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Panditrao MM, Panditrao MM. "Burnout syndrome" in anesthesiologists and remedial measures- A narrative review. J Anaesthesiol Clin Pharmacol 2024; 40:206-216. [PMID: 38919431 PMCID: PMC11196043 DOI: 10.4103/joacp.joacp_322_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 06/27/2024] Open
Abstract
Anesthesiology, as an occupation, has its own unique sets of challenges, problems, issues, and circumstances, all leading to "occupational stress," which by now should be unequivocally accepted as a well-established fact. It is futile to continue pursuing research questions like, if there "really" is stress existing among practicing anesthesiologists/trainees, by conducting questionnaire-based surveys and doing meta-analyses. A significantly high incidence of existence of occupational stress in anesthesiologists is an undisputable and practical reality, which, when longstanding, gets culminated into "burnout syndrome" with its disastrous outcomes. Rather than pursuing the often-trodden path of finding the incidence, sources, and other superficial issues, an in-depth study of available literary evidence in relation to burnout has been carried out. Objectifying it as a "syndrome," its etiopathogenesis, pathophysiology inclusive of the prevalent theories of its causality, typology, and progression into various stages of/continuum of the process as an evolving clinical entity have been described. The preventive measures and "coping strategies" have been discussed at length in the end. It is the fervent hope and the desire of the authors that this discourse will sensitize all anesthesiologists, especially the younger and upcoming future generation, and help them avoid becoming a prey to this dreadful entity!
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Affiliation(s)
- Mridul M. Panditrao
- Department of Anaesthesiology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Minnu M. Panditrao
- Department of Anaesthesiology, Adesh Institute of Medical Sciences and Research (AIMSR), Bathinda, Punjab, India
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Wang Y, Wang J, Ye X, Xia R, Ran R, Wu Y, Chen Q, Li H, Huang S, Shu A, Yang L, Qin B, Dong W, Xia Z, Zhang Z, Wan L, Peng X, Liu J, Wang Z, Wang Y, Yin P, Chen X, Yao S. Anaesthesia-related mortality within 24 h following 9,391,669 anaesthetics in 10 cities in Hubei Province, China: a serial cross-sectional study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100787. [PMID: 37693877 PMCID: PMC10485673 DOI: 10.1016/j.lanwpc.2023.100787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 09/12/2023]
Abstract
Background The mortality risk related to anaesthesia in China remains poorly characterized. The objective of this study was to evaluate the anaesthesia-related mortality in terms of its incidence, changes, causes and preventability in Hubei, China, between 2017 and 2021 using a series of annual surveys. Methods We prospectively collected information on patient, surgical, anaesthesia, and hospital characteristics for 9,391,669 anaesthesia procedures performed between 2017 and 2021 in 10 cities within Hubei Province, China. Anaesthesia-related death was defined as death that deemed to be entirely or partially attributable to anaesthesia, occurring within 24 h following anaesthesia administration. All fatalities were scrutinized consecutively to determine their root causes and preventability. The incidence and patterns of anaesthesia-related deaths were analysed from 2017 to 2021. A mixed-effects model with a Poisson link function was fitted to evaluate the city-level annual changes in risk-adjusted incidence of anaesthesia-related deaths. Findings 600 cases of anaesthetic deaths occurred from 2017 to 2021, yielding an incidence of 6.4 per 100,000 anaesthesia procedures [95% confidence interval (95% CI): 5.9, 6.9], and most were preventable (71.3%). There was a significant decrease from 2017 to 2021, in the incidences of anaesthesia-related death across all patients, those with American Society of Anaesthesiologists physical status (ASAPS) ≥III, and those who had general anaesthesia, with a percentage reduction of 57.6%, 59.1%, and 55.9%, respectively. The risk-adjusted annual changes indicated significant downward trends for the incidence of anaesthetic mortality from 2017 to 2018, 2019, 2020, and 2021. For instance, the risk-adjusted annual changes for the anaesthetic mortality incidence from 2017 to 2021 was -2.5 (95% CI: -1.4, -4.7). Interpretation In this large, comprehensive database study conducted in Central China, the anaesthesia-related death incidence was 6.4 per 100,000. Notably, the incidence of anaesthesia-related deaths decreased between 2017 and 2021. However, further in-depth analysis is needed to understand the extent to which these trends represent a change in patient safety. Funding Innovation and optimization of perioperative respiratory system management strategy (Hubei Technological Innovation Special Fund, 2019ACA167).
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Affiliation(s)
- Yu Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Jie Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Xihong Ye
- Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Rui Xia
- Department of Anesthesiology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Ran Ran
- Department of Anesthesiology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Yaohua Wu
- Department of Anesthesiology, Huanggang Central Hospital, Huanggang, China
| | - Qinghong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Haopeng Li
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Shiqian Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Aihua Shu
- Department of Anesthesiology, The First People's Hospital of Yichang, Yichang, China
| | - Longqiu Yang
- Department of Anesthesiology, The Central Hospital of Huangshi, Huangshi, China
| | - Bin Qin
- Department of Anesthesiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
| | - WenLi Dong
- Department of Anesthesiology, The Central Hospital of Xianning, Xianning, China
| | - Zhongyuan Xia
- Department of Anesthesiology, People's Hospital of Wuhan University, Wuhan, China
| | - Zongze Zhang
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Li Wan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohong Peng
- Department of Anesthesiology, Wuhan Fourth Hospitail, Wuhan, China
| | - Juying Liu
- Department of Anesthesiology, Shiyan Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zaiping Wang
- Department of Anesthesiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
| | - Yanlin Wang
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
| | - Shanglong Yao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, China
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Yap R, Wilkins S, Asghari-Jafarabadi M, Oliva K, Wang WC, Centauri S, McMurrick PJ. Factors affecting the post-operative outcomes in patients aged over 80 following colorectal cancer surgery. Int J Colorectal Dis 2023; 38:11. [PMID: 36633697 PMCID: PMC9836984 DOI: 10.1007/s00384-022-04291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE In 2019, in Australia, there were 500,000 people aged 85 and over. Traditionally, clinicians have adopted the view that surgery is not desirable in this cohort due to increasing perioperative risk, perceived minimal clinical benefit, and shortened life expectancy. This cohort study is aimed at investigating postoperative outcomes from elective and non-elective colorectal cancer surgery in patients aged 80 and over. METHODS A retrospective analysis was conducted on patients from 2010 to 2020 on a prospectively maintained colorectal database. Patients aged over 80 who underwent surgical resection for colorectal cancer were reviewed. Oncological characteristics, short-term outcomes, overall survival, and relapse-free survival rates were analysed. RESULTS A total of 832 patients were identified from the database. Females comprised 55% of patients aged 80 and above. The median age was 84 for octogenarians and 92 for nonagenarians. Most patients were ASA 2 (212) or ASA 3 (501). ASA 3 and 4 and stage III pathology were associated with higher postoperative complications. Fifty percent of over 80 s and 37% of over 90 s were surgically discharged to their own home. Overall survival at 30, 180, and 360 days and 5 years was 98.1%, 93.1%, 87.2%, and 57.2% for the over 80 s and 98.1%, 88.9%, 74.9%, and 24.4% for the over 90 s. CONCLUSION Our results demonstrate that surgical treatment of older patients is safe with acceptable short-, medium-, and long-term survival. Nonetheless, efforts are needed to reduce the rates of complications in older patients, including utilisation of multi-disciplinary teams to assess the optimal treatment strategy and postoperative care.
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Affiliation(s)
- Raymond Yap
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, 3144, Australia
| | - Simon Wilkins
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, 3144, Australia.
