Anaesthetic mortality in cats: A worldwide analysis and risk assessment.

BACKGROUND: Patient safety is essential in small animal anaesthesia. This study aimed to assess anaesthesia-related deaths in cats worldwide, identify risk and protective factors and provide insights for clinical practice. METHODS: A prospective multicentre cohort study of 14,962 cats from 198 veterinary centres across different countries was conducted. Data on anaesthesia-related deaths, from premedication up to 48 hours postextubation, were collected. Logistic regression was used to analyse patient demographics, American Society of Anesthesiologists (ASA) classification, procedure type and anaesthetic drugs. RESULTS: The anaesthesia-related mortality was 0.63%, with 74.5% of deaths occurring postoperatively. Cats with cachexia, a higher ASA status or who underwent abdominal, orthopaedic/neurosurgical or thoracic procedures exhibited elevated mortality. Mechanical ventilation use was associated with increased mortality. Mortality odds were reduced by the use of alpha2-agonist sedatives, pure opioids in premedication and locoregional techniques. LIMITATIONS: Limitations include non-randomised sampling, potential biases, unquantified response rates, subjective death cause classification and limited variable analysis. CONCLUSIONS: Anaesthetic mortality in cats is significant, predominantly postoperative. Risk factors include cachexia, higher ASA status, specific procedures and mechanical ventilation. Protective factors include alpha2-agonist sedatives, pure opioids and locoregional techniques. These findings can help improve anaesthesia safety and outcomes. However, further research is required to improve protocols, enhance data quality and minimise risks.

Effects of anesthesia and perioperative management on mortality in geriatric orthopedic surgery: a retrospective study of 451 patients.

OBJECTIVE: We aimed to investigate the effects of anesthesia methods and perioperative procedures on mortality in geriatric patients operated for hip fracture. PATIENTS AND METHODS: This retrospective study included patients over 65 years of age who underwent hip fracture surgery. Demographic data, risk scores, perioperative and anesthesia management were analyzed in terms of mortality. RESULTS: Data from 451 patients who were eligible for the study were analyzed. It was determined that there was no difference in mortality between the anesthesia methods administered to the patients in hip fracture surgery (p>0.05).  Being male increased the mortality risk by 4.568 times (95% CI: 1.215-17.168), and a one-unit increase in the number of erythrocyte suspensions given perioperatively increased the mortality risk by 2.801 times (95% CI: 1.509-5.197). Additionally, an American Society of Anesthesiologists (ASA) II score increased the mortality risk by 0.120 times (95% CI: 0.021-0.690), and a higher modified Charlson comorbidity index (mCCI) of 5-7 increased the mortality risk by 0.052 times (95% CI: 0.009-0.289). CONCLUSIONS: Although high ASA and mCCI scores, male sex, and blood transfusion were associated with mortality in geriatric hip fracture surgery, we found that the method of anesthesia did not affect mortality.

A standard operating procedure for prehospital anaesthesia and its effect on mortality-An observational study.

BACKGROUND: Prehospital anaesthesia is a complex intervention performed for critically ill patients. To minimise complications, a standard operating procedure (SOP) outlining the process is considered valuable. We investigated the implementation of an SOP for prehospital anaesthesia in helicopter emergency medical services (HEMS). METHODS: We performed a retrospective observational study of patients receiving prehospital anaesthesia by Finnish HEMS from January 2012 to August 2019. The intervention studied was the implementation of an SOP at two of the five bases during 2015-2016. Patients were stratified according to whether they were anaesthetised before, during or after implementation and the primary outcomes were 1- and 30-day mortality. Secondary outcomes included anaesthesia quality indicators. Confounding factors was assessed via logistic regression. RESULTS: A total of 3902 tracheal intubations were performed without an SOP, 430 during implementation and 1525 after implementation. The SOP had a significant effect on 1-day mortality during implementation with an odds ratio (OR) of 0.56, 95% confidence interval (95% CI) 0.37-0.81 and a further trend towards benefit after implementation (OR 0.84, 95% CI 0.68-1.04), but no difference in 30-day mortality (OR after implementation 1.10, 95% CI 0.92-1.30). Implementation of an SOP improved first-pass success rate from 87.3% to 96.5%, p < 0.001. CONCLUSION: Implementation of an SOP for prehospital anaesthesia was associated with a trend towards lower 1-day mortality and an improved first-pass success but did not affect 30-day mortality. Despite this, we advocate prehospital systems to consider implementation of a prehospital anaesthesia SOP as immediate performance markers improved significantly.

