Crisis management during anaesthesia: bradycardia

Haemodynamic monitoring during noncardiac surgery: past, present, and future

During surgery, various haemodynamic variables are monitored and optimised to maintain organ perfusion pressure and oxygen delivery - and to eventually improve outcomes. Important haemodynamic variables that provide an understanding of most pathophysiologic haemodynamic conditions during surgery include heart rate, arterial pressure, central venous pressure, pulse pressure variation/stroke volume variation, stroke volume, and cardiac output. A basic physiologic and pathophysiologic understanding of these haemodynamic variables and the corresponding monitoring methods is essential. We therefore revisit the pathophysiologic rationale for intraoperative monitoring of haemodynamic variables, describe the history, current use, and future technological developments of monitoring methods, and finally briefly summarise the evidence that haemodynamic management can improve patient-centred outcomes.

Sedation versus general anesthesia on all-cause mortality in patients undergoing percutaneous procedures: a systematic review and meta-analysis

BACKGROUND

The comparison between sedation and general anesthesia (GA) in terms of all-cause mortality remains a subject of ongoing debate. The primary objective of our study was to investigate the impact of GA and sedation on all-cause mortality in order to provide clarity on this controversial topic.

METHODS

A systematic review and meta-analysis were conducted, incorporating cohort studies and RCTs about postoperative all-cause mortality. Comprehensive searches were performed in the PubMed, EMBASE, and Cochrane Library databases, with the search period extending until February 28, 2023. Two independent reviewers extracted the relevant information, including the number of deaths, survivals, and risk effect values at various time points following surgery, and these data were subsequently pooled and analyzed using a random effects model.

RESULTS

A total of 58 studies were included in the analysis, with a majority focusing on endovascular surgery. The findings of our analysis indicated that, overall, and in most subgroup analyses, sedation exhibited superiority over GA in terms of in-hospital and 30-day mortality. However, no significant difference was observed in subgroup analyses specific to cerebrovascular surgery. About 90-day mortality, the majority of studies centered around cerebrovascular surgery. Although the overall pooled results showed a difference between sedation and GA, no distinction was observed between the pooled ORs and the subgroup analyses based on RCTs and matched cohort studies. For one-year all-cause mortality, all included studies focused on cardiac and macrovascular surgery. No difference was found between the HRs and the results derived from RCTs and matched cohort studies.

CONCLUSIONS

The results suggested a potential superiority of sedation over GA, particularly in the context of cardiac and macrovascular surgery, mitigating the risk of in-hospital and 30-day death. However, for the longer postoperative periods, this difference remains uncertain.

TRIAL REGISTRATION

PROSPERO CRD42023399151; registered 24 February 2023.

Local versus General Anaesthesia for Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomised and Propensity-Score Matched Studies

Transcatheter aortic valve implantation (TAVI) is a common practice for severe aortic stenosis, but the choice between general (GA) and local anesthesia (LA) remains uncertain. We conducted a comprehensive literature review until April 2023, comparing the safety and efficacy of LA versus GA in TAVI procedures. Our findings indicate significant advantages of LA, including lower 30-day mortality rates (RR: 0.69; 95% CI [0.58, 0.82]; p < 0.001), shorter in-hospital stays (mean difference: -0.91 days; 95% CI [-1.63, -0.20]; p = 0.01), reduced bleeding/transfusion incidents (RR: 0.64; 95% CI [0.48, 0.85]; p < 0.01), and fewer respiratory complications (RR: 0.56; 95% CI [0.42, 0.76], p<0.01). Other operative outcomes were comparable. Our findings reinforce prior evidence, presenting a compelling case for LA's safety and efficacy. While patient preferences and clinical nuances must be considered, our study propels the discourse towards a more informed anaesthesia approach for TAVI procedures.

Endotypes of intraoperative hypotension during major abdominal surgery: a retrospective machine learning analysis of an observational cohort study

BACKGROUND

Intraoperative hypotension is associated with myocardial injury, acute kidney injury, and death. In routine practice, specific causes of intraoperative hypotension are often unclear. A more detailed understanding of underlying haemodynamic alterations of intraoperative hypotension may identify specific treatments. We thus aimed to use machine learning - specifically, hierarchical clustering - to identify underlying haemodynamic alterations causing intraoperative hypotension in major abdominal surgery patients. Specifically, we tested the hypothesis that there are distinct endotypes of intraoperative hypotension, which may help refine therapeutic interventions.

