Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a predictive risk model (AEGEP Study) / Eventos adversos relacionados con procedimientos endoscópicos gastrointestinales en niños bajo cuidado anestésico: modelo predictivo de riesgo (estudio AEGEP)

Background. Multiple studies have analyzed perioperative factors related to adverse events (AEs) in children who require gastrointestinal endoscopic procedures (GEP) in settings where deep sedation is the preferred anesthetic technique over general anesthesia (GA) but not for the opposite case. Methods. We reviewed our anesthesia institutional database, seeking children less than 12 years who underwent GEP over a 5-year period. A logistic regression was used to determine significant associations between preoperative conditions, characteristics of the procedure, airway management, anesthetic approaches and the presence of serious and non-serious AEs. Results. GA was preferred over deep sedation [77.8% vs. 22.2% in 2178 GEP under anesthesia care (n = 1742)]. We found 96 AEs reported in 77 patients, including hypoxemia (1.82%), bronchospasm (1.14%) and laryngospasm (0.91%) as the most frequent. There were 2 cases of severe bradycardia related to laryngospasm/hypoxemia and a case of aspiration resulting in unplanned hospitalization, but there were no cases of intra- or postoperative deaths. Final predictive model for perioperative AEs included age <1 year, upper respiratory tract infections (URTI) <1 week prior to the procedure and low weight for the age (LWA) as independent risk factors and ventilation by facial mask as a protector against these events (p < 0.05). Conclusions. AEs are infrequent and severe ones are remote in a setting where AG is preferred over deep sedation. Ventilatory AEs are the most frequent and depend on biometrical and comorbid conditions more than anesthetic drugs chosen. Age <1 year, history of URTI in the week prior to the procedure and LWA work as independent risk factors for AEs in these patients (AU)

Antecedentes. Múltiples estudios han analizado los eventos adversos (EA) relacionados con procedimientos endoscópicos gastrointestinales (PEG) en niños cuando la sedación profunda es la técnica preferida sobre la anestesia general pero no en el caso contrario. Métodos. Revisamos nuestra base de datos en busca de niños < 12 años sometidos a PEG bajo cuidado anestésico durante un periodo de 5 años. Se registraron las condiciones preoperatorias, las características del procedimiento, el manejo de la vía aérea y los enfoques anestésicos y se construyó un modelo de regresión logística para determinar su relación con EAs grave y no graves. Resultados. La anestesia general fue preferida sobre la sedación (77,8 frente a 22,2% en 2.178 PEG bajo cuidado anestésico [n = 1742]). Se encontraron 96 EA en 77 pacientes, incluyendo hipoxemia (1,82%), broncoespasmo (1,14%) y laringoespasmo (0,91%) como los más frecuentes. Hubo 2 casos de bradicardia severa relacionada con laringoespasmo/hipoxemia y un caso de aspiración que resultó en hospitalización no planeada, pero no se registraron casos de muertes intraoperatorias o posoperatorias. La edad < 1 año, infecciones del tracto respiratorio superior < 1 semana antes del procedimiento y bajo peso para la edad (BPE) se identificaron como factores de riesgo independientes, y la ventilación con mascarilla facial, como factor protector (p < 0,05). Conclusiones. En niños bajo cuidado anestésico para PEG, los EAs en general son poco frecuentes en un entorno donde se prefiere la anestesia general. Estos son usualmente de tipo ventilatorio y dependen primordialmente de condiciones mórbidas y biométricas, independientemente de los fármacos anestésicos elegidos. La edad < 1 año, el antecedente de infecciones del tracto respiratorio superior en la semana previa al procedimiento y el bajo peso para la edad son factores de riesgo independientes para EA en estos pacientes (AU)

Adverse events related to gastrointestinal endoscopic procedures in pediatric patients under anesthesia care and a predictive risk model (AEGEP Study).

BACKGROUND: Multiple studies have analyzed perioperative factors related to adverse events (AEs) in children who require gastrointestinal endoscopic procedures (GEP) in settings where deep sedation is the preferred anesthetic technique over general anesthesia (GA) but not for the opposite case. METHODS: We reviewed our anesthesia institutional database, seeking children less than 12 years who underwent GEP over a 5-year period. A logistic regression was used to determine significant associations between preoperative conditions, characteristics of the procedure, airway management, anesthetic approaches and the presence of serious and non-serious AEs. RESULTS: GA was preferred over deep sedation [77.8% vs. 22.2% in 2178 GEP under anesthesia care (n=1742)]. We found 96 AEs reported in 77 patients, including hypoxemia (1.82%), bronchospasm (1.14%) and laryngospasm (0.91%) as the most frequent. There were 2 cases of severe bradycardia related to laryngospasm/hypoxemia and a case of aspiration resulting in unplanned hospitalization, but there were no cases of intra- or postoperative deaths. Final predictive model for perioperative AEs included age <1 year, upper respiratory tract infections (URTI) <1 week prior to the procedure and low weight for the age (LWA) as independent risk factors and ventilation by facial mask as a protector against these events (p<0.05). CONCLUSIONS: AEs are infrequent and severe ones are remote in a setting where AG is preferred over deep sedation. Ventilatory AEs are the most frequent and depend on biometrical and comorbid conditions more than anesthetic drugs chosen. Age <1 year, history of URTI in the week prior to the procedure and LWA work as independent risk factors for AEs in these patients.

[A mortality study in the Internal Medicine Emergency Service of October 12 Hospital during 1989]. / Estudio de mortalidad en el Servicio de Urgencias de Medicina Interna del Hospital 12 de Octubre durante 1989.

152,902 patients were attended at the Emergency Department of "12 de Octubre" Hospital during 1989; 48,701 of them were seen in the Internal Medicine area. 196 dead, 164 case histories were selected in order to fulfil the protocol. Several variants were analysed, such as age, sex, diagnosis, time spent at the hospital, quality of life, date, etc. 53.6% were male; the median age was 73 years and the overall median age of all patients seen was 55.9 years. Median Karnovsky was 52.50% of the patients died during their first 5 hours at the Emergency Department. The most frequent diagnoses for the area were neurological, followed by cardiovascular, oncological, digestive, etc. The most frequent diseases observed were cerebrovascular accident, cardiac insufficiency and acute infarction, oncological cases and death on arrival. Mortality was higher in winter. On the whole, mortality was higher in oncology patients followed way behind by neurology digestive and cardiovascular patients.