Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Epidural anaesthesia and analgesia3. Severe hypotension (due to bradycardia or excessivevasodilatation).4. Nausea (due to hypotension).5. Shortness of breath.6. Abnormal bradycardia.Action:If a high block is detected:1. Stop the epidural infusion.2. Administer oxygen.3. Check and record pulse, blood pressure, respiratory rate andsedation score.4. If any “danger signs” are present, contact the acute pain serviceor the on-call anaesthetist who must review the patient beforethe epidural infusion is recommenced.5. All necessary emergency actions must be taken by the attendingnurse / doctor whilst waiting for anaesthetic assistance.6. Monitor patient observations, including block heightmeasurement, every fifteen minutes.7. When the block falls to a safe level (below T4) restart theinfusion at the original rate minus 2 mL/h -1 .8. Continue the observations half-hourly for two hours anddocument on the chart.Management of acute confusionIn all cases of confusion give oxygen as the first line of treatment• Acute confusion may follow any operative procedure especiallyin the elderly.136 Anaesthetists Handbook January 2010