Intraoperative Myocardial Ischaemia

🔑 Key Priorities

• Reduce myocardial oxygen demand

• Increase myocardial oxygen supply

• Expedite surgical end and cardiac review

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🧠 Team Actions

Role	Task
Team Leader	Coordinate clinical stabilisation and plan with surgeon
Airway Manager	Ensure oxygenation, avoid hyperoxia
Drug Assistant	Prepare vasopressors, GTN, beta blockers

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🧭 Management Algorithm

1. Confirm ST changes on ECG (12-lead if available)

2. Increase FiO₂ to maintain SpO₂ 94–98%

3. Reduce O₂ demand:

   • Control HR (target 60–80 bpm)

   • Deepen anaesthesia

   • Treat shivering, pain

4. Increase O₂ supply:

   • Ensure MAP > 65 mmHg (noradrenaline, metaraminol)

   • GTN infusion if hypertensive or ongoing ischaemia

   • Transfuse if anaemic (Hb < 80–90)

5. Involve cardiology early ± prepare for PCI

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🔄 Ideal Crisis Flow

     Intraop Myocardial Ischaemia
              ↓
     Confirm ST Changes, Optimise ECG
              ↓
     Reduce HR and Demand, Increase Supply
              ↓
     GTN / Pressors / Transfusion as needed
              ↓
      Consider PCI and Expedite Surgery End