Crisis Management in Anesthesia

Anesthesiologist in the operating room.

Given the nature of an anesthesia provider’s responsibilities, chances are they will experience at least one crisis during their career. Despite the patient’s level of acuity or the complexity of the case, crises can occur without notice. Crisis management in anesthesia requires vigilance, level-headedness and an ability to think critically under intense pressure.

Cognitive Strategies for Anesthetic Crises

Anesthesia providers are highly trained on how to respond in crisis situations. As anyone can imagine, sometimes the most difficult part of navigating a high-stress situation is remembering the appropriate steps to take to mitigate the issue. Adrenaline and stress can take a toll on memory and cognitive function. Anesthesia providers must be prepared to recognize a crisis and respond to it calmly, thoughtfully and thoroughly. There are numerous cognitive strategies anesthesia providers can use to help get them through a crisis:

Core Algorithms and Helpful Mnemonics

A “core” algorithm forms the basis for the management of any crisis in which an anesthesia provider is uncertain of the exact cause or which is not going as expected. This algorithm is a common starting sequence for all crises to prevent the formation of a mindset that is decided upon a particular problem when, in fact, the problem is a different one requiring a different solution. The mnemonic, “COVER ABCD—A SWIFT CHECK,” was devised for this core algorithm. Although there are several iterations of this mnemonic, the basic premise prompts the anesthesia provider to examine a patient’s:

  • C – Circulation, Capnograph and Color
  • O – Oxygen supply
  • V – Ventilation and Vaporizers
  • E – Endotracheal tube
  • R – Review monitors and equipment
  • A – Airway (with a face or laryngeal mask)
  • B – Breathing (with spontaneous ventilation)
  • C – Circulation
  • D – Drugs (consider all given or not given)
  • A – Awareness of Air and Allergy
  • SWIFT CHECK of patient, surgeon, process and responses


Although checklists are seemingly simple, they have played a major role in the successes of many safety initiatives, both in and out of the healthcare arena. For example, pilots have been using pre-flight safety checklists for decades to prevent mistakes or oversights made in haste. When it comes to healthcare in general, checklists have proven to be beneficial. In fact, in 2009, the World Health Organization Safe Surgery Saves Lives Study Group published a study showing that utilization of a surgical safety checklist resulted in reduced perioperative mortality and complication rates.

Checklists are commonly used by anesthesia providers when it comes to routine occurrences such as inspecting the anesthesia machine or transferring a patient to the recovery unit. The Anesthesia Patient Safety Foundation has also established a template Pre-Anesthetic Induction Patient Safety (PIPS) checklist that includes essential steps that should be completed prior to a procedure. When these types of checklists are carefully followed, crises are mitigated or avoided completely. 

Our Commitment to Quality and Safety

At CCI, patient safety is our topmost priority. To best uphold our commitment to patient safety, we have developed and implemented a comprehensive quality program that is designed to not only optimize clinical outcomes, but also patient safety, operational efficiency and customer satisfaction. Our quality program assures our clients that their anesthesia department and service lines are working in accordance with TJC, CMS and DNV compliance standards. We believe our quality program equips our anesthesia providers with the tools and training needed to mitigate potential risks as much as possible and know how to react in the event of a crisis.

To learn more about our quality assurance program and how to reduce anesthesia-related risks in your facility, call us at 800.494.3948 today