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Redondo JI, Martínez-Taboada F, Viscasillas J, Doménech L, Marti-Scharfhausen R, Hernández-Magaña EZ, Otero PE. Anaesthetic mortality in cats: A worldwide analysis and risk assessment. Vet Rec 2024; 195:e4147. [PMID: 38959210 DOI: 10.1002/vetr.4147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Patient safety is essential in small animal anaesthesia. This study aimed to assess anaesthesia-related deaths in cats worldwide, identify risk and protective factors and provide insights for clinical practice. METHODS A prospective multicentre cohort study of 14,962 cats from 198 veterinary centres across different countries was conducted. Data on anaesthesia-related deaths, from premedication up to 48 hours postextubation, were collected. Logistic regression was used to analyse patient demographics, American Society of Anesthesiologists (ASA) classification, procedure type and anaesthetic drugs. RESULTS The anaesthesia-related mortality was 0.63%, with 74.5% of deaths occurring postoperatively. Cats with cachexia, a higher ASA status or who underwent abdominal, orthopaedic/neurosurgical or thoracic procedures exhibited elevated mortality. Mechanical ventilation use was associated with increased mortality. Mortality odds were reduced by the use of alpha2-agonist sedatives, pure opioids in premedication and locoregional techniques. LIMITATIONS Limitations include non-randomised sampling, potential biases, unquantified response rates, subjective death cause classification and limited variable analysis. CONCLUSIONS Anaesthetic mortality in cats is significant, predominantly postoperative. Risk factors include cachexia, higher ASA status, specific procedures and mechanical ventilation. Protective factors include alpha2-agonist sedatives, pure opioids and locoregional techniques. These findings can help improve anaesthesia safety and outcomes. However, further research is required to improve protocols, enhance data quality and minimise risks.
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Affiliation(s)
- José I Redondo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | - Fernando Martínez-Taboada
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
- 3A Animal Anaesthesia and Analgesia, Victoria, Australia
| | | | - Luis Doménech
- Departamento de Matemáticas, Física y Ciencias Tecnológicas, Escuela Superior de Enseñanzas Técnicas, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | | | - Eva Z Hernández-Magaña
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | - Pablo E Otero
- Department of Anaesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
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Redondo JI, Otero PE, Martínez-Taboada F, Doménech L, Hernández-Magaña EZ, Viscasillas J. Anaesthetic mortality in dogs: A worldwide analysis and risk assessment. Vet Rec 2024; 195:e3604. [PMID: 37953683 DOI: 10.1002/vetr.3604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Ensuring patient safety during small animal anaesthesia is crucial. This study aimed to assess anaesthetic-related deaths in dogs globally, identify risks and protective factors and inform clinical practice. METHODS This prospective cohort multicentric study involved 55,022 dogs from 405 veterinary centres across various countries. Data on anaesthesia-related deaths from premedication to 48 hours post-extubation were collected. Logistic regression was used to analyse patient demographics, American Society of Anesthesiologists (ASA) classification, procedure type and anaesthetic drugs used. RESULTS Anaesthetic-related mortality was 0.69%. Most deaths occurred postoperatively (81%). Age, obesity and a higher ASA classification score were associated with increased mortality. Urgent procedures, non-urgent but unscheduled anaesthesias and short procedures also had higher mortality. Some sedatives, systemic analgesics, hypnotics and the use of locoregional anaesthesia were linked to a decrease in mortality. LIMITATIONS The limitations of the study include the non-randomised sample, potential selection bias, lack of response rate quantification, variable data quality control, subjectivity in classifying causes of death and limited analysis of variables. CONCLUSION Careful patient evaluation, drug selection and monitoring can be associated with reduced mortality. These findings can be used to develop guidelines and strategies to improve patient safety and outcomes. Further research is needed to refine protocols, enhance data quality systems and explore additional risk mitigation measures.