Classificação anestésica do estado físico e mortalidade anestésico-cirúrgica em cães / Anesthetic classification of the physical status and surgical-anesthetic mortality in dogs

A classificação de estado físico ASA (Sociedade Americana de Anestesiologistas) é uma ferramenta importante para a avaliação pré-anestésica do paciente. Assim, é utilizada em diversos estudos por possuir estreita relação com a morbidade e a mortalidade anestésica. Realizou-se tal classificação em 243 pacientes caninos submetidos a procedimentos cirúrgicos em um Hospital Veterinário Universitário. Os resultados obtidos foram os seguintes: ASA I (38; 15,64%), ASA II (53; 21,81%), ASA II emergencial (E) (2; 0,82%), ASA III (78; 32,10%), ASA III E (23; 9,46%), ASA IV (11; 4,53%), ASA IV E (36; 14,81%) e ASA V (2; 0,82%). Verificou-se que a maior parte dos pacientes foram classificados como ASA III (doença sistêmica moderada), o que demonstra que, no serviço analisado, a maioria dos animais submetidos à cirurgia são portadores de enfermidades. A mortalidade foi de 2,46%, com a maioria dos óbitos ocorridos no pós-operatório e em pacientes com emergências. Concluiu-se que, no serviço analisado, os maiores riscos estão relacionados aos pacientes com categorias ASA de maior gravidade, em cirurgias emergenciais e, especialmente, no período pós-operatório.(AU)

The classification ASA (American Society of Anesthesiologists) is an important tool for assessing a patient's pre anesthetic. Thus, it is used in many studies because it has close relation with anesthetic morbidity and mortality. This classification was performed on 243 canine patients undergoing surgical procedures at the Veterinary Teaching Hospital. The results obtained were as follows: ASA I (38, 15.64%), ASA II (53; 21.81%), ASA II Emergency (E) (2; 0.82%), ASA III (78; 32.10%), ASA III E (23; 9.46%), ASA IV (11; 4.53 %), ASA IV E (36; 14.81%), and ASA V (2; 0.82%). Most patients were ASA III (moderate systemic disease), demonstrating that in the analyzed service the most operated animals are carriers of disease. The mortality rate was 2.46%, with most deaths occurring postoperatively and in patients with an emergency. The greatest risks are related to patients with more severe categories of the classification ASA, in emergency surgery, and especially in the postoperative period.(AU)

Morbimortalidad relacionada con el método anestésico en la fractura de cadera / Morbidity and mortality related to the anesthetic method in hip fracture

Fundamento: la fractura de cadera es la causa más frecuente de cirugía en mayores de 65 años, su incidencia ha aumentado y la mortalidad duplica a las personas de la misma edad, exceso este que se mantiene por años.Objetivos: evaluar el impacto del método anestésico, de las comorbilidades y del retraso en la cirugía en la mortalidad y estadía hospitalaria.Resultados: la media de edad fue 84 años ± 9,3 años. El 95 porciento eran hipertensos, el 51, 1 porciento cardiópata. El 42 porciento de los pacientes sufrió algún tipo de retraso para el proceder quirúrgico. El 51,1 porciento presentó complicaciones. La mortalidad global fue de 13 porciento. La anestesia general se asoció con aumento de la mortalidad (11 porciento) x2 =0,61, Odd Ratio= 8,6 y con aumento de las complicaciones posoperatorias (29porciento) x2 =0,77; Odd Ratio= 1,8. Las comorbilidades (84 porciento) de los pacientes se asociaron a un aumento en la mortalidad X2=0,67; Odd Ratio= 1.58. La estadía hospitalaria se prolongó luego de la anestesia general x2 =0,91; Odd Ratio= 7,7. El retraso para la intervención quirúrgica se asoció a un incremento en la mortalidad x2 =0,18; Odd Ratio= 8,9.Conclusiones: la anestesia neuroaxial redujo la mortalidad en el posoperatorio. La anestesia general se asoció con mayor número de complicaciones. Las enfermedades asociadas fueron un factor de riesgo de mortalidad posoperatoria. La estadía hospitalaria se prolongó luego de anestesia general. Otro factor que influyó en la mortalidad fue el retraso en la intervención quirúrgica (AU)