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Hospital, Malvern, VIC, 3144, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Karen Oliva
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, 3144, Australia
| | - Wei Chun Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- Cabrini Research, Cabrini Hospital, Malvern, VIC, 3144, Australia
| | - Suellyn Centauri
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, 3144, Australia
| | - Paul J McMurrick
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, 3144, Australia
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Messina A, La Via L, Milani A, Savi M, Calabrò L, Sanfilippo F, Negri K, Castellani G, Cammarota G, Robba C, Morenghi E, Astuto M, Cecconi M. Spinal anesthesia and hypotensive events in hip fracture surgical repair in elderly patients: a meta-analysis. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2022; 2:19. [PMID: 37386657 DOI: 10.1186/s44158-022-00047-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/20/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND Spinal anesthesia (SA) is widely used for anesthetic management of patients undergoing hip surgery, and hypotension is the most common cardiovascular side effect of SA. This paper aims to assess the lowest effective dose of SA that reduces the occurrence of intraoperative hypotension in elderly patients scheduled for major lower limb orthopedic surgery. METHODS We conducted a systematic review of randomized controlled trials (RCTs) performed in elderly patients scheduled for surgical hip repair and a meta-analysis with meta-regression on the occurrence of hypotensive episodes at different effective doses of anesthetics. We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials registered. RESULTS Our search retrieved 2085 titles, and after screening, 6 were finally included in both the qualitative and quantitative analysis, including 344 patients [15% (10-28) males], with a median (25th to 75th interquartile) age of 82 (80-85). The risk of bias assessment reported "low risk" for 5 (83.3%) and "some concerns" for 1 (16.7%) of the included RCTs. The low dose of SA of [mean 6.5 mg (1.9)] anesthetic was associated with a lower incidence of hypotension [OR = 0.09 (95%CI 0.04-0.21); p = 0.04; I2 = 56.9%], as compared to the high-dose of anesthetic [mean 10.5 mg (2.4)]. CONCLUSIONS In the included studies of this meta-analysis, a mean dose of 6.5 mg of SA was effective in producing intraoperative comfort and motor block and associated with a lower incidence of hypotension as compared to a mean dose of 10.5 mg. TRIAL REGISTRATION CRD42020193627.
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Affiliation(s)
- Antonio Messina
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Angelo Milani
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | - Marzia Savi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | - Lorenzo Calabrò
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Katerina Negri
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
| | | | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care Medicine, Maggiore della Carità University Hospital, Novara, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Emanuela Morenghi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center - IRCCS, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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Aloweidi A, Alghanem S, Bsisu I, Ababneh O, Alrabayah M, Al-Zaben K, Qudaisat I. Perioperative Cardiac Arrest: A 3-Year Prospective Study from a Tertiary Care University Hospital. Drug Healthc Patient Saf 2022; 14:1-8. [PMID: 35046730 PMCID: PMC8759986 DOI: 10.2147/dhps.s332162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/13/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Perioperative cardiac arrests (CAs) are a rare but catastrophic perioperative complication. Much about incidence, risk factors, and outcomes of such events are still unknown. This study investigated anesthesia-related CAs at a tertiary teaching hospital. Methods CA incidence within 24 hours of anesthesia administration was prospectively identified from May 1, 2016 to April 31, 2019. Each CA was matched by four other cases without CA receiving anesthesia on the same date and under similar operating conditions. The CA cases were reviewed and assigned to one of three groups: anesthesia-related, anesthesia-contributing, and anesthesia not related. Results A total of 58,303 patients underwent 73,557 procedures under anesthesia during the study period. In sum, 27 CAs were reported for incidence of 3.7 per 10,000 anesthesia administrations (95% CI 2.3–5.1). Eleven CA were anesthesia-related for incidence of 1.5 per 10,000 anesthesia administrations. Four CA cases were anesthesia-contributing for incidence of 0.5 per 10,000 anesthesia administrations, while 53% of the anesthesia-related and -contributing CAs were due to respiratory problems. American Society of Anesthesiologists (ASA) physical status score, cardiovascular surgery, emergency surgery, and increased duration of surgery were significantly correlated with CA incidents when compared to the control group. ASA physical status score is an independent risk factor of the occurrence of perioperative CA (OR 7.6, 95% CI 2.6–22.4; P<0.001). Conclusion Identifying factors associated with increased risk for anesthesia-related CA is of great importance in risk stratification for surgical patients. ASA physical status score was found to be a major factor in predicting perioperative CA, since patients with higher ASA scores had a statistically significant increased risk of CA. Therefore, extra precautions must be taken when dealing with unprepared patients who have uncontrolled medical illnesses, especially those who will be undergoing emergency surgery.
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Affiliation(s)
- Abdelkarim Aloweidi
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Subhi Alghanem
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Isam Bsisu
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Omar Ababneh
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mustafa Alrabayah
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Khaled Al-Zaben
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Ibraheem Qudaisat
- Department of Anesthesia and Intensive Care, School of Medicine, The University of Jordan, Amman, 11942, Jordan
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Blaise Pascal FN, Malisawa A, Barratt-Due A, Namboya F, Pollach G. General anaesthesia related mortality in a limited resource settings region: a retrospective study in two teaching hospitals of Butembo. BMC Anesthesiol 2021; 21:60. [PMID: 33622245 PMCID: PMC7901086 DOI: 10.1186/s12871-021-01280-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/15/2021] [Indexed: 12/05/2022] Open
Abstract
Background General anaesthesia (GA) in developing countries is still a high-risk practice, especially in Africa, accompanied with high morbidity and mortality. No study has yet been conducted in Butembo in the Democratic Republic of the Congo to determine the mortality related to GA practice. The main objective of this study was to assess mortality related to GA in Butembo. Methods This was a retrospective descriptive and analytic study of patients who underwent surgery under GA in the 2 main teaching hospitals of Butembo from January 2011 to December 2015. Data were collected from patients files, anaesthesia registries and were analysed with SPSS 26. Results From a total of 921 patients, 539 (58.5%) were male and 382 (41.5%) female patients. A total of 83 (9.0%) patients died representing an overall perioperative mortality rate of 90 per 1000. Out of the 83 deaths, 38 occurred within 24 h representing GA related mortality of 41 per 1000. There was a global drop in mortality from 2011 to 2015. The risk factors of death were: being a neonate or a senior adult, emergency operation, ASA physical status > 2 and a single deranged vital sign preoperatively, presenting any complication during GA, anaesthesia duration > 120 minutes as well as visceral surgeries/laparotomies. Ketamine was the most employed anaesthetic. Conclusion GA related mortality is very high in Butembo. Improved GA services and outcomes can be obtained by training more anaesthesia providers, proper patients monitoring, improved infrastructure, better equipment and drugs procurement and considering regional anaesthesia whenever possible.
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Affiliation(s)
- Furaha Nzanzu Blaise Pascal
- Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Blantyre, Malawi. .,Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
| | - Agnes Malisawa
- Matanda Hospital of Butembo, Butembo, Democratic Republic of the Congo
| | - Andreas Barratt-Due
- Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Felix Namboya
- Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gregor Pollach
- Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, Blantyre, Malawi
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Epidemiology of perioperative cardiac arrest and mortality in Brazil: a systematic review. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32475700 PMCID: PMC9373521 DOI: 10.1016/j.bjane.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background and objectives The perioperative cardiac arrest (CA) and mortality rates in Brazil, a developing country, are higher than in developed countries. The hypothesis of this review was that knowledge of the epidemiology of perioperative CA and mortality in Brazil enables the comparison with developed countries. The systematic review aimed to verify, in studies conducted in Brazil, the epidemiology of perioperative CA and mortality. Method and results A search strategy was carried out on different databases (PubMed, EMBASE, SciELO and LILACS) to identify observational studies that reported perioperative CA and/or mortality up to 48 hours postoperatively in Brazil. The primary outcomes were data on epidemiology of perioperative CA and mortality. In 8 Brazilian studies, there was a higher occurrence of perioperative CA and mortality in males; in extremes of age; in patients in worse physical status according to the American Society of Anesthesiologists (ASA); in emergency surgeries; in general anesthesia; and in cardiac, thoracic, vascular, abdominal and neurological surgeries. The patient's disease/condition was the main triggering factor, with sepsis and trauma as the main causes. Conclusions The epidemiology of both perioperative CA and mortality events reported in Brazilian studies does not show important differences and, in general, is similar to studies in developed countries. However, sepsis represents one of the major causes of perioperative CA and mortality in Brazilian studies, contrasting with studies in developed countries in which sepsis is a secondary cause.
