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Cardiac arrest during anaesthesia. A computer-aided study in 250 543 anaesthetics

Department of Paediatric Anaesthesia, St Görans Hospital, Stockholm, Sweden.
Acta Anaesthesiologica Scandinavica (Impact Factor: 2.31). 12/1988; 32(8):653-64.
Source: PubMed

ABSTRACT With the aid of a computer-based anaesthetic record-keeping system, all cardiac arrests during anaesthesia at the Karolinska Hospital between July 1967 and December 1984 were retrieved. There were a total of 170 cardiac arrests and 250,543 anaesthetics in the data file, which gives an incidence of 6.8 cardiac arrests per 10,000 anaesthetics. Sixty patients died, constituting a mortality of 2.4 per 10,000 anaesthetics: 42 were considered as inevitable deaths (rupture of aortic or cerebral aneurysm, multitrauma, etc.); 13 cases of cardiac arrest were considered as non-anaesthetic, i.e. complications due to surgery and other procedures. Nine of these patients died. 115 cases of cardiac arrest were considered as caused by the anaesthetic and nine of these patients died. Thus mortality caused by anaesthesia was 0.3 per 10,000 anaesthetics. The most common cause of cardiac arrest due to anaesthesia was hypoxia because of ventilatory problems (27 patients), postsuccinylcholine asystole (23 patients) and post-induction hypotension (14 patients). The highest mortality was seen when spinal or epidural anaesthetics were given to patients with impaired physical status including hypovolaemia. The incidence of cardiac arrest has declined considerably during the period studied, and this coincides with an increasing number of qualified anaesthetists employed in the department during the same period.

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    • "The ASA physical status indexes a given patient's level of risk based on her/his medical condition before surgery, with larger numbers indicating increased risk: level 1 refers to healthy patients; level 2 refers to patients with a mild systemic disease (e.g., mild diabetes); level 3 refers to patients with severe systemic disease (e.g., frequent angina); level 4 refers to patients with severe systemic disease with acute, unstable symptoms (e.g., congestive heart failure); and level 5 refers to patients who are approaching death and who are not expected to survive without the operation. Most children undergoing CI surgery are typically considered ASA physical status 1 or 2. The anesthetic risk for individuals in either of these categories is significantly lower than for individuals classified as ASA 3, 4, or 5 (Keenan, et al., 1994; Olsson & Hallen, 1988; Tay, et al., 2001; Tiret, et al., 1988). In fact, Morray et al. (2000) reported that when ASA physical status was controlled for, patient's age was no longer the sole predictor of anesthesia-related mortality. "
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    • "Ceci a été confirmé par l'étude rétrospective des arrêts cardiaques survenus au CHU de Rouen de 1967 à 1970 [8] : la fréquence était de 1 pour 900 anesthésies chez l'enfant, 1 pour 1 200 anesthésies chez l'adulte. Cette différence a été rapportée plus récemment par l'enquête d'Olsson et Hallen [4] : 1,7 arrêt cardiaque pour 1 000 anesthésies chez l'enfant de moins de 1 an, 0,5 arrêt cardiaque pour 1 000 anesthésies entre 1 et 9 ans. En France, Tiret et coll [1] ont montré que pour 40 000 anesthésies pédiatriques, l'incidence globale d'arrêt cardiaque était de 0,3 pour 1 000 anesthésies avec un risque significativement plus élevé chez le nourrisson (1,9 pour 1 000 anesthésies) que chez l'enfant (0,2 pour 1 000 anesthésies). "
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