Background: hip fracture is the most frequent cause of surgery in patients older than 65. Its incidence has increased and mortality doubles in people of this age.Objectives: to assess the impact of the anesthetic method, of comorbidities and of the delay of surgery on mortality and hospital stay.Results: the average age was 84 years ± 9, 3 years. The 95 percent of the patients suffered from high blood pressure; the 51, 1percent presented heart diseases. The 42 percent of the patients suffered any type of delay of the surgery. The 51, 1 percent presented complications. Global mortality was of a 13 percent. General anesthesia was related to an increase in mortality (11 percent) x2 =0, 61, Odd Ratio= 8, 6 and an increase in the postoperative complications (29 percent) x2 =0.77; Odd Ratio= 1.8. The comorbidities (84 percent) of the patients were related to an increase in the mortality X2=0.67; Odd Ratio= 1.58. The hospital stay carried on after the general anesthesia x2 =0.91; Odd Ratio= 7.7. The delay of surgery was related to an increase in the mortality x2 =0.18; Odd Ratio= 8.9.Conclusions: neuraxial anesthesia reduced the mortality in the postoperative period. General anesthesia was related to a greater number of complications. The related diseases were a risk factor of postoperative mortality. The hospital stay carried on after the general anesthesia. Delay in the surgical procedure was another factor that influenced on the mortality (AU)

Utilidad de la criobiopsia en el diagnóstico de la enfermedad pulmonar intersticial difusa: análisis de rentabilidad y coste / Cryobiopsy in the Diagnosis of Diffuse Interstitial Lung Disease: Yield and Cost-Effectiveness Analysis

Introducción: En los pacientes con enfermedad pulmonar intersticial difusa (EPID) que presentan datos clínicos y radiológicos inconsistentes es recomendable la realización de una biopsia pulmonar quirúrgica (BPQ). La criobiopsia es una técnica endoscópica reciente menos invasiva que la BPQ que podría jugar un papel relevante en el diagnóstico de las EPID. El objetivo del presente estudio es analizar la rentabilidad diagnóstica, las complicaciones y los costes económicos derivados del uso de la criobiopsia en el diagnóstico de las EPID. Métodos: Estudio observacional retrospectivo en el que se incluyeron pacientes afectados de EPID tributarios de biopsia pulmonar, a los que se les practicaron criobiopsias desde enero de 2011 a enero de 2014. El procedimiento se realizó mediante videobroncoscopio, bajo anestesia general y ventilación mecánica. Se analizó la rentabilidad diagnóstica, las complicaciones producidas y los costes económicos derivados de esta técnica. Resultados: Se analizaron las muestras de criobiopsia de un total de 33 pacientes. Se obtuvo un diagnóstico específico en 26, lo que representa una rentabilidad diagnóstica del 79%. Cinco pacientes hubieran requerido BPQ para confirmación histológica, aunque en 4 de ellos no pudo realizarse por presentar comorbilidades graves. Las complicaciones más frecuentes fueron el neumotórax (12%) y el sangrado moderado (21%). No hubo complicaciones graves. Considerando que a los pacientes con diagnóstico específico se les evitó unaBPQ, la criobiopsia representó unahorro económico estimado dehasta 59.846 Euros. Conclusiones: La criobiopsia es una técnica segura y potencialmente útil en el diagnóstico de las EPID que permite, además, un ahorro económico considerable