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Braz LG, Morais ACD, Sanchez R, Porto DDSM, Pacchioni M, Serafim WDS, Módolo NSP, Jr. PDN, Braz MG, Braz JRC. Epidemiologia de parada cardíaca e de mortalidade perioperatória no Brasil: revisão sistemática. Braz J Anesthesiol 2020; 70:82-89. [DOI: 10.1016/j.bjan.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/16/2020] [Accepted: 02/08/2020] [Indexed: 10/24/2022] Open
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Sato M, Ida M, Naito Y, Kawaguchi M. Perianesthetic death: a 10-year retrospective observational study in a Japanese university hospital. JA Clin Rep 2020; 6:8. [PMID: 32025938 PMCID: PMC7002636 DOI: 10.1186/s40981-020-0314-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies reporting on perianesthetic death and anesthesia-related death are limited. The present study aimed to assess the incidence of perianesthetic death and its relation to anesthesia and to describe the patient characteristics and main events leading to death in cases of anesthesia-related death and anesthesia-contributory death. METHODS We conducted a retrospective chart review of patients in whom anesthesia procedures were performed by anesthesiologists at a Japanese tertiary hospital between January 2008 and December 2017. Perianesthetic death was defined as death occurring within 48 h of an anesthetic, and it was divided into the following three categories: anesthesia-related death, anesthesia-contributory death, and nonanesthesia-related death. Patient demographics and perioperative factors were analyzed in cases of anesthesia-related death and anesthesia-contributory death. RESULTS Among 46,378 patients who underwent anesthetics, 41 experienced perianesthetic death, with an incidence of 8.8/10,000 anesthetics (95% confidence interval [CI], 6.1-11.6). No patient experienced anesthesia-related death, whereas 10 experienced anesthesia-contributory death, with an incidence of 2.1/10,000 (95% CI, 0.69-3.6), and 31 experienced nonanesthesia-related death, with an incidence of 6.8/10,000 (95% CI, 4.2-9.1). The events leading to anesthesia-contributory death were hypovolemia, myocardial infarction, arrhythmia, and respiratory failure, and they occurred during anesthesia maintenance in 5 patients and after surgery in 5 patients. CONCLUSIONS The incidence of perianesthetic death was 8.8/10,000 anesthetics; however, anesthesia-related death was not detected. Ten patients experienced anesthesia-contributory death, and hypovolemia during or after surgery was most frequently associated with anesthesia-contributory death.
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Affiliation(s)
- Mariko Sato
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yusuke Naito
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Eisler LD, Hua M, Li G, Sun LS, Kim M. A Multivariable Model Predictive of Unplanned Postoperative Intubation in Infant Surgical Patients. Anesth Analg 2019; 129:1645-1652. [PMID: 31743186 PMCID: PMC6894615 DOI: 10.1213/ane.0000000000004043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Unplanned postoperative intubation is an important quality indicator, and is associated with significantly increased mortality in children. Infant patients are more likely than older pediatric patients to experience unplanned postoperative intubation, yet the literature provides few characterizations of this outcome in our youngest patients. The objective of this study was to identify risk factors for unplanned postoperative intubation and to develop a scoring system to predict this complication in infants undergoing major surgical procedures. METHODS In this retrospective cohort study, The National Surgical Quality Improvement Program-Pediatric database was surveyed for all infants who underwent noncardiac surgery between January 1, 2012 and December 31, 2015 (derivation cohort, n = 56,962) and between January 1 and December 31, 2016 (validation cohort, n = 20,559). Demographic and perioperative clinical characteristics were examined in association with our primary outcome of unplanned postoperative intubation within 30 days of surgery. Risk factors were analyzed in the derivation cohort (2012-2015 data) using multivariable logistic regression with stepwise selection. Parameters from the final model were used to create a scoring system for predicting unplanned postoperative intubation. Data from the validation cohort were utilized to assess the performance of the scoring system using the area under the receiver operating characteristic curve. RESULTS In the derivation cohort, 2.2% of the infants experienced unplanned postoperative intubation within 30 days of surgery. Of the 14 risk factors identified in multivariable analysis, 10 (age, prematurity, American Society of Anesthesiologists physical status, inpatient status, operative time >120 minutes, cardiac disease, malignancy, hematologic disorder, oxygen supplementation, and nutritional support) were included in the final multivariable logistic regression model to create the risk score. The area under the receiver operating characteristic curve of the final model was 0.86 (95% CI, 0.85-0.87) for the derivation cohort and 0.83 (95% CI, 0.82-0.85) for the validation cohort. CONCLUSIONS About 1 in 50 infants undergoing major surgical procedures experiences unplanned postoperative intubation. Our scoring system based on routinely collected perioperative assessment data can predict risk in infants with good accuracy. Further investigation should assess the clinical utility of the scoring system for risk stratification and improvement in perioperative care quality and patient outcomes.
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Affiliation(s)
- Lisa D. Eisler
- Department of Anesthesiology, Columbia University Medical Center, New York, New York
| | - May Hua
- Department of Anesthesiology, Columbia University Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Guohua Li
- Department of Anesthesiology, Columbia University Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Lena S. Sun
- Department of Anesthesiology, Columbia University Medical Center, New York, New York
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Minjae Kim
- Department of Anesthesiology, Columbia University Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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12
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Argo A, Zerbo S, Lanzarone A, Buscemi R, Roccuzzo R, Karch SB. Perioperative and anesthetic deaths: toxicological and medico legal aspects. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2019. [DOI: 10.1186/s41935-019-0126-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Predictors and their prognostic value for no ROSC and mortality after a non-cardiac surgery intraoperative cardiac arrest: a retrospective cohort study. Sci Rep 2019; 9:14975. [PMID: 31628390 PMCID: PMC6802384 DOI: 10.1038/s41598-019-51557-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/01/2019] [Indexed: 01/10/2023] Open
Abstract
Data on predictors of intraoperative cardiac arrest (ICA) outcomes are scarce in the literature. This study analysed predictors of poor outcome and their prognostic value after an ICA. Clinical and laboratory data before and 24 hours (h) after ICA were analysed as predictors for no return of spontaneous circulation (ROSC) and 24 h and 1-year mortality. Receiver operating characteristic curves for each predictor and sensitivity, specificity, positive and negative likelihood ratios, and post-test probability were calculated. A total of 167,574 anaesthetic procedures were performed, including 158 cases of ICAs. Based on the predictors for no ROSC, a threshold of 13 minutes of ICA yielded the highest area under curve (AUC) (0.867[0.80–0.93]), with a sensitivity and specificity of 78.4% [69.6–86.3%] and 89.3% [80.4–96.4%], respectively. For the 1-year mortality, the GCS without the verbal component 24 h after an ICA had the highest AUC (0.616 [0.792–0.956]), with a sensitivity of 79.3% [65.5–93.1%] and specificity of 86.1 [74.4–95.4]. ICA duration and GCS 24 h after the event had the best prognostic value for no ROSC and 1-year mortality. For 24 h mortality, no predictors had prognostic value.
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14
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Effect of forced-air warming by an underbody blanket on end-of-surgery hypothermia: a propensity score-matched analysis of 5063 patients. BMC Anesthesiol 2019; 19:50. [PMID: 30967133 PMCID: PMC6456966 DOI: 10.1186/s12871-019-0724-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/01/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Underbody blankets have recently been launched and are used by anesthesiologists for surgical patients. However, the forced-air warming effect of underbody blankets is still controversial. The aim of this study was to determine the effect of forced-air warming by an underbody blanket on body temperature in anesthetized patients. METHODS We retrospectively analyzed 5063 surgical patients. We used propensity score matching to reduce the bias caused by a lack of randomization. After propensity score matching, the change in body temperature from before to after surgery was compared between patients who used underbody blankets (Under group) and those who used other types of warming blankets (Control group). The incidence of hypothermia (i.e., body temperature < 36.0 °C at the end of surgery) was compared between the two groups. A p value < 0.05 was considered to indicate statistical significance. RESULTS We obtained 489 propensity score-matched pairs of patients from the two groups, of whom 33 and 63 had hypothermia in the Under and Control groups, respectively (odds ratio: 0.49, 95% confidence interval: 0.31-0.76, p = 0.0013). CONCLUSIONS The present study suggests that the underbody blanket may help reduce the incidence of intraoperative hypothermia and may be more efficient in warming anesthetized patients compared with other types of warming blankets. TRIAL REGISTRATION UMIN Clinical Trials Registry (Identifier: UMIN000022909 ; retrospectively registered on June 27, 2016).
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15
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Gibbs NM. National Anaesthesia Mortality Reporting in Australia from 1985–2008. Anaesth Intensive Care 2019; 41:294-301. [DOI: 10.1177/0310057x1304100304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- N. M. Gibbs
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Medicine and Pharmacology, University of Western Australia and Head of Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands
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16
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Komasawa N, Berg BW, Minami T. Problem-based learning for anesthesia resident operating room crisis management training. PLoS One 2018; 13:e0207594. [PMID: 30452480 PMCID: PMC6242352 DOI: 10.1371/journal.pone.0207594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Senior anesthesia residents must acquire competency in crisis management for operating room (OR) emergencies. We conducted problem based learning (PBL) OR emergency scenarios for anesthesia residents, focused on emergencies in 'Airway', 'Circulation', 'Central venous catheter', and 'Pain management complications'. Non-technical skills are an integral component of team-based OR emergency management. METHODS Prior to integrated OR emergency clinical and non-technical skills PBL training, participating 35 anesthesia residents completed two 5-point scale surveys regarding frequency of emergency experiences in the operating room, and self-confidence for anesthesia-related crisis management. Repeat administration of the self-confidence survey was completed immediately following PBL training. RESULTS Post-PBL resident clinical management self- confidence improved (P<0.05) in all scenarios on Circulation, Central venous catheter, and Pain treatment related complication topics. Impossible intubation, impossible oxygenation, and awake intubation did not show significant difference following PBL. CONCLUSION Our findings suggest that PBL for OR emergency management can improve resident self- confidence in anesthesia residents.