METHODS

We conducted a secondary analysis of intraoperative haemodynamic measurements from a prospective observational study in 100 patients who had major abdominal surgery under general anaesthesia. We used stroke volume index, heart rate, cardiac index, systemic vascular resistance index, and pulse pressure variation measurements. Intraoperative hypotension was defined as any mean arterial pressure ≤65 mm Hg or a mean arterial pressure between 66 and 75 mm Hg requiring a norepinephrine infusion rate exceeding 0.1 μg kg^-1 min^-1. To identify endotypes of intraoperative hypotension, we used hierarchical clustering (Ward's method).

RESULTS

A total of 615 episodes of intraoperative hypotension occurred in 82 patients (46 [56%] female; median age: 64 [57, 73] yr) who had surgery of a median duration of 270 (195, 335) min. Hierarchical clustering revealed six distinct intraoperative hypotension endotypes. Based on their clinical characteristics, we labelled these endotypes as (1) myocardial depression, (2) bradycardia, (3) vasodilation with cardiac index increase, (4) vasodilation without cardiac index increase, (5) hypovolaemia, and (6) mixed type.

CONCLUSION

Hierarchical clustering identified six endotypes of intraoperative hypotension. If validated, considering these intraoperative hypotension endotypes may enable causal treatment of intraoperative hypotension.

Relationship Between Intraoperative and Preoperative Ambulatory Nighttime Heart Rates: A Secondary Analysis of a Prospective Observational Study

BACKGROUND

It remains unknown what constitutes physiologically relevant intraoperative bradycardia. Intraoperative bradycardia is usually defined using absolute heart rate thresholds, ignoring preoperative baseline heart rates. In contrast, we considered defining intraoperative bradycardia relative to preoperative ambulatory nighttime heart rate. Specifically, we hypothesized that the individual mean intraoperative heart rate is lower than the mean preoperative ambulatory nighttime heart rate. We, therefore, sought to investigate the relationship between the intraoperative and preoperative ambulatory nighttime heart rates in adults having noncardiac surgery with general anesthesia. Additionally, we sought to investigate the incidence of intraoperative bradycardia using relative versus absolute heart rate thresholds.

METHODS

We conducted a secondary analysis of a database from a prospective study including preoperative ambulatory and intraoperative heart rates in 363 patients having noncardiac surgery with general anesthesia.

RESULTS

The mean intraoperative heart rate was lower than the mean nighttime heart rate (mean difference, -9 bpm; 95% confidence interval [CI], -10 to -8 bpm; P < .001). The mean intraoperative heart rate was lower than the mean nighttime heart rate in 319 of 363 patients (88%; 95% CI, 84%-91%). The incidence of intraoperative bradycardia was 42% (95% CI, 38%-47%) when it was defined as intraoperative heart rate >30% lower than mean nighttime heart rate and 43% (95% CI, 38%-49%) when it was defined as intraoperative heart rate <45 bpm.

CONCLUSIONS

The mean intraoperative heart rate is lower than the mean nighttime heart rate in about 9 of 10 patients. Intraoperative bradycardia might thus be physiologically and clinically important. Future research needs to investigate whether there is an association between intraoperative bradycardia and postoperative outcomes.

Use of Dexmedetomidine in Transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI) Procedures

INTRODUCTION

Dexmedetomidine is a highly selective alpha-2 adrenoreceptor agonist without any effect on the GABA receptor. Its sedative, anxiolytic, analgesic, and sympatholytic activities together with opioid-sparing effects make it suitable for short- and long-term sedation in the intensive care setting. We report our experience with dexmedetomidine use during transfemoral transcatheter aortic valve implantation (TAVI) procedure as an alternative to general anesthesia.

METHODS

This is a retrospective analysis of high-risk patients undergoing dexmedetomidine infusion for the transfemoral TAVI procedure between July 2017 and October 2019. The primary outcome parameters were hemodynamic: heart rate (HR), mean arterial pressure (MAP); respiratory oxygen saturation (SpO₂), pH, partial pressure of arterial oxygen (PaO₂), partial pressure of arterial carbon dioxide (PaCO₂), and sedation level (Richmond Agitation-Sedation Scale, RASS). The frequency of conversion to general anesthesia and the need for sedative "rescue therapy" were secondary endpoints. We also reported the overall anesthetic management and the incidence of intra- and postoperative complications.