Background: Assessment of patients with suspected interstitial lung disease (ILD) includes surgical lung biopsy (SLB) when clinical and radiological data are inconclusive. However, cryobiopsy is acquiring an important role in the ILD diagnostic process. The objective of this study was to evaluate the diagnostic yield, safety and economic costs of the systematic use of cryobiopsy in the assessment of patients with suspected ILD. Methods: This was a retrospective observational study of patients who had undergone transbronchial cryobiopsy for evaluation of ILD from January 2011 to January 2014. The procedures were performed with a video bronchoscope using a cryoprobe for the collection of lung parenchyma specimens, which were analyzed by pathologists. Diagnostic yield, complications and economic costs ofthis technique were analyzed Results: Criobiopsy specimens from a total of 33 patients were included. A specific diagnosis was obtained in 26, producing a diagnostic yield of 79%. In 5 patients, SLB was required for a histopathological confirmation of disease, but the procedure could not be performed in 4, due to severe comorbidities. The most frequent complications were pneumothorax (12%) and grade i (9%) or grade ii (21%) bleeding. There were no life-threatening complications. The systematic use of cryobiopsy saved up to 59,846 Euros. Conclusion: Cryobiopsy is a safe and potentially useful technique in the diagnostic assessment

Long-term admission to the intensive care unit: a cost-benefit analysis / Ingresos de larga duración en la unidad de cuidados intensivos: análisis de costo-beneficio

Objective. To assess outcomes in long-term ICU patients, with follow-ups carried out at one year post discharge, in order to calculate the costs incurred by the hospital in relation to the benefits gained. Material. Of 3639 patients consecutively admitted over the course of three years to ICU, 235 (6.5%) were assessed for the purposes of the study, having spent a period exceeding 20 days in intensive care. Method. The survey tool used was the Spanish Minimum Data Set (MDS). The length of ICU stay and hospital stay following discharge from ICU were calculated, and one year post discharge the patient/next of kin was contacted in order to carry out a follow-up survey on survival and functional status (according to GOS-E scale). Results. The 235 study patients had a mean stay of 37 days, occupied 34% of ICU beds available and consumed 29% of the ICU's economic resources ($14,400,175). Their stay on hospital wards was (mean) 33 days. Mortality in ICU and on hospital wards was 40% higher amongst older patients, and those with a higher APACHE II and Charlson index score. Mortality rates were three times higher among neurosurgical patients: mortality at follow-up was 25%, and only 21% recovered an acceptable functional status. Conclusions. Mortality rates in long-term ICU patients are high, both during their hospital stay and in the first year post discharge. Surviving patients (AU)

Objetivo. Evaluar los resultados de los pacientes de larga duración en la UCI por medio de un seguimiento al año del alta a fin de calcular los gastos soportados por el hospital en relación con los beneficios obtenidos. Materiales. de los 3.639 pacientes consecutivos ingresados en la UCI durante tres años, se evaluó a 235 (un 6,5%) para el presente estudio, todos ellos con una estancia superior a 20 días. Métodos. el instrumento de evaluación fue la base de datos española CMBD (conjunto mínimo de base de datos). Se calcularon la duración de la estancia en la UCI y en la planta después del alta de la UCI y, un año después del alta hospitalaria, se contactó con el paciente o su pariente más próximo para realizar una encuesta de seguimiento sobre su estado funcional (según la escala GOSE). Resultados. los 235 pacientes estudiados estuvieron ingresados un promedio de 37 días, ocuparon un 34% de las camas disponibles en la UCI y emplearon un 29% de los recursos económicos de dicha unidad (14.400.175$). Su estancia media en planta fue de 33 días. La mortalidad en la UCI y en planta fue un 40% más alta en los pacientes de mayor edad, puntuación del APACHE II e índice de Charlson. Las tasas de mortalidad se triplicaron en los pacientes neuroquirúrgicos. En el seguimiento después de un año, la tasa de mortalidad fue del 25%, y únicamente el 21% recuperó un estado funcional aceptable. Conclusiones. las tasas de mortalidad en pacientes de larga duración en la UCI son altas, tanto durante la estancia hospitalaria como durante el año posterior al alta. Los pacientes de larga duración no presentan una recuperación correcta y consumen una gran proporción de recursos económicos (AU)

Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn / Mortalidade precoce apos cirurgia neonatal: analise de fatores de risco em um sistema otimizado de prestacao de cuidados de saude ao recem-nascido cirurgico

OBJECTIVE: Anesthetic and operative interventions in neonates remain hazardous procedures, given the vulnerability of the patients in this pediatric population. The aim was to determine the preoperative and intraoperative factors associated with 30-day post-operative mortality and describe mortality outcomes following neonatal surgery under general anesthesia in our center. METHODS: Infants less than 28 days of age who underwent general anesthesia for surgery during an 11-year period (2000 - 2010) in our tertiary care pediatric center were retrospectively identified using the pediatric intensive care unit database. Multiple logistic regression was used to identify independent preoperative and intraoperative factors associated with 30-day post-operative mortality. RESULTS: Of the 437 infants in the study (median gestational age at birth 37 weeks, median birth weight 2,760 grams), 28 (6.4%) patients died before hospital discharge. Of these, 22 patients died within the first post-operative month. Logistic regression analysis showed increased odds of 30-day post-operative mortality among patients who presented American Society of Anesthesiologists physical status (ASA) score 3 or above (odds ratio 19.268; 95%CI 2.523 - 147.132) and surgery for necrotizing enterocolitis/gastrointestinal perforation (OR 5.291; 95%CI 1.962 - 14.266), compared to those who did not. CONCLUSION: The overall in-hospital mortality of 6.4% is within the prevalence reported for developed countries. Establishing ASA score 3 or above and necrotizing enterocolitis/gastrointestinal perforation as independent risk factors for early mortality in neonatal surgery may help clinicians to more adequately manage this high risk population. .

Elementos predictores en la evaluación del riesgo anestésico por el anestesiólogo / Prediction elements of the evaluation of anesthetic risk made by the anesthesiologist

Introducción: evaluar el riesgo anestésico-quirúrgico en un paciente que será intervenido quirúrgicamente no es tarea fácil para el anestesiólogo.Objetivo: hacer una puesta al día sobre los diferentes elementos predictores en la evaluación del riesgo anestésico por el anestesiólogo. Desarrollo: la evaluación preanestésica implica tener en consideración múltiples elementes entre ellos los inherentes al paciente. Existen varios índices multifactoriales, que combinan y asignan una importancia relativa a muchos parámetros clínicos y son más útiles que cualquier factor aislado para determinar el riesgo; sin embargo, tienen limitaciones. Conclusiones: se debe considerar diferentes elementos en la estimación del riego anestésico quirúrgico y partir de un grupo de estos factores de riesgo previamente seleccionados, para realizar estudios y determinar cuáles de ellos son los predictores de mortalidad y de complicaciones mayores(AU)

Background: the evaluation of the surgical and anesthetic risk for a patient that will undergo surgery is not an easy task for the anesthesiologist. Objective: to make an update on the different prediction elements for the evaluation of the anesthetic risk made by the anesthesiologist. Development: pre-anesthetic evaluation involves taking into consideration multiple elements, among them, the ones that are inherent to the patient. There are several multifactor indexes that combine and assign a relative importance to many clinical parameters and are more useful than any isolated factor to determine the risk; however, they have limitations. Conclusions: Different elements should be considered in estimating the surgical and anesthetic risk and, from a group of previously selected risk factors, studies should be developed to determine which of them are considered predictors for mortality and major complications(AU)

Incidência de parada cardíaca e mortalidade pediátrica durante a anestesia em hospital universitário de atendimento terciário no período de 2005 a 2010 / Pediatric cardiac arrest and mortality incidence in pediatric patients during anesthesia in a tertiary care university hospital from 2005 to 2010