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Affiliation(s)
- Nobuyasu Komasawa
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan
- * E-mail:
| | - Benjamin W. Berg
- SimTiki Simulation Center, John A Burns School of Medicine, University of Hawai‘i, Honolulu, Hawaii, United States of America
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Osaka, Japan
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17
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Pollard RJ, Hopkins T, Smith CT, May BV, Doyle J, Chambers CL, Clark R, Buhrman W. Perianesthetic and Anesthesia-Related Mortality in a Southeastern United States Population. Anesth Analg 2018; 127:730-735. [DOI: 10.1213/ane.0000000000003483] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Krawczyk P, Andres J. Unexpected perioperative cardiac arrest. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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19
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Nishizawa T, Suzuki H. Propofol for gastrointestinal endoscopy. United European Gastroenterol J 2018; 6:801-805. [PMID: 30023057 PMCID: PMC6047291 DOI: 10.1177/2050640618767594] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/05/2018] [Indexed: 12/12/2022] Open
Abstract
Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continues to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals. According to published values, endoscopist-directed propofol has a lower mortality rate than endoscopist-delivered benzodiazepines and opioids, and a comparable rate to general anesthesia by anesthesiologists. Rapid recovery has a major impact on patient satisfaction, post-procedure education and the general flow of the endoscopy unit. According to estimates, the absolute economic benefit of endoscopist-directed propofol implementation in a screening setting is probably substantial, with 10-year savings of $3.2 billion in the USA. Guidelines concerning the use of propofol emphasize the need for adequate training and certification in sedation by non-anesthetists.
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Affiliation(s)
- Toshihiro Nishizawa
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Keio University School of Medicine, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Keio University School of Medicine, Tokyo, Japan
- Fellowship Training Center and Medical Education Center, Keio University School of Medicine, Tokyo, Japan
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20
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Kwon MA. Perioperative surgical home: a new scope for future anesthesiology. Korean J Anesthesiol 2018; 71:175-181. [PMID: 29690755 PMCID: PMC5995011 DOI: 10.4097/kja.d.18.27182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/23/2017] [Accepted: 12/10/2017] [Indexed: 01/08/2023] Open
Abstract
The health care system is changing from ‘pay for volume’ to ‘pay for value.’ These changes are turning health care delivery into a more cost-effective and coordinated care setup that drives hospitals to lower costs and greater quality gains. The present perioperative care service in Korea has proven to be costly, fragmented, and neither evidence-based nor patient-centered. Recently, a new concept of a perioperative care model termed perioperative surgical home (PSH) has been proposed. The PSH is a patient-centered, team-based, and coordinated perioperative care setup, composed of the head anesthesiologist-perioperativist in tandem with dedicated nurse practitioners and other PSH team doctors. All pre-, intra-, and postoperative patient care functions are performed by a single PSH team, not several different departments. The PSH care extends from the decision to operate till 30 days post-discharge. Several evidence-driven perioperative strategies for reducing postoperative complications and shortening hospital stay can be adapted to each specific hospital situation, rather than strictly applying any given strategies. With the PSH, patients are more satisfied and experience better outcomes. It is also a good hospital business model. The expanded role of anesthesiologists in the PSH has the potential to invigorate the specialty.
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Affiliation(s)
- Min A Kwon
- Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan, Korea
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21
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Cook TM. Strategies for the prevention of airway complications - a narrative review. Anaesthesia 2017; 73:93-111. [DOI: 10.1111/anae.14123] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 12/17/2022]
Affiliation(s)
- T. M. Cook
- Anaesthesia and Intensive Care Medicine; Royal United Hospital; Bath UK
- School of Clinical Sciences; Bristol University; Bristol UK
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22
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Hur M, Lee HC, Lee KH, Kim JT, Jung CW, Park HP. The incidence and characteristics of 3-month mortality after intraoperative cardiac arrest in adults. Acta Anaesthesiol Scand 2017; 61:1095-1104. [PMID: 28799206 DOI: 10.1111/aas.12955] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is little information about clinical outcomes after intraoperative cardiac arrest (IOCA). We determined the incidence and characteristics of 3-month mortality after IOCA. METHODS The electronic medical records of 238,648 adult surgical patients from January 2005 to December 2014 were reviewed retrospectively. Characteristics of IOCA were documented using the Utstein reporting template. RESULTS IOCA occurred in 50 patients (21/100,000 surgeries). Nineteen patients died in the operating room, and further 12 patients died within 3 months post-arrest (total mortality: 62%). Three survivors at 3 months post-arrest had unfavourable neurological outcome. Finally, 34 patients showed unfavourable clinical outcomes at 3 months post-arrest. The incidences of non-cardiac surgery, emergency, pre-operative intubation state, non-shockable initial cardiac rhythm, hypovolaemic shock, pre-operative complications-induced cardiac arrest, non-anaesthetic cause of cardiac arrest, intra- and post-arrest transfusion, and continuous infusion of inotrope or vasopressor in intensive care unit (ICU) were significantly higher in non-survivors at 3 months post-arrest. Total epinephrine dose administrated during arrest was higher, and the duration of cardiac compressions was longer in non-survivors at 3 months post-arrest. CONCLUSIONS In this study, the incidence of IOCA was 21/100,000 surgeries and the 3-month mortality rate after IOCA was 62%. Several factors including surgical emergency, non-shockable initial cardiac rhythm, pre-operative complications, surgical complications, long duration of cardiac compressions, high total epinephrine dose, transfusion, and continuous infusion of inotropes or vasopressors in ICU seemed to be risk factors for 3-month mortality after IOCA. These risk factors should be considered in the light of relatively small sample size of this study.
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Affiliation(s)
- M. Hur
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - H.-C. Lee
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - K. H. Lee
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - J.-T. Kim
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - C.-W. Jung
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
| | - H.-P. Park
- Department of Anaesthesiology and Pain Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
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23
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Bustamante R. ¿QUÉ HACEMOS LOS ANESTESIÓLOGOS? DESDE LA VIGILANCIA ANESTÉSICA MONITORIZADA HASTA LA ANESTESIA GENERAL. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Han F, Wang Y, Wang Y, Dong J, Nie C, Chen M, Hou L. Intraoperative cardiac arrest: A 10-year study of patients undergoing tumorous surgery in a tertiary referral cancer center in China. Medicine (Baltimore) 2017; 96:e6794. [PMID: 28445319 PMCID: PMC5413284 DOI: 10.1097/md.0000000000006794] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Intraoperative cardiac arrest (IOCA) is a lethal complication of noncardiac surgery. According to several reports, immediate survival after IOCA is approximately 50%. In this study, a retrospective case analysis was performed to determine the incidence of IOCA, the potential causes of cardiac arrest, and the risk factors of no resuscitation in patients undergoing tumorous surgery.The medical records of surgery patients who experienced cardiac arrest during the intraoperative period between 2005 and 2014 were reviewed. The general conditions of the patients with IOCA were compared between the successfully resuscitated group and the unresuscitated group.Fifteen patients with IOCA among 142,853 patients undergoing tumorous surgery were reviewed during the study period. Immediate survival after IOCA was 60%. Hospital survival was 46.7%. The incidence of IOCA decreased during 2010 to 2014 when compared with the rate during 2005 to 2009 (P < .05). The risk factors affecting the success of resuscitation after IOCA included American Society of Anesthesiologists Physical Status (ASA PS) classification ≥ III (P < .05) and preoperative tachycardia (heart rate ≥100/min, P < .05). The methods of anesthesia had no effects on the results of resuscitation.The incidence of IOCA in patients undergoing tumorous surgery was 1.05 per 10,000 anesthesia. The overall mortality of IOCA was 0.56/10,000. The frequency of IOCA decreased within 10 years. There was no cardiac arrest primarily attributable to anesthesia over this study period. The risk factors leading to unsuccessful resuscitation after IOCA were ASA PS classification ≥ III and preoperative tachycardia.
