Cardiac arrest during anaesthesia. A computer-aided study in 250 543 anaesthetics
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.
- SourceAvailable from: Mario A Svirsky
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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. "
ABSTRACT: Since the advent of cochlear implants, age at implantation has declined as investigators report greater benefit the younger a child is implanted. Infants younger than 12 mos currently are excluded from Food and Drug Administration clinical trials, but have been implanted with Food and Drug Administration-approved devices. With a chance that an infant without profound hearing loss could be implanted because of the limitations of the diagnostic measures used with this population and the potential for additional anesthetic risks to infants younger than 1-yr-old, it is prudent to evaluate benefit in the youngest cochlear implant recipients. The goals of this research were to investigate whether significant gains are made by children implanted before 1-yr-old relative to those implanted at later ages, while controlling for potential covariates, and whether there is behavioral evidence for sensitive periods in spoken language development. It was expected that children implanted before age 1 yr would have more advanced spoken language skills than children implanted at later ages; there would be a negative relationship between age at implantation and rate of spoken language development, allowing for an examination of the effects of sensitive periods in spoken language development; and these trends would remain despite accounting for participant characteristics and experiences that might influence spoken language outcomes. Ninety-six children with congenital profound sensorineural hearing loss bilaterally and no additional identified disabilities who were implanted before the age of 4 yrs were stratified into four groups based on age at implantation. Children's spoken language development was followed for at least 2 yrs after device activation. Spoken language scores and rate of development were evaluated along with four covariates (unaided pure-tone average, communication mode, gender, and estimated family income) as a function of age at implantation. In general, the developmental trajectories of children implanted earlier were significantly better than those of children implanted later. However, the advantage of implanting children before 1-yr old versus waiting until the child was between 1 and 2 yrs was small and only was evident in receptive language development, not expressive language or word recognition development. Age at implantation did not significantly influence the rate of the word recognition development, but did influence the rate of both receptive and expressive language acquisition: children implanted earlier in life had faster rates of spoken language acquisition than children implanted later in life. Although in general earlier cochlear implantation led to better outcomes, there were few differences in outcome between the small sample of six children implanted before 12 mos of age and those implanted at 13 to 24 mos. Significant performance differences remained among the other age groups despite accounting for potential confounds. Further, oral language development progressed faster in children implanted earlier rather than later in of life (up to age 4 yrs), whereas the rate of open-set speech recognition development was similar. Together, the results suggest that there is a sensitive period for spoken language during the first 4 yrs of life, but not necessarily for word recognition development during the same period.Ear and hearing 09/2008; 29(4):492-511. DOI:10.1097/AUD.0b013e31816c409f · 2.83 Impact Factor
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- "0 ' 0.02- 0.01 - 0.00 <1 1-10 11-20 21-30 31-40 41-60 >60 Age Range (years) Jastak and Peskin 43 I 44 Analysis of Morbidity/Mortality Anesth Prog 38:39-44 1991 Table 10. ASA Status Versus Anesthesia Caused Cardiac Arrest or Death ASA Class 1 2 3/4 Eventa Anesthetic Cases Author/Year 0 9 10 D 11,925 Bradley, et al, 198815 11 53 46 CA 250,543 Olsson & Hallen, 19887 4 8 9 CA 113,074 Chopra, et al, 199016 "
ABSTRACT: A closed-claim analysis of anesthetic-related deaths and permanent injuries in the dental office setting was conducted in cooperation with a leading insurer of oral and maxillofacial surgeons and dental anesthesiologists. A total of 13 cases occurring between 1974 and 1989 was included. In each case, all available records, reports, depositions, and proceedings were reviewed. The following were determined for each case: preoperative physical status of the patient, anesthetic technique used (classified as either general anesthesia or conscious sedation), probable cause of the morbid event, avoidability of the occurrence, and contributing factors important to the outcome. The majority of patients were classified as American Society of Anesthesiologists (ASA) status II or III. Most patients had preexisting conditions, such as gross obesity, cardiac disease, epilepsy, and chronic obstructive pulmonary disease, that can significantly affect anesthesia care. Hypoxia arising from airway obstruction and/or respiratory depression was the most common cause of untoward events, and most of the adverse events were determined to be avoidable. The disproportionate number of patients in this sample who were at the extremes of age and with ASA classifications below I suggests that anesthesia risk may be significantly increased in patients who fall outside the healthy, young adult category typically treated in the oral surgical/dental outpatient setting.Anesthesia Progress 38(2):39-44.
- "Ceci a été confirmé par l'étude rétrospective des arrêts cardiaques survenus au CHU de Rouen de 1967 à 1970  : 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  : 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  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). "