A população pediátrica apresenta incidência mais elevada de parada cardíaca e de óbito perioperatório em relação à adulta. O objetivo do presente estudo foi avaliar a incidência, os fatores desencadeantes e as causas de parada cardíaca e de óbito em pacientes pediátricos durante a anestesia em hospital universitário de atendimento terciário no período de 2005 a 2010. Por meio de um Banco de Dados, o estudo prospectivo identificou a incidência de parada cardíaca e de óbito em 10.649 anestesias pediátricas. As incidências foram calculadas em relação aos atributos: faixa etária, sexo, estado físico segundo a ASA, tipo de atendimento, especialidade cirúrgica, técnica anestésica empregada e fatores desencadeantes (doença/condição do paciente, cirurgia e anestesia como fator principal ou fator contributivo). Foram identificadas 22 paradas cardíacas na sala de operações em crianças sendo que 11 evoluíram ao óbito. Maiores incidências de parada cardíaca ocorreram em pacientes neonatais e lactentes com estado físico ASA IV e V, em cirurgia de emergência durante anestesia geral ou em cuidados de monitorização e suporte e durante cirurgias cardíaca e vascular. A doença/condição do paciente foi o principal fator de parada cardíaca e de óbito. O índice de letalidade foi maior em crianças de 31 dias a um ano de idade, com estado físico ASA V, em cirurgia de emergência e em pacientes ASA V sob cuidados de monitorização e suporte e relacionado ao fator doença/condição do paciente. Ocorreram três paradas cardíacas por fator anestésico contributivo (2,81:10.000) todas em razão de causas respiratórias. Não houve óbito por fator anestésico. Em hospital de ensino de atendimento terciário, a incidência de parada cardíaca (20,65:10.000 anestesias) e de óbito (10,32:10.000 anestesias) em pacientes pediátricos durante a anestesia foi elevada...

Perioperative cardiac arrest and mortality incidences in children are higher than in adults. This study aimed to evaluate the incidence, causes, and outcomes of cardiac arrest and death in a pediatric surgical population during anesthesia in a tertiary care university hospital from 2005 to 2010. Cardiac arrest and death incidences during anesthesia in 10,649 anesthetics performed in children were identified from an anesthesia database. Cardiac arrest and death rates were calculated in relation to age, gender, ASA physical status classification, anesthesia provider information, surgical speciality, type of procedure and triggering factors (totally anesthesia-related; partially anesthesia-related; totally surgery-related; or totally child disease/condition-related). There were 22 cardiac arrests and 11 deaths in children during anesthesia. Major cardiac arrest and death incidences were observed in children under one year age; emergency surgery; ASA physical status IV or V; monitoring care and support in ASA V patients; and in cardiac and vascular procedures. Child disease/condition was the major cause of cardiac arrest or death. Lethality calculated rates were higher in 31 days - 1 year age children; emergency surgery; ASA V physical status; monitoring care and support in ASA V patients; and child disease/condition related. There were three cardiac arrests partially anesthesia-related (2,81:10.000). There were no anesthesia-related deaths. Respiratory classified events were the most common causes of anesthesia-related cardiac arrest. Cardiac arrest (20.65 per 10,000 anesthetics) and mortality (10.32 per 10,000 anesthetics) incidences were increased over a 6-year period in a tertiary teaching hospital. Anesthesia-related cardiac arrest incidence was 2.81 per 10,000 anesthetics...