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25
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Constant AL, Mongardon N, Morelot Q, Pichon N, Grimaldi D, Bordenave L, Soummer A, Sauneuf B, Merceron S, Ricome S, Misset B, Bruel C, Schnell D, Boisramé-Helms J, Dubuisson E, Brunet J, Lasocki S, Cronier P, Bouhemad B, Carreira S, Begot E, Vandenbunder B, Dhonneur G, Jullien P, Resche-Rigon M, Bedos JP, Montlahuc C, Legriel S. Targeted temperature management after intraoperative cardiac arrest: a multicenter retrospective study. Intensive Care Med 2017; 43:485-495. [PMID: 28220232 DOI: 10.1007/s00134-017-4709-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 01/31/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Few outcome data are available about temperature management after intraoperative cardiac arrest (IOCA). We describe targeted temperature management (TTM) (32-34 °C) modalities, adverse events, and association with 1-year functional outcome in patients with IOCA. METHODS Patients admitted to 11 ICUs after IOCA in 2008-2013 were studied retrospectively. The main outcome measure was 1-year functional outcome. RESULTS Of the 101 patients [35 women and 66 men; median age, 62 years (interquartile range, 42-72)], 68 (67.3%) were ASA PS I to III and 57 (56.4%) had emergent surgery. First recorded rhythms were asystole in 44 (43.6%) patients, pulseless electrical activity in 36 (35.6%), and ventricular fibrillation/tachycardia in 20 (19.8%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation (ROSC) were 0 min (0-0) and 10 min (4-20), respectively. The 30 (29.7%) patients who received TTM had an increased risk of infection (P = 0.005) but not of arrhythmia, bleeding, or metabolic/electrolyte disorders. By multivariate analysis, one or more defibrillation before ROSC was positively associated with a favorable functional outcome at 1-year (OR 3.06, 95% CI 1.05-8.95, P = 0.04) and emergency surgery was negatively associated with 1-year favorable functional outcome (OR 0.36; 95% CI 0.14-0.95, P = 0.038). TTM use was not independently associated with 1-year favorable outcome (OR 0.82; 95% CI 0.27-2.46, P = 0.72). CONCLUSIONS TTM was used in less than one-third of patients after IOCA. TTM was associated with infection but not with bleeding or coronary events in this setting. TTM did not independently predict 1-year favorable functional outcome after IOCA in this study.
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Affiliation(s)
- Anne-Laure Constant
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France.,Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Nicolas Mongardon
- Department of Anesthesiology and Surgical Intensive Care Units, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.,Faculté de médecine, Université Paris Est, 8 avenue du général Sarrail, 94000, Créteil, France.,Inserm, U955, Equipe 3 "Stratégies pharmacologiques et thérapeutiques expérimentales des insuffisances cardiaques et coronaires", 8 avenue du général Sarrail, Créteil, France
| | - Quentin Morelot
- SBIM Biostatistics and Medical information, Hôpital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris, France.,Université Paris Diderot, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Nicolas Pichon
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Universitaire de Limoges, 2, avenue Martin-Luther-King, 87042, Limoges, France
| | - David Grimaldi
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Lauriane Bordenave
- Department of Anesthesiology, Institut Gustave Roussy, 39, rue Camille-Desmoulins, 94805, Villejuif Cedex, France
| | - Alexis Soummer
- Department of Intensive Care Medicine, Foch Hospital, 40 rue Worth, 92150, Suresnes, France
| | - Bertrand Sauneuf
- Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Avenue de la côte de Nacre, CS30001, 14033, Caen Cedex 9, France
| | - Sybille Merceron
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Sylvie Ricome
- Department of Anesthesiology and Critical Care, Assistance Publique des Hôpitaux de Paris, 100 boulevard du Général-Leclerc, 92110, Clichy la Garenne, France
| | - Benoit Misset
- Medical-Surgical Intensive Care Unit, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France.,Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France
| | - Cedric Bruel
- Medical-Surgical Intensive Care Unit, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France
| | - David Schnell
- Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julie Boisramé-Helms
- Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de médecine, Université de Strasbourg, Strasbourg, France
| | - Etienne Dubuisson
- Department of Anesthesiology, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Jennifer Brunet
- Pôle Anesthésie-Réanimation-SAMU, CHU de Caen, Avenue de la côte de Nacre, CS30001, 14033, Caen Cedex 9, France
| | - Sigismond Lasocki
- Pôle d'Anesthésie Réanimation, CHU d'Angers, 4 rue Larrey, 49933, Angers Cedex 9, Angers, France.,LUNAM Université, CHU d'Angers, 49933, Angers Cedex, France
| | - Pierrick Cronier
- Intensive Care Unit, Centre Hospitalier Sud-Francilien, 116 boulevard Jean Jaurès, 91106, Corbeil-Essonnes Cedex, France
| | - Belaid Bouhemad
- Department of Anesthesiology and Critical Care, Groupe Hospitalier Saint Joseph, 185 rue Raymond Losserand, 75614, Paris Cedex, France
| | - Serge Carreira
- Department of Intensive Care Medicine, Hôpital Saint-Camill, 2 rue des Pères-Camiliens, 94360, Bry-sur-Marne, France
| | - Emmanuelle Begot
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Universitaire de Limoges, 2, avenue Martin-Luther-King, 87042, Limoges, France
| | - Benoit Vandenbunder
- Department of Anesthesiology, Foch Hospital, 40 rue Worth, 92150, Suresnes, France
| | - Gilles Dhonneur
- Department of Anesthesiology and Surgical Intensive Care Units, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.,Faculté de médecine, Université Paris Est, 8 avenue du général Sarrail, 94000, Créteil, France
| | - Philippe Jullien
- Department of Anesthesiology, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Matthieu Resche-Rigon
- SBIM Biostatistics and Medical information, Hôpital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris, France.,Université Paris Diderot, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-Pierre Bedos
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France
| | - Claire Montlahuc
- SBIM Biostatistics and Medical information, Hôpital Saint-Louis, APHP, 1, avenue Claude Vellefaux, Paris, France.,Université Paris Diderot, Paris, France.,ECSTRA Team (Epidémiologie Clinique et Statistiques pour la Recherche en Santé), UMR 1153 INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Stephane Legriel
- Medical-Surgical Intensive Care Unit, Intensive Care Department, Centre Hospitalier de Versailles-Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France. .,Sorbonne Paris Cité-Medical School, Paris Descartes University, Paris, France. .,INSERM U970, Paris Cardiovascular Research Center, Paris, France.
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Weaver JB, Kumar AB. Tension pneumomediastnum: A rare cause of acute intraoperative circulatory collapse in the setting of unremarkable TEE findings. J Clin Anesth 2017; 37:136-138. [PMID: 28235505 DOI: 10.1016/j.jclinane.2016.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/07/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
DESIGN Case report. SETTING Operating room. PATIENT 25YF, ASA IV E who underwent an emergent decompressive craniectomy for refractory intracranial hypertension secondary to acute intracranial hemorhage. INTERVENTIONS A 25Y caucasian female presented with acute intracranial hemorrhage with intraventricular extension secondary to Moya Moya disease. Post admisison, she underwent an emergent decompressive craniectomy for medically refractory intracranial hypertension. Introperatively (post dural closure and bone flap removal) the patient developed acutely worsening peak and plateau pressures followed by pulseless electrical activity necessitating CPR with epinephrine and Vasopressin before return of circulation before return of circulation. Intraoperative TEE done during return of circulation, was essentially non diagnostic, the patient had normal breath sounds throughout, and non-contributory bronchoscopy findings. MEASUREMENTS EKG, arterial blood pressure, heart rate, resp. rate, introperative tranesophageal echocardiogram (TEE), Pulse oximetry, serial arterial blood gases, introperative bronchoscopy, ventilatory peak pressures. MAIN RESULTS A post operative chest CT revealed extensive pneumomediastinum with subcutaneous emphysema. The focussed introperative echocardiogram showed preserved left ventricular function and no evidence of tamponade physiology. CONCLUSIONS Tension pneumomediastinum was the likely etiologic factor for the acute hemodynamic collapse and should be considered in the differential diagnosis of intraoperative circulatory arrest.
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Affiliation(s)
- Jonathan B Weaver
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Avinash B Kumar
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States.
