A Review of Current Literature of Interest to the Office-Based Anesthesiologist

Cardiac arrest in the operating room and procedural areas has a spectrum of causes (eg, hypovolemia, gas embolism, and hyperkalemia) that are not directly reflected in the standard advanced cardiac life support (ACLS) recommendations. Rapid, appropriate evaluation and management of these causes require modification of the traditional algorithms. These events are almost always witnessed, are frequently known, and involve rescuer providers with knowledge of the patient and the procedure. In such a setting, there can be formulation of a differential diagnosis and a direct intervention that treats the likely underlying cause, resulting in concurrent resolution of the crisis. Similarly, periprocedural cardiac arrest (PPCA) can arise from other causes not addressed in the ACLS algorithms (eg, malignant hyperthermia, massive trauma, and local anesthetic toxicity). Formulation of an appropriate differential diagnosis and rapid, targeted interventions are critical for good patient outcomes. There is a growing body of literature describing the incidence, causes, treatment, and outcomes of PPCA. These narrative review articles provide expanded algorithms that incorporate both published evidence and expert opinion to aid the practicing anesthesiologist in addressing these crises