Anestesia en cirugía torácica: un reto en el siglo XXI / No disponible

No disponible

Atelectasias perioperatorias y maniobras de reclutamiento alveolar / Peri-Operative Atelectasis and Alveolar Recruitment Manoeuvres

Las complicaciones respiratorias postoperatorias constituyen una causa importante de morbimortalidad. Las atelectasias perioperatorias, en concreto, afectan hasta al 90% de los pacientes quirúrgicos y su repercusión puede prolongarse en el tiempo en forma de alteraciones de la mecánica respiratoria, de la circulación pulmonar y de hipoxemia. El colapso alveolar se produce en presencia de ciertos factores predisponentes, fundamentalmente por mecanismos de compresión y absorción. Para prevenir o tratar estas atelectasias, se han propuesto diversas estrategias terapéuticas, como las maniobras de reclutamiento alveolar, cuyo uso se ha popularizado en los últimos años. Su aplicación en pacientes con colapso alveolar, pero sin lesión pulmonar aguda previa relevante, presenta ciertas particularidades, por lo que su empleo no está exento de incertidumbres y complicaciones. Esta revisión describe la frecuencia, la fisiopatología, la relevancia y el tratamiento de las atelectasias perioperatorias, y hace especial incidencia en el tratamiento con maniobras de reclutamiento con el objetivo de proporcionar las bases para un empleo racional y adecuado de éstas(AU)

Respiratory complications are a significant cause of post-operative morbidity and mortality. Peri-operative atelectasis, in particular, affects 90% of surgical patients and its effects can be prolonged, due to changes in respiratory mechanics, pulmonary circulation and hypoxaemia. Alveolar collapse is caused by certain predisposing factors, mainly by compression and absorption mechanisms. To prevent or treat these atelectasis several therapeutic strategies have been proposed, such as alveolar recruitment manoeuvres, which has become popular in the last few years. Its application in patients with alveolar collapse, but without a previous significant acute lung lesion, has some special features, therefore its use is not free of uncertainties and complications. This review describes the frequency, pathophysiology, importance and treatment of peri-operative atelectasis. Special attention is paid to treatment with recruitment manoeuvres, with the purpose of providing a basis for the their rational and appropriate use(AU)

Anestesia: morbilidad y mortalidad perioperatorias Hospital de San José, octubre y noviembre de 2007 / Anesthesia morbidity and mortality in the perioperative period San José Hospital, October and November 2007

Antecedentes: el Hospital de San José no tiene registros sobre morbimortalidad relacionada con anestesia en las cirugías realizadas en esta institución. Objetivo: describir la morbilidad y mortalidad perioperatorias relacionadas con la anestesia en pacientes sometidos a cirugía electiva en el Hospital de San José durante octubre y noviembre de 2007. Métodos: estudio observacional descriptivo longitudinal, donde los desenlaces de interés fueron morbilidad y mortalidad perioperatorias relacionadas con anestesia. Resultados: se incluyeron 727 pacientes programados para cirugía electiva. La edad promedio fue 44.5 años (DE 16.0), se caracterizaron por ser clase funcional I (69,9%), clasificación ASA I en 51,1%, vía aérea fácil en 85% de los pacientes y sometidos a cirugía electiva categoría quirúrgica A (50,7%) y B (43%). No se presentó mortalidad y el evento adverso más frecuente fue arritmia (23 casos) 3,1%, la mayoría en pacientes en buenas condiciones clínicas. Conclusiones: las arritmias y demás eventos adversos observados en pacientes con buenas condiciones clínicas preanestésicas, sugieren profundizar estrategias como la mejor evaluación preanestésica, para disminuir la morbilidad relacionada con anestesia.

Antecedents: Hospital de San José has no records on anesthesia-related morbidity and mortality rates in surgical procedures conducted at this institution. Objective: to describe anesthesia-related morbidity and mortality rates in the perioperative period of patients who underwent elective surgical procedures at Hospital de San José during October and November 2007. Methods: a longitudinal obsevational descriptive study was conducted. Outcomes of interest were the anesthesia-related morbidity and mortality rates during the perioperative period. Results: a sample of 727 patients scheduled for elective surgical procedures was included. The mean age was 44.5 years (OF 16.0) and patients were categorized in, functional class I (69,9%), ASA classification I 51,1%, easy airway management 85% and those who underwent elective surgery category A (50,7%) and B (43%). No mortality occured and the main adverse event was arrythmia (23 cases) 3,1%, the majority in healthy patients. Conclusions: arrhytmias and other adverse events observed in patients in good preanesthetic medical condition suggest in-depth assessment strategies as the best preanesthetic evaluation in order to ameliorate anesthesia-related morbidity.