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Affiliation(s)
- José I Redondo
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera - CEU, Valencia, Spain
| | - Pablo E Otero
- Department of Anaesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Martínez-Taboada
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
- 3A Animal Anaesthesia and Analgesia, Victoria, Australia
| | - Luis Doménech
- Departamento de Matemáticas, Física y Ciencias Tecnológicas, Escuela Superior de Enseñanzas Técnicas, Universidad Cardenal Herrera - CEU, Valencia, Spain
| | - Eva Zoe Hernández-Magaña
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera - CEU, Valencia, Spain
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Schmidt MJ, Farke D. Surgical management of primary and idiopathic internal hydrocephalus in dogs and cats. Front Vet Sci 2024; 11:1435982. [PMID: 39027907 PMCID: PMC11254760 DOI: 10.3389/fvets.2024.1435982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Ventriculoperitoneal shunt placement is an effective method to treat internal hydrocephalus in dogs and cats. Although it has a long history in veterinary medicine, the technique continues to evolve. Despite continuing attempts to reduce the incidence of associated complications, shunt failure remains a major problem, and often leads to multiple hospital admissions. This review gives an overview about current knowledge of ventriculoperitoneal shunting techniques in animals, applicable shunt hardware as well as shunt-associated complications and their prevention and treatment.
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Affiliation(s)
| | - Daniela Farke
- Department of Veterinary Clinical Sciences, Neurosurgery, Neuroradiology and Clinical Neurology, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
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Patterson H, Eady J, Sommerfield A, Sommerfield D, Hauser N, von Ungern-Sternberg BS. Patient positioning and its impact on perioperative outcomes in children: A narrative review. Paediatr Anaesth 2024; 34:507-518. [PMID: 38546348 DOI: 10.1111/pan.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 05/12/2024]
Abstract
Patient positioning interacts with a number of body systems and can impact clinically important perioperative outcomes. In this educational review, we present the available evidence on the impact that patient positioning can have in the pediatric perioperative setting. A literature search was conducted using search terms that focused on pediatric perioperative outcomes prioritized by contemporary research in this area. Several key themes were identified: the effects of positioning on respiratory outcomes, cardiovascular outcomes, enteral function, patient and carer-centered outcomes, and soft issue injuries. We encountered considerable heterogeneity in research in this area. There may be a role for lateral positioning to reduce respiratory adverse outcomes, head elevation for intubation and improved oxygenation, and upright positioning to reduce peri-procedural anxiety.
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Affiliation(s)
- Heather Patterson
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Jonathan Eady
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Anaesthesia, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Westren Australia, Australia
- Perioperative Care Program, Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Westren Australia, Australia
- Perioperative Care Program, Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Neil Hauser
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Westren Australia, Australia
- Perioperative Care Program, Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Westren Australia, Australia
- Perioperative Care Program, Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Western Australia, Australia
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Taverner F, Krishnan P, Baird R, von Ungern‐Sternberg BS. Perioperative management of infant inguinal hernia surgery; a review of the recent literature. Paediatr Anaesth 2023; 33:793-799. [PMID: 37449338 PMCID: PMC10947457 DOI: 10.1111/pan.14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
Inguinal hernia surgery is one of the most common electively performed surgeries in infants. The common nature of inguinal hernia combined with the high-risk population involving a predominance of preterm infants makes this a particular area of interest for those concerned with their perioperative care. Despite a large volume of literature in the area of infant inguinal hernia surgery, there remains much debate amongst anesthetists, surgeons and neonatologists regarding the optimal perioperative management of these patients. The questions asked by clinicians include; when should the surgery occur, how should the surgery be performed (open or laparoscopic), how should the anesthesia be conducted, including regional versus general anesthesia and airway devices used, and what impact does anesthesia choice have on the developing brain? There is a paucity of evidence in the literature on the concerns, priorities or goals of the parents or caregivers but clearly their opinions do and should matter. In this article we review the current clinical surgical and anesthesia practice and evidence for infants undergoing inguinal hernia surgery to help clinicians answer these questions.
