced access techniques for the circulation are also presented, including internal jugular catheters, femoral vein catheters, intraosseous needle insertion, and venous cut-down. Pacing is discussed within the contexts of initiating new pacing (internal and external) and providing anaesthesia for patients with pre-existing implantable pacing systems and cardioverter defibrillators. A final section gives guidance on transferring critically ill patients.

Miscellaneous problems

The penultimate chapter covers miscellaneous topics not described elsewhere. Major haemorrhage is addressed with sections on controlling haemorrhage, using blood products, and diagnosing/treating acute transfusion reactions. Guidance is given for treating patients with burns, extravasation of anaesthetic agents, intra-arterial injection, inoculation injury, and bone cement implantation syndrome. Advice is presented for managing fire in theatre. Clinical guidance/recipes are given for anaesthetising patients who have bled after tonsillectomy, thyroid surgery, or carotid endarterectomy. The final two sections concern patients undergoing emergency laparotomy or emergency aortic aneurysm repair. Each problem is addressed by firstly its definitions, presentation, investigations, risk factors, and exclusions; then how it can be managed in the immediate, medium-, and long-term situations. Finally, any special considerations are outlined, followed by a list of further reading.

Recovery problems

This chapter details the clinical problems anaesthetists often face with patients in the recovery unit. These include acute coronary syndromes and other causes of chest pain, acute heart failure, hypertension and hypotension, respiratory failure and hypoxia, acute confusion, lowered consciousness level and stroke, residual neuromuscular blockade, oliguria and acute renal failure, severe postoperative nausea and vomiting, and epidural problems. In addition, the definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each potential recovery-related situation are given and elaborated upon. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.

Metabolic and endocrine

This chapter deals with a plethora of metabolic and endocrine abnormalities from an anaesthetic perspective. Major biochemical cation derangements are covered including high and low sodium, potassium, calcium, and magnesium levels. Guidelines are also presented for the management of anaphylaxis/severe allergy, diabetic ketoacidosis, and hyperosmolar non-ketotic coma, malignant hyperthermia, porphyric crisis, thyrotoxic storm, phaeochromocytoma, Addisonian crisis, disseminated intravascular coagulopathy, hypoglycaemia, acute liver failure, sickle cell crisis, TURP syndrome, and hypothermia. In addition, the definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each potential metabolic and endocrine-related situation are given and elaborated upon. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.

Regional anaesthesia

There are a number of important emergencies associated with regional anaesthesia that the anaesthetist should be aware of. Life-threatening emergencies, such as local anaesthetic systemic toxicity leading to cardiorespiratory arrest can occur irrespective of the site of local anaesthetic infiltration. Specific procedures including epidural and spinal anaesthesia, eye blocks, and peripheral nerve blocks cause a range of surgical emergencies and severe complications. Neuraxial anaesthesia carries the risk of epidural haematoma and abscess while infiltration or local anaesthetic around the globe carries the risk of both retro-orbital haematoma and globe perforation, all of which may require urgent surgical intervention. Although literature supports the safety of low concentration (1 in 200 000) adrenaline as an additive to digital blocks, inadvertent injection of higher concentrations may have the potential for ischaemic injury. Finally, the assessment and diagnosis of perioperative nerve injuries when associated with a peripheral nerve block present a formidable clinical challenge.

Neurology/neurosurgery

In this chapter on neurosurgery and anaesthesia, the authors give clear guidance for the management of time critical brain and neurological conditions, including raised intracerebral pressure, severe head injury, subarachnoid and intracerebral haemorrhage, sodium disturbances, venous air embolism, acute spinal cord injury, spinal shock, autonomic dysreflexia, dystonic reactions, and status epilepticus. In addition, the definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each potential neurosurgical and neurologically related situation are given. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.

Airway

This chapter covers the guidelines for airway emergencies in anaesthesia. Strategies, checklists, and flowcharts are presented for the management of unexpected difficult mask ventilation and difficult intubation, e.g. ‘Cannot intubate, cannot oxygenate’ (CICO) and front of neck airway (FONA), partial airway obstruction, rapid sequence induction, laryngospasm, endobronchial intubation, oesophageal intubation, aspiration, airway fire, and difficult tracheal extubation. Definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations (e.g. paediatric implications) for each airway-related situation are covered. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.

Cardiovascular

In this chapter, the latest basic and advanced life support guidelines are presented. Treatment guidelines are included for asystole, pulseless electrical activity, ventricular fibrillation, bradycardia, atrial fibrillation, narrow-complex tachycardia, broad-complex tachycardia, intraoperative hypotension/hypertension, and myocardial ischaemia. Anaesthesia and emergency management guidelines are presented for patients with cardiac tamponade, pulmonary embolus, cardiac trauma, thoracic aortic dissection, aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation. Definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each cardiovascular situation are all covered here. Detailed checklists and clear flowcharts are also provided to guide the user when time is of the essence, along with a list of up-to-date online resources and further reading.