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Anesthesia related mortality? A national and international overview. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Surgery in the very elderly is a topic that has not been well studied, despite the steady rise in this population. With the rise in this population, there is now discussion on the safety of surgery in this cohort for colorectal cancer. OBJECTIVE The purpose of this study was to investigate elective and nonelective colorectal cancer surgery outcomes in patients aged ≥90 years at both private and public hospitals in Melbourne, Victoria, Australia. DESIGN This was a retrospective analysis of patients aged ≥90 years who were included in the prospectively maintained Cabrini Monash University Department of Surgery colorectal neoplasia database for patients entered between January 2010 and February 2015. Comorbidity, ASA score, acuity of surgery, treatment, mortality, morbidity, and survival were analyzed. SETTINGS This study was conducted in a tertiary referral hospital. PATIENTS A total of 48 patients were identified from the database. The majority of these patients were women (58.0%), ASA score III to IV (91.7%), and treated in an elective setting (79.2%). The median age was 91.8 years. MAIN OUTCOME MEASURES We measured 30-day mortality, 180-day mortality, and perioperative morbidity. RESULTS Thirty-day mortality rate was 2.1%. The 180-day mortality rate was 10.4%. A total of 29.2% of patients had a perioperative complication. Median follow-up was 21 months (range, 13-54 months). In 180-day mortality, minimally invasive surgery was associated with a lower mortality rate vs open surgery (p = 0.043). Perioperative complications were associated with nonelective surgery (p = 0.045), open surgery procedures (p = 0.014), and higher stages of disease (p = 0.014). A total of 81.3% of patients were able to return home after surgery. LIMITATIONS This was a retrospective study with the usual limitations; however, these have been minimized with the use of a high-quality, prospective data collection database. The median follow-up was 21 months. CONCLUSIONS Colorectal surgery was generally safe for nonagenarians in this study. This study demonstrates that excellent outcomes can be achieved in a selected group. Additional prospective studies with larger numbers and 5-year follow-up are recommended.
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Lim CW, Lee JH, Im SM, Song IK, Park HP, Kim HS, Kim JT. Characteristics of 1-day postoperative mortality: a comparison with 2- to 7-day postoperative mortality. Acta Anaesthesiol Scand 2016; 60:432-40. [PMID: 26763613 DOI: 10.1111/aas.12683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/26/2015] [Accepted: 11/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this study was to determine causes and characteristics of early postoperative mortality focusing on postoperative day 1 (POD 1). METHODS We reviewed the electronic medical records of patients who died within 7 days after surgery under anesthesia at a tertiary university hospital from January 2004 to December 2014. Postoperative mortalities were divided into POD 1 group and POD 7 group, which included death that occurred from days 2 to 7 after surgery. Characteristics of POD 1 group were compared with those of POD 7 group. RESULTS The mortality rates of POD 1 and POD 7 groups were 3.6 and 7.8 per 10,000 anesthesia, respectively. The incidence of POD 1 mortality is higher than any other day of the week of surgery. The incidences of massive transfusion, intraoperative cardiac arrest, and intraoperative use of epinephrine were higher in POD 1 group than in POD 7 group. In adults, the proportion of emergency operations was higher in POD 1 group than in POD 7 group. The leading cause of death in POD 1 group was hypovolemic and cardiogenic shock, whereas that in POD 7 group was distributive shock. Human factor-related mortality was more frequent in POD 1 group (15.3%) compared with POD 7 group (6.1%). CONCLUSIONS The characteristics of POD 1 mortality were different from those of POD 2-7 mortality. A large proportion of early postoperative deaths were due to POD 1 mortality. Human factor-related causes were more associated with POD 1 mortality, indicating much room for improvement.
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Affiliation(s)
- C.-W. Lim
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - J.-H. Lee
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - S.-M. Im
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - I.-K. Song
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - H.-P. Park
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - H.-S. Kim
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
| | - J.-T. Kim
- Department of Anesthesiology and Pain Medicine; Seoul National University Hospital; Seoul Korea
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Parada cardíaca perioperatória: uma análise evolutiva da incidência de parada cardíaca intraoperatória em centros terciários no Brasil. Braz J Anesthesiol 2016; 66:176-82. [DOI: 10.1016/j.bjan.2016.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/26/2014] [Indexed: 11/24/2022] Open
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Pignaton W, Braz JRC, Kusano PS, Módolo MP, de Carvalho LR, Braz MG, Braz LG. Perioperative and Anesthesia-Related Mortality: An 8-Year Observational Survey From a Tertiary Teaching Hospital. Medicine (Baltimore) 2016; 95:e2208. [PMID: 26765400 PMCID: PMC4718226 DOI: 10.1097/md.0000000000002208] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In 2006, a previous study at our institution reported high perioperative and anesthesia-related mortality rates of 21.97 and 1.12 per 10,000 anesthetics, respectively. Since then, changes in surgical practices may have decreased these rates. However, the actual perioperative and anesthesia-related mortality rates in Brazil remains unknown. The study aimed to reexamine perioperative and anesthesia-related mortality rates in one Brazilian tertiary teaching hospital.In this observational study, deaths occurring in the operation room and postanesthesia care unit between April 2005 and December 2012 were identified from an anesthesia database. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, and medical specialty teams, as well as the types of surgery and anesthesia. All deaths were reviewed and grouped by into 1 of 4 triggering factors groups: totally anesthesia-related, partially anesthesia-related, surgery-related, or disease/condition-related. The mortality rates are expressed per 10,000 anesthetics with 95% confidence intervals (CIs).A total of 55,002 anesthetics and 88 deaths were reviewed, representing an overall mortality rate of 16.0 per 10,000 anesthetics (95% CI: 13.0-19.7). There were no anesthesia-related deaths. The major causes of mortality were patient disease/condition-related (13.8, 95% CI: 10.7-16.9) followed by surgery-related (2.2, 95% CI: 1.0-3.4). The major risks of perioperative mortality were children younger than 1-year-old, older patients, patients with poor ASA physical status (III-V), emergency, cardiac or vascular surgeries, and multiple surgeries performed under the same anesthetic technique (P < 0.0001).There were no anesthesia-related deaths. However, the high mortality rate caused by the poor physical conditions of some patients suggests that primary prevention might be the key to reducing perioperative mortality. These findings demonstrate the need to improve medical perioperative practices for high-risk patients in under-resourced settings.
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Affiliation(s)
- Wangles Pignaton
- From the Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Anesthesiology, Botucatu Medical School (WP, JRCB, PSK, MPM, MGB, LGB); and Department of Biostatistics, Institute of Biosciences, UNESP, University Estadual Paulista, Botucatu, Brazil (LRDC)
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de Bruin L, Pasma W, van der Werff DBM, Schouten TANJ, Haas F, van der Zee DC, van Wolfswinkel L, de Graaff JC. Perioperative hospital mortality at a tertiary paediatric institution. Br J Anaesth 2015; 115:608-15. [PMID: 26385669 DOI: 10.1093/bja/aev286] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Research in postoperative mortality is scarce. Insight into mortality and cause of death might improve and innovate perioperative care. The objective for this study was to report the 24-hour and 30-day overall, and surgery and anaesthesia-related, in-hospital mortality at a tertiary paediatric hospital. METHODS All patients <18 yr old who underwent anaesthesia with or without surgery between January 1, 2006, and December 31, 2012, at the Wilhelmina Children's Hospital, Utrecht, The Netherlands, were included in this retrospective cohort study. Causes of death within 30 days were identified and tabulated into four major categories according to principal cause. RESULTS A total of 45,182 anaesthetics were administered during this 7-yr period. The all-cause 24-hour hospital mortality was 13.1 per 10,000 anaesthetics (95% CI: 9.9-16.8) and the all-cause 30-day in-hospital mortality was 41.6 per 10,000 anaesthetics (95% CI: 35.9-48.0). In total five patients were partially contributable to anaesthesia (30-day mortality: 1.1/10,000, 95% CI: 0.4-2.6) and four patients were partially contributable to surgery (30-day mortality: 0.9/10,000, 95% CI: 0.2-2.3). Mortality was higher in neonates and infants, children with ASA physical status III and IV, and emergency- and cardiothoracic surgery. CONCLUSIONS Neonates and infants, children with ASA physical status III or poorer, and emergency- and cardiothoracic surgery are associated with a higher postoperative mortality. Anaesthesia- or surgery-related complications contribute to mortality in only a small amount of the deaths, indicating the relative safety of paediatric surgical and anaesthetic procedures.
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Affiliation(s)
- L de Bruin
- Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands Present affiliation: Department of Surgery, Amstelland Hospital, Amstelveen, The Netherlands
| | - W Pasma
- Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - D B M van der Werff
- Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - T A N J Schouten
- Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F Haas
- Paediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - D C van der Zee
- Department of Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L van Wolfswinkel
- Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J C de Graaff
- Department of Anaesthesia, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands Brain Center Rudolph Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
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Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil. Braz J Anesthesiol 2015; 66:176-82. [PMID: 26952227 DOI: 10.1016/j.bjane.2014.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/26/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. OBJECTIVES The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. CONTENTS There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. CONCLUSIONS There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.
