Table 2

 “A SWIFT CHECK” (the checklist arising from the mnemonic need not be memorised but should be immediately available in the operating theatre)

If the problem has not been solved, direct the available resources to its solution. Get skilled and experienced help. Work from first principles.
AAir embolusHypotension, hypocarbia
AAnaphylaxisHypotension, bronchospasm, urticaria
AAir in pleuraPneumothorax, any unexpected circulatory or respiratory deterioration
AAwarenessConsider dilution of anaesthetic gases, “resistant” patient
SSurgeon/situationVagal stimulation, caval compression, bleeding, direct myocardial stimulation
SSepsisHypotension, desaturation, acidosis, hyperdynamic circulation
WWoundTrauma, bleeding, tamponade, pneumothorax, problems due to retractors
WWater intoxicationElectrolyte disturbance, fluid overload
IInfarctMyocardial conduction or rhythm problem, hypotension, poor cardiac output
IInsufflationVagal tone, reduced venous return, pulmonary venous or paradoxical arterial gas embolism
F“Fat” syndromeDesaturation and/or hypotension, especially after induction and in the lithotomy position including distended abdomen for any cause
FFull bladderMay cause marked haemodynamic changes and/or sympathetic stimulation
TTraumaConsider spinal injury, undiagnosed sub- or diaphragmatic injury, ruptured viscus
TTourniquet downLocal anaesthetic toxicity or unseen bleeding
CCatheter/IV cannula/chest drain problemsLeaks, failure to deliver, wrong drug or label, obstructed, wrong connected, wrong rate
CCementHaemodynamic change with methylmethacrylate
HHyperthermia (hypothermia)Tachycardia and hypercarbia/ECG changes, (poor perfusion, ECG changes)
HHypoglycaemiaConsider inappropriate or inadvertent insulin preoperatively, fasting and beta blockers, hepatic compromise and beta blockers
EEmbolusFat, thrombus, amniotic fluid; hypotension, hypocarbia, ECG changes
EEndocrineHyperthyroid or hypothyroid/adrenal medullar or cortex/pituitary/diabetes/5-HT
CCheckRight patient, right operation, right surgeon
CCheckCase notes, preoperative status, preoperative drugs, preoperative diseases
KK+Potassium and any other electrolyte abnormality (“hyper” or “hypo”), ECG changes, CNS signs
KKeepKeep the patient “asleep” until a new anaesthetic machine can be obtained (e.g. diazepam, ketamine)