Anaesthetic morbidity at the University Hospital of the West Indies / Morbilidad anestésica en el Hospital Universitario de West Indies: un estudio transversal prospectivo

OBJECTIVE: There is little information on adverse anaesthetic outcomes from the Caribbean. The aim of this study was to investigate the occurrence of anaesthetic morbidity and mortality at the University Hospital of the West Indies (UHWI) and to identify possible risk factors. METHODS: All anaesthetic procedures at the UHWI were monitored for adverse events and patient outcomes for the 12-month period from March 2004 to February 2005. Possible risk factors for these adverse events were assessed using logistic regression. RESULTS: Of 3185 anaesthetic proceduress, the incidence of intra-operative events was 201 per 1000 (95% CI 187, 215); 151 per 1000 being cardiovascular and 26 per 1000 respiratory. Others included excess blood loss and equipment failure, hyperglycaemia, nausea and vomiting. Patients with intraoperative complications were three times more likely to have complications during recovery (OR = 3.35; 95% CI 2.59, 4.33, p < 0.001). The incidence of complications among paediatric patients was 139 per 1000 (95% CI 104, 174) intra-operatively and 58 per 1000 (95% CI 34, 81) during recovery. Risk factors for developing complications (p < 0.05) included age > 50 years, ASA status > II, prolonged anaesthesia, high surgical risk, general or combined anaesthetic techniques, senior anaesthetist, intubated patients and co-morbidities. There were 14 operative mortalities, none of which was anaesthesia-related. CONCLUSION: Anaesthetic complication rates at the UHWI are comparable to those in developed countries, except for higher paediatric complication rates and ICU admissions and lower rates of postoperative nausea and vomiting.

OBJETIVO: Existe poca información sobre resultados anestésicos adversos en el Caribe. El propósito del presente estudio fue investigar la manifestación de la morbilidad y la mortalidad anestésicas en el Hospital Universitario de West Indies (UHWI) e identificar los posibles factores de riesgo. MÉTODOS: Todos los procedimientos anestésicos en el UHWI fueron monitoreados en busca de eventos adversos y resultados con los pacientes, durante un período de 12 meses a partir de marzo del 2004. Los posibles factores de riesgo para estos eventos adversos fueron evaluados mediante regresión logística. RESULTADOS: De 3185 procedimientos anestésicos, la incidencia de eventos intraoperatorios fue de 201 por 1000 (95% CI 187, 215); siendo 151 por 1000 cardiovasculares y 26 por 1000 respiratorios. Otros incluyeron exceso en pérdida de sangre y fallo de equipos, hiperglicemia, náusea, y vómitos. Los pacientes con complicaciones intraoperatorias presentaron una probabilidad de complicaciones tres veces mayor en la fase de recuperación (OR = 3.35; 95% CI 2.59, 4.33, p < 0.001). La incidencia de complicaciones entre pacientes pediátricos fue 139 por 1000 (95% CI 104, 174) intraoperatoriamente y 58 por 1000 (95% CI 34, 81) durante la recuperación. Entre los factores de riesgo que desarrollaban complicaciones (p < 0.05) se hallaban: la edad > 50 años, estatus de ASA > II, anestesia prolongada, alto riesgo quirúrgico, técnicas anestésicas combinadas o generales, anestesiólogos de la tercera edad, pacientes entubados, y comorbilidades. Se produjeron 14 mortalidades operatorias, ninguna de las cuales guardó relación con la anestesia. CONCLUSIÓN: Las tasas de complicación anestésica en UHWI son comparables a las que se producen en países desarrollados, excepto por las tasas de complicación pediátrica más altas, mayor número de ingresos a las UCIs, y tasas más bajas de náuseas y vómitos postoperatorios.

Mortality in anesthesia: a systematic review

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.