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Wright SM. Patient safety in anesthesia: learning from the culture of high-reliability organizations. Crit Care Nurs Clin North Am 2014; 27:1-16. [PMID: 25725532 DOI: 10.1016/j.cnc.2014.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There has been an increased awareness of and interest in patient safety and improved outcomes, as well as a growing body of evidence substantiating medical error as a leading cause of death and injury in the United States. According to The Joint Commission, US hospitals demonstrate improvements in health care quality and patient safety. Although this progress is encouraging, much room for improvement remains. High-reliability organizations, industries that deliver reliable performances in the face of complex working environments, can serve as models of safety for our health care system until plausible explanations for patient harm are better understood.
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Affiliation(s)
- Suzanne M Wright
- Department of Nurse Anesthesia, School of Allied Health Professions, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA 23298, USA.
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Abstract
Abstract
Background:
Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA.
Methods:
Patients admitted to 11 intensive care units in a period of 2000–2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2.
Results:
Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012).
Conclusions:
By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.
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Schiff JH, Welker A, Fohr B, Henn-Beilharz A, Bothner U, Van Aken H, Schleppers A, Baldering HJ, Heinrichs W. Major incidents and complications in otherwise healthy patients undergoing elective procedures: results based on 1.37 million anaesthetic procedures. Br J Anaesth 2014; 113:109-21. [PMID: 24801456 DOI: 10.1093/bja/aeu094] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Improved anaesthesia safety has made severe anaesthesia-related incidents, complications, and deaths rare events, but concern about morbidity and mortality in anaesthesia continues. This study examines possible severe adverse outcomes or death recorded in a large national surveillance system based on a core data set (CDS). METHODS Cases from 1999 to 2010 were filtered from the CDS database. Cases were defined as elective patients classified as ASA physical status grades I and II (without relevant risk factors) resulting in death or serious complication. Four experts reviewed the cases to determine anaesthetic involvement. RESULTS Of 1 374 678 otherwise healthy, ASA I and II patients in the CDS database, 36 met the study inclusion criteria resulting in a death or serious complication rate of 26.2 per million [95% confidence interval (CI), 19.4-34.6] procedures, and for those with possible direct anaesthetic involvement, 7.3 per million cases (95% CI, 3.9-12.3). CONCLUSIONS This is the first study assessing severe incidents and complications from a national outcome-tracking database. Annual identification and review of cases, perhaps with standardized database queries in the respective departments, might provide more detailed information about the cascades that lead to unfortunate outcomes.
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Affiliation(s)
- J H Schiff
- Department of Anaesthesia and Intensive Care, Katharinenkrankenhaus, Klinikum Stuttgart, Stuttgart, Germany James Cook University, Queensland, Australia
| | - A Welker
- Department of Anaesthesia, Dr-Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - B Fohr
- Department of Anaesthesia, University of Heidelberg, Heidelberg, Germany
| | - A Henn-Beilharz
- Department of Anaesthesia and Intensive Care, Katharinenkrankenhaus, Klinikum Stuttgart, Stuttgart, Germany
| | - U Bothner
- Department of Anaesthesia, Ulm University, Ulm, Germany
| | - H Van Aken
- Department of Anaesthesia and Intensive Care, University Hospital Muenster, Muenster, Germany
| | - A Schleppers
- DGAI (German Society of Anaesthesia and Intensive Care Medicine), Nuremberg, Germany
| | - H J Baldering
- AQAI (Applied Quality Assurance in Anaesthesia and Intensive-Care Medicine/Angewandte Qualitätssicherung in Anästhesie und Intensivmedizin, AQAI Ltd), Mainz, Germany
| | - W Heinrichs
- AQAI (Applied Quality Assurance in Anaesthesia and Intensive-Care Medicine/Angewandte Qualitätssicherung in Anästhesie und Intensivmedizin, AQAI Ltd), Mainz, Germany
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Abstract
Concerns about the safety of endoscopist-directed propofol (EDP) have been voiced that propofol should be given only by healthcare professionals trained in the administration of general anesthesia. Here we discuss the safety and drawbacks of EDP for routine endoscopic procedures. Currently, both diagnostic and therapeutic endoscopy are well tolerated and accepted by both patients and endoscopists due to the application of sedation in most clinics worldwide. Accordingly, propofol use is increasing in many countries. It is crucial for endoscopists to be very familiar with the use of propofol or a combination of drugs. However, the controversy regarding the administration of sedation by an endoscopist or an anesthesiologist continues. Until now, there have been no randomized control trials comparing sedation induced by propofol administered by an endoscopist or by an anesthesiologist. It might be difficult to perform this kind of study. For the convenience and safety of sedative endoscopy, it would be important that EDP be generally applied to endoscopic procedures, and for more safety, an anesthesiologist may automatically take care of particular patients at high risk of suffering from propofol side effects.
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Affiliation(s)
- Eun Hye Kim
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Bartels K, Karhausen J, Clambey ET, Grenz A, Eltzschig HK. Perioperative organ injury. Anesthesiology 2014; 119:1474-89. [PMID: 24126264 DOI: 10.1097/aln.0000000000000022] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite the fact that a surgical procedure may have been performed for the appropriate indication and in a technically perfect manner, patients are threatened by perioperative organ injury. For example, stroke, myocardial infarction, acute respiratory distress syndrome, acute kidney injury, or acute gut injury are among the most common causes for morbidity and mortality in surgical patients. In the current review, the authors discuss the pathogenesis of perioperative organ injury, and provide select examples for novel treatment concepts that have emerged over the past decade. Indeed, the authors are of the opinion that research to provide mechanistic insight into acute organ injury and identification of novel therapeutic approaches for the prevention or treatment of perioperative organ injury represent the most important opportunity to improve outcomes of anesthesia and surgery.
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Affiliation(s)
- Karsten Bartels
- * Fellow in Critical Care Medicine and Cardiothoracic Anesthesiology, † Assistant Professor of Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina. ‡ Assistant Professor of Anesthesiology, § Associate Professor of Anesthesiology, ‖ Professor of Anesthesiology, Department of Anesthesiology, University of Colorado Denver, Aurora, Colorado
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Outcomes of patients with trauma and intraoperative cardiac arrest. Resuscitation 2013; 84:635-8. [DOI: 10.1016/j.resuscitation.2012.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 09/05/2012] [Accepted: 09/10/2012] [Indexed: 11/19/2022]
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Sebbag I, Carmona MJC, Gonzalez MMC, Alcântara HM, Lelis RGB, Toledo FDO, Aranha GF, Nuzzi RXDP, Auler JOC. Frequency of intraoperative cardiac arrest and medium-term survival. SAO PAULO MED J 2013; 131:309-14. [PMID: 24310799 PMCID: PMC10876325 DOI: 10.1590/1516-3180.2013.1315507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/27/2012] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Although advances in surgical and anesthetic techniques have reduced perioperative morbidity-mortality, the survival rate following cardiac arrest remains low. The aim of this study was to evaluate, over the course of one year, the prevalence of intraoperative cardiac arrest and the 30-day survival rate after this event in a tertiary teaching hospital. DESIGN AND SETTING Prospective cohort study in a tertiary teaching hospital. METHODS Following approval by the institutional ethics committee, anesthetic procedures and cases of intraoperative cardiac arrest between January and December 2007 were evaluated. Patients undergoing cardiac surgery were excluded. The data were gathered prospectively using the modified Utstein model, with evaluation of demographic data, pre-arrest conditions, intraoperative care, care during arrest and postoperative outcome up to the 30th day. The data were recorded by the attending anesthesiologist. RESULTS During the study period, 40,379 anesthetic procedures were performed, and 52 cases of intraoperative cardiac arrest occurred (frequency of 13:10,000). Among these, 69% presented spontaneous return of circulation after the initial arrest, and only 25% survived for 30 days after the event. The following factors were associated with shorter survival: American Society of Anesthesiologists physical status IV and V, emergency surgery, hemorrhagic events, hypovolemia as the cause of arrest and use of atropine during resuscitation. CONCLUSIONS Although the frequency of cardiac arrest in the surgical environment has declined and resources to attend to this exist, the survival rate is low. Factors associated with worst prognosis are more frequent in critical patients.
