Intraoperative Myocardial Ischaemia

🔑 Key Priorities

  • Reduce myocardial oxygen demand

  • Increase myocardial oxygen supply

  • Expedite surgical end and cardiac review

🧠 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

🧭 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

🔄 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

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