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Affiliation(s)
- Fiona Taverner
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Department of Anaesthesia and Pain ManagementFlinders Medical CentreAdelaideSouth AustraliaAustralia
| | - Prakash Krishnan
- Department of AnesthesiaBC Children's HospitalVancouverBritish ColumbiaCanada
- Department of Anesthesiology, Pharmacology and Therapeutics UBCVancouverBritish ColumbiaCanada
| | - Robert Baird
- Division of Pediatric SurgeryBC Children's HospitalVancouverBritish ColumbiaCanada
| | - Britta S. von Ungern‐Sternberg
- Department of Anaesthesia and Pain MedicinePerth Children's HospitalNedlandsWestern AustraliaAustralia
- Division of Emergency Medicine, Anaesthesia and Pain MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
- Perioperative Medicine Team, Perioperative Care ProgramTelethon Kids InstituteNedlandsWestern AustraliaAustralia
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Fuchs A, Franzmeier L, Cheseaux-Carrupt M, Kaempfer M, Disma N, Pietsch U, Huber M, Riva T, Greif R. Characteristics and neurological survival following intraoperative cardiac arrest in a Swiss University Hospital: a 7-year retrospective observational cohort study. Front Med (Lausanne) 2023; 10:1198078. [PMID: 37396914 PMCID: PMC10309035 DOI: 10.3389/fmed.2023.1198078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Little is known about intraoperative cardiac arrest during anesthesia care. In particular, data on characteristics of cardiac arrest and neurological survival are scarce. Methods We conducted a single-center retrospective observational study evaluating anesthetic procedures from January 2015 until December 2021. We included patients with an intraoperative cardiac arrest and excluded cardiac arrest outside of the operating room. The primary outcome was the return of spontaneous circulation (ROSC). Secondary outcomes were sustained ROSC over 20 min, 30-day survival, and favorable neurological outcome according to Clinical Performance Category (CPC) 1 and 2. Results We screened 228,712 anesthetic procedures, 195 of which met inclusion criteria and were analyzed. The incidence of intraoperative cardiac arrest was 90 (CI 95% 78-103) in 100,000 procedures. The median age was 70.5 [60.0; 79.4] years, and two-thirds of patients (n = 135; 69.2%) were male. Most of these patients with cardiac arrest had ASA physical status IV (n = 83; 42.6%) or V (n = 47; 24.1%). Cardiac arrest occurred more frequently (n = 104; 53.1%) during emergency procedures than elective ones (n = 92; 46.9%). Initial rhythm was pre-dominantly non-shockable with pulseless electrical activity mostly. Most patients (n = 163/195, 83.6%; CI 95 77.6-88.5%) had at least one instance of ROSC. Sustained ROSC over 20 min was achieved in most patients with ROSC (n = 147/163; 90.2%). Of the 163 patients with ROSC, 111 (68.1%, CI 95 60.4-75.2%) remained alive after 30 days, and most (n = 90/111; 84.9%) had favorable neurological survival (CPC 1 and 2). Conclusion Intraoperative cardiac arrest is rare but is more likely in older patients, patients with ASA physical status ≥IV, cardiac and vascular surgery, and emergency procedures. Patients often present with pulseless electrical activity as the initial rhythm. ROSC can be achieved in most patients. Over half of the patients are alive after 30 days, most with favorable neurological outcomes, if treated immediately.
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Affiliation(s)
- Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Unit for Research in Anaesthesia, Department of Paediatric Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Lea Franzmeier
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Marie Cheseaux-Carrupt
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Martina Kaempfer
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Nicola Disma
- Unit for Research in Anaesthesia, Department of Paediatric Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Urs Pietsch
- Department of Emergency Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
- ERC Research Net, Niel, Belgium
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Lonsdale H, Matava CT. Paediatric perioperative mortality estimation-Are we barking up the wrong tree? Acta Anaesthesiol Scand 2023; 67:124-125. [PMID: 36305729 DOI: 10.1111/aas.14164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Hannah Lonsdale
- Department of Anesthesia and Pediatric Anesthesia, University of Vanderbilt School of Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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