Cardiac arrest during anaesthesia. A computer-aided study in 250 543 anaesthetics
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.
Available from: Hiroyoshi Kawaai
- "From the 1950s to the 1990s, the mortality caused by general anesthesia plummeted from 1/2,860 to 1/400,000 respectively.22,23 The mortality caused by local anesthesia is approximately 7 times higher than that caused by general anesthesia.24 "
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ABSTRACT: From a retrospective evaluation of data on accidents and deaths during dental procedures, it has been shown that several patients who refused dental treatment died of asphyxia during dental procedures. We speculated that forcible maximum opening of the mouth by using a mouth prop triggers this asphyxia by affecting the upper airway. Therefore, we assessed the morphological changes of the upper airway following maximal opening of the mouth. In 13 healthy adult volunteers, the sagittal diameter of the upper airway on lateral cephalogram was measured between the two conditions; closed mouth and maximally open mouth. The dyspnea in each state was evaluated by a visual analog scale. In one subject, a computed tomograph (CT) was taken to assess the three-dimensional changes in the upper airway. A significant difference was detected in the mean sagittal diameter of the upper airway following use of the prop (closed mouth: 18.5 +/- 3.8 mm, maximally open mouth: 10.4 +/- 3.0 mm). All subjects indicated upper airway constriction and significant dyspnea when their mouth was maximally open. Although a CT scan indicated upper airway constriction when the mouth was maximally open, muscular compensation was admitted. Our results further indicate that the maximal opening of the mouth narrows the upper airway diameter and leads to dyspnea. The use of a prop for the patient who has communication problems or poor neuromuscular function can lead to asphyxia. When the prop is used for patient refusal in dentistry, the respiratory condition should be monitored strictly, and it should be kept in mind that the "sniffing position" is effective for avoiding upper airway constriction. Practitioners should therefore consider applying not only systematic desensitization, but also general anesthesia to the patient who refuses treatment, because the safety of general anesthesia has advanced, and general anesthesia may be safer than the use of a prop and restraints.
Therapeutics and Clinical Risk Management 05/2010; 6:239-48. · 1.47 Impact Factor
Available from: Luciano Fernandes
- "In these reports, the definitions for deaths in which anesthesia was the primary or a contributing cause3–35 varied widely, as did the time windows for the considered perioperative period. The perioperative period has been defined as intraoperative only,12,14,16,24,33 intraoperative and recovery from anesthesia,24,29,31 the first 12 postoperative hours,34 the first 24 postoperative hours,5,7,8,11,13,18,20,22,26,28,30,32,33 two or three postoperative days,3,9,10,17,35 or seven postoperative days.6,19,21,23,25 Furthermore, mortality incidence may depend on the surgical population. "
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ABSTRACT: This systematic review of the Brazilian and worldwide literature aims to evaluate the incidence and causes of perioperative and anesthesia-related mortality. Studies were identified by searching the Medline and Scielo databases, followed by a manual search for relevant articles. Our review includes studies published between 1954 and 2007. Each publication was reviewed to identify author(s), study period, data source, perioperative mortality rates, and anesthesia-related mortality rates. Thirty-three trials were assessed. Brazilian and worldwide studies demonstrated a similar decline in anesthesia-related mortality rates, which amounted to fewer than 1 death per 10,000 anesthetics in the past two decades. Perioperative mortality rates also decreased during this period, with fewer than 20 deaths per 10,000 anesthetics in developed countries. Brazilian studies showed higher perioperative mortality rates, from 19 to 51 deaths per 10,000 anesthetics. The majority of perioperative deaths occurred in neonates, children under one year, elderly patients, males, patients of ASA III physical status or poorer, emergency surgeries, during general anesthesia, and cardiac surgery followed by thoracic, vascular, gastroenterologic, pediatric and orthopedic surgeries. The main causes of anesthesia-related mortality were problems with airway management and cardiocirculatory events related to anesthesia and drug administration. Our systematic review of the literature shows that perioperative mortality rates are higher in Brazil than in developed countries, while anesthesia-related mortality rates are similar in Brazil and in developed countries. Most cases of anesthesia-related mortality are associated with cardiocirculatory and airway events. These data may be useful in developing strategies to prevent anesthesia-related deaths.
Clinics (São Paulo, Brazil) 10/2009; 64(10):999-1006. DOI:10.1590/S1807-59322009001000011 · 1.19 Impact Factor
Available from: Mario A Svirsky
- "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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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 · 2.84 Impact Factor
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