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Haemodynamic changes to a midazolam–fentanyl–rocuronium protocol for pre-hospital anaesthesia following return of spontaneous circulation after cardiac arrest

Miller, M, Groombridge, C and Lyon, Richard (2017) Haemodynamic changes to a midazolam–fentanyl–rocuronium protocol for pre-hospital anaesthesia following return of spontaneous circulation after cardiac arrest Anaesthesia, 72 (5). pp. 585-591.

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Abstract

Following the return of spontaneous circulation after cardiac arrest, neurological dysfunction, airway or ventilatory compromise can impede transport to early percutaneous coronary intervention, necessitating pre-hospital or emergency department anaesthesia to facilitate this procedure. There are no published reports of the ideal induction agents in these patients. We sought to describe haemodynamic changes associated with a midazolam (0.1mg/kg) fentanyl (2mcg/kg) rocuronium (1mg/kg) regimen developed from expert opinion, and adherence to the protocol by our pre-hospital teams. We performed a retrospective review of electronic vital-signs recorded during induction of return of spontaneous circulation patients over a 30-month period. We analysed the changes in systolic blood pressure and heart rate using a repeated-measures design, and the rate of new hypotension or hypertension. Sixty four patients had four consecutive measurements for analysis (one pre-induction and three post-induction). Systolic blood pressure was significantly lower than the pre-induction value at all three post-induction measurements. Heart rate did not differ between any time-point. New episodes of hypotension (systolic pressure <90mmHg) occurred in 6% at the first measurement post-induction (95%CI 2% to 15%) and 16% at the third measurement (95%CI 8% to 27%). Three patients (5%; 95%CI 1% to 13%) had a hypertensive response. Median midazolam dose given at induction was 0.04mg/kg, only 14% of patients received 0.1mg/kg midazolam. Adherence to recommended fentanyl and rocuronium doses was high. Overall, systolic blood pressure reduced post-induction and systolic pressures <90mmHg may occur more often at later measurements (up to 9 minutes). Changes in heart rate and new hypertension were uncommon.

Item Type: Article
Subjects : Health Sciences
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
NameEmailORCID
Miller, MUNSPECIFIEDUNSPECIFIED
Groombridge, CUNSPECIFIEDUNSPECIFIED
Lyon, Richardr.lyon@surrey.ac.ukUNSPECIFIED
Date : 15 February 2017
Identification Number : 10.1111/anae.13809
Copyright Disclaimer : This is the peer reviewed version of the following article: Miller, M., Groombridge, C. and Lyon, R. (2017), Haemodynamic changes to a midazolam–fentanyl–rocuronium protocol for pre-hospital anaesthesia following return of spontaneous circulation after cardiac arrest. Anaesthesia. doi:10.1111/anae.13809 which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/anae.13809/full. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Uncontrolled Keywords : Cardiac arrest Midazolam Anaesthesia techniques
Depositing User : Symplectic Elements
Date Deposited : 28 Feb 2017 12:34
Last Modified : 06 Jul 2017 11:03
URI: http://epubs.surrey.ac.uk/id/eprint/813641

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