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 varies considerably between anaesthetists.


OBJECTIVE
To examine the role of a previously described "core" algorithm COVER ABCD-A SWIFT CHECK, supplemented by a specific sub-algorithm for desaturation, in the management of incidents of desaturation occurring in association with anaesthesia.


METHODS
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.


RESULTS
Amongst the first 4000 incidents reported to AIMS there were 584 episodes of desaturation in association with general anaesthesia; 41% were dealt with by COVER, 48% by ABCD, and 11% required a specific desaturation sub-algorithm. Nearly a fifth of all desaturations were caused by endobronchial intubation. Within the specific desaturation subgroup, half were due to pulmonary problems in the form of underlying lung disease, excessive secretions or obesity and a third could not be diagnosed.


CONCLUSIONS
Desaturation may have many causes, some of which are obscure, and failure to respond promptly may place the patient at risk. In the face of persistent desaturation, management should consist of hand ventilation with 100% oxygen, completion of COVER ABCD-A SWIFT CHECK, and a return to a supine posture. Blood gases, chest radiography, and bronchoscopy may be required where desaturation is persistent and/or no apparent causes can be found.
Szekely
S M
SM
Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia.
Runciman
W B
WB
Webb
R K
RK
Ludbrook
G L
GL
D000465:Algorithms; D000768:Anesthesia, General / Q000009:adverse effects* / Q000295:instrumentation; D000776:Anesthesiology / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D001315:Australia; D004630:Emergencies; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D007442:Intubation, Intratracheal; D008370:Manuals as Topic; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000097:blood*; D010102:Oxygen Inhalation Therapy; D012308:Risk Management; D013647:Task Performance and Analysis
D010100:Oxygen