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Affiliation(s)
- Ilana Sebbag
- MD. Attending Anesthesiologist, Instituto Central (IC), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Maria José Carvalho Carmona
- MD, PhD. Assistant Professor, Discipline of Anesthesiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Maria Margarita Castro Gonzalez
- MD, PhD. Cardiologist, Instituto do Coração (InCOR), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Hermes Marcel Alcântara
- MD. Resident Physician in Psychiatry, Instituto de Psiquiatria (IPq), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Rolison Gustavo Bravo Lelis
- MD. Attending Anesthesiologist, Instituto de Ortopedia (IOT), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Flavia de Oliveira Toledo
- MD. Attending Anesthesiologist, Instituto do Câncer do Estado de São Paulo (ICESP), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Gustavo Fábio Aranha
- MD. Resident Physician in Anesthesiology, Instituto Central (IC), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Rafael Ximenes do Prado Nuzzi
- MD, PhD. Head Professor of Discipline of Anesthesiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - José Otávio Costa Auler
- MD, PhD. Head Professor of Discipline of Anesthesiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
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McMichael M, Herring J, Fletcher DJ, Boller M. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 2: Preparedness and prevention. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S13-25. [DOI: 10.1111/j.1476-4431.2012.00752.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Maureen McMichael
- College of Veterinary Medicine; University of Illinois; Urbana; IL; 61802
| | - Jennifer Herring
- College of Veterinary Medicine; University of Illinois; Urbana; IL; 61802
| | | | - Manuel Boller
- Department of Clinical Studies, School of Veterinary Medicine, and the Department of Emergency Medicine, School of Medicine; Center for Resuscitation Science, University of Pennsylvania; Philadelphia; PA
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Grocott M, Pearse R. Perioperative medicine: the future of anaesthesia? Br J Anaesth 2012; 108:723-6. [DOI: 10.1093/bja/aes124] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Solheim O, Jakola AS, Gulati S, Johannesen TB. Incidence and causes of perioperative mortality after primary surgery for intracranial tumors: a national, population-based study. J Neurosurg 2012; 116:825-34. [PMID: 22224790 DOI: 10.3171/2011.12.jns11339] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgical mortality is a frequent outcome measure in studies of volume-outcome relationships, and the Agency for Healthcare Research and Quality has endorsed surgical mortality after craniotomies as an Inpatient Quality Indicator. Still, the frequency and causes of 30-day mortality after neurosurgical procedures have not been much explored. The authors sought to study the frequency and possible causes of death following primary intracranial tumor operations. They also sought to explore a possible predictive value of perioperative mortality rates from neurosurgical centers in relation to long-term survival. METHODS Using population-based data from the Norwegian cancer registry, the authors identified 15,918 primary operations for primary CNS tumors treated in Norway in the period from August 1955 through December 2008. Patients were followed up until death, emigration, or September 2009. Causes of mortality as indicated on death certificates were studied. Factors associated with an increased risk of perioperative death were identified. RESULTS The overall risk of perioperative death after first-time surgery for primary intracranial tumors is currently 2.2% and has decreased over the last decades. An age ≥ 70 years and histopathological entities with poor long-term prognoses are risk factors. Overlapping lesions are also associated with excess risk, indicating that lesion size or multifocality may matter. The overall risk of perioperative death is also higher in biopsy cases than in resection cases. Perioperative mortality rates of the 4 Norwegian neurosurgical centers were not predictive of their respective long-term survival rates. CONCLUSIONS Although considered surgically related if they occur within the first 30 days of surgery, most early postoperative deaths can happen independent of the handiwork of the operating surgeon or anesthesiologist. Overall prognosis of the disease seems to be a strong predictor of perioperative death-perhaps not surprisingly since the 30-day mortality rate is merely the intonation of the Kaplan-Meier curve. Both referral and treatment policies at a neurosurgical center will therefore markedly affect such early outcomes, but early deaths may not necessarily reflect overall quality of care or long-term results. The low incidence of perioperative death in intracranial tumor surgery also greatly limits the statistical power in comparative analyses, such as between published patient series or between centers and certainly between surgeons. Therefore the authors question the value of perioperative mortality rates as a quality indicator in modern neurosurgery for tumors.
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Affiliation(s)
- Ole Solheim
- Department of Neuroscience, Norwegian University of Science and Technology, Norway.
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Professional stress in anesthesiology: a review. J Clin Monit Comput 2011; 26:329-35. [DOI: 10.1007/s10877-011-9328-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
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How do we know that we are doing a good job – Can we measure the quality of our work? Best Pract Res Clin Anaesthesiol 2011; 25:109-22. [DOI: 10.1016/j.bpa.2011.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 02/23/2011] [Accepted: 02/23/2011] [Indexed: 11/19/2022]
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Haller G, Laroche T, Clergue F. Morbidity in anaesthesia: Today and tomorrow. Best Pract Res Clin Anaesthesiol 2011; 25:123-32. [DOI: 10.1016/j.bpa.2011.02.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 02/18/2011] [Indexed: 11/15/2022]
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Deshpande JK. Cause and Effect or Conjecture? A Call for Consensus on Defining “Anesthesia-Related Mortality”. Anesth Analg 2011; 112:1259-61. [DOI: 10.1213/ane.0b013e3182182199] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nemeth Z, Ott J. Complete recovery of severe postpartum genital prolapse after conservative treatment--a case report. Int Urogynecol J 2011; 22:1467-9. [PMID: 21614441 DOI: 10.1007/s00192-011-1452-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 05/03/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Zoltan Nemeth
- Department of Gynecology, Saint John of God Hospital, Johannes Gott Platz 1, 1020 Vienna, Austria.
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van der Griend BF, Lister NA, McKenzie IM, Martin N, Ragg PG, Sheppard SJ, Davidson AJ. Postoperative mortality in children after 101,885 anesthetics at a tertiary pediatric hospital. Anesth Analg 2011; 112:1440-7. [PMID: 21543787 DOI: 10.1213/ane.0b013e318213be52] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mortality is a basic measure for quality and safety in anesthesia. There are few anesthesia-related mortality data available for pediatric practice. Our objective for this study was to determine the incidence of 24-hour and 30-day mortality after anesthesia and to determine the incidence and nature of anesthesia-related mortality in pediatric practice at a large tertiary institution. METHODS Children ≤ 18 years old who had an anesthetic between January 1, 2003, and August 30, 2008, at the Royal Children's Hospital, Melbourne, Australia, were included for this study. Data were analyzed by merging a database for every anesthetic performed with an accurate electronic record of mortality of children who had ever been a Royal Children's Hospital patient. Cases of children dying within 30 days and 24 hours of an anesthetic were identified and the patient history and anesthetic record examined. Anesthesia-related death was defined as those cases whereby a panel of 3 senior anesthesiologists all agreed that anesthesia or factors under the control of the anesthesiologist more likely than not influenced the timing of death. RESULTS During this 68-month period, 101,885 anesthetics were administered to 56,263 children. The overall 24-hour mortality from any cause after anesthesia was 13.4 per 10,000 anesthetics delivered and 30-day mortality was 34.5 per 10,000 anesthetics delivered. The incidence of death was highest in children ≤ 30 days old. Patients undergoing cardiac surgery had a higher incidence of 24-hour and 30-day mortality than did those undergoing noncardiac surgery. From 101,885 anesthetics there were 10 anesthesia-related deaths. The incidence of anesthesia-related death was 1 in 10,188 or 0.98 cases per 10,000 anesthetics performed (95%confidence interval, 0.5 to 1.8). In all 10 cases, preexisting medical conditions were identified as being a significant factor in the patient's death. Five of these cases (50%) involved children with pulmonary hypertension. CONCLUSIONS Anesthesia-related mortality is higher in children with heart disease and in particular those with pulmonary hypertension. The lack of anesthetic-related deaths in children who did not have major comorbidities reinforces the safety of pediatric anesthesia in healthy children.
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Abstract
PURPOSE OF REVIEW To encapsulate the recent developments in endoscopic procedural sedation from the standpoints of safety, efficacy and policy. RECENT FINDINGS Initial studies addressing the presence of obstructive sleep apnea in patients undergoing upper endoscopy and colonoscopy did not find an increased risk of cardiopulmonary complications. A worldwide study of 646 080 patients receiving endoscopist-directed propofol sedation found a mortality rate of one per 161 515 cases, which all occurred in patients with high-risk comorbidities. The incidence of bag mask ventilation was significantly higher for upper endoscopy when compared to colonoscopy (185/185 245; 0.1% vs. 20/142 863, 0.01%; P<0.001). SUMMARY The presence of obstructive sleep apnea whether diagnosed by a surrogate validated questionnaire to by the gold standard sleep study does not appear to lead to increased rates of hypoxemia in patients undergoing ambulatory upper endoscopy. Endoscopist-directed propofol sedation is well tolerated in the appropriately selected patient. The use of anesthesia-assisted sedation for American Society of Anesthesiologists class I and II patients for upper endoscopy and colonoscopy is cost-ineffective.
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