RESULTS

Eighty-five patients were evaluated (age 81.58 ± 5.23 years, 36.5% men, 63.5% women). High comorbidity, according to the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM). The patients' hemodynamic functions were kept normal. Complications such as cardiac arrest occurred in four patients; orotracheal intubation and cardiopulmonary resuscitation were necessary. Atrioventricular block occurred in nine patients. Respiratory parameters were maintained stable. Complications such as apnea, hypoventilation, and hypoxemia did not occur. All patients had RASS scores above or equal to 0 and - 1. No patient required rescue midazolam or fentanyl. No conversion to general anesthesia in patients sedated with dexmedetomidine was observed in the absence of hemodynamic complications caused by the surgical technique.

CONCLUSION

In this series, sedation with dexmedetomidine for TAVI procedures with femoral access was proven effective and safe. Dexmedetomidine may be a valid alternative to general anesthesia in high-risk older patients undergoing transfemoral TAVI.

Intraoperative Surgical Complications in Transoral Laser CO2 Microsurgery of the Larynx: An Observational, Prospective, Single-Center Study

INTRODUCTION

Despite good outcomes of CO₂ laser of the larynx, a lack of prospective data related to intraoperative complications in the indexed literature is evident.

MATERIALS AND METHODS

An observational, prospective, nonrandomized study.

RESULTS

One hundred and twenty-eight patients met the inclusion criteria. The total rate of intraoperative complications was 14.8% (19/128). The rate of complications according to anatomical location was 7 (38.8%) of 18 for supraglottic tumors and 11 (10.3%) of 107 for glottic tumors, and 1 (33.3%) of 3 for subglottic tumors (P = .001). We do not found difference in complications according to severity (minor vs major complication).

CONCLUSION

Previous studies reported good oncologic outcomes and low complication rates with CO₂ transoral laser microsurgery (TOLMS) compared to traditional open surgery. However, it is important to consider the different intraoperative surgical, major and minor complications related to CO₂ TOLMS and discuss this with our patients during the preoperative assessment, especially in those patients who need a supraglottic tumor resection.

Improving Emergency Airway Knowledge and Self-Efficacy Levels of Outpatient Gastroenterology Staff via Implementation of Online Education and In Situ Simulation

Twenty percent of all ambulatory surgery cases utilizing monitored anesthesia care and sedation report at least one perioperative respiratory complication such as bronchospasm, hypoxia, laryngospasm, or aspiration (). However, the national Standards of Practice for both surgical technicians and ambulatory care nurses do not mandate emergency airway education beyond cardiopulmonary resuscitation and Basic Life Support training. A local outpatient gastroenterology clinic noticed the gap in education, and the anesthesia team decided to implement an evidence-based dual-factorial quality improvement project utilizing online education and in situ simulation. First, registered nurses and procedural technologists completed a test to assess their baseline knowledge and airway emergency performance self-efficacy levels. Then an online module was distributed that included information on the 3 most common anesthesia airway emergencies in the outpatient setting: laryngospasm, aspiration, and obstruction with resultant hypoxemia. Next, participants completed an in situ simulation of the 3 airway emergencies using low-fidelity mannequins. A post-education assessment was distributed after completion of the simulation training and again at 6 weeks and 3 months post-implementation. The data collected showed a statistically significant increase in both knowledge scores and levels of self-efficacy at 6 weeks and 3 months posteducation (p < .001).

Risk factors for intraoperative bradycardia during ear, nose, throat and maxillofacial surgery

Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient's blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (OR = 1.158; 95% CI = 1.068-1.256; p = 0.000), sex (OR = 0.786; 95% CI = 0.623-0.993; p = 0.043), ischemic heart disease (OR = 2.016; 95% CI = 1.182-3.441; p = 0.010); ear surgery (OR = 1.593; 95% CI = 1.232-2.060; p = 0.000), anesthesia duration, (OR = 1.006; 95% CI = 1.004-1.007; p = 0.000) and controlled hypotension (OR = 2.204; 95% CI = 1.761-2.758; p = 0.000). IOB is common in maxillofacial, ear, nose and throat surgery, particularly in male, older age and patients with ishemic heart disease. The ear surgery, longer anesthesia duration and controlled hypotension raise the risk for occurrence of IOB.

Is local anaesthesia a favourable approach for transcatheter aortic valve implantation? A systematic review and meta-analysis comparing local and general anaesthesia

OBJECTIVES

We conducted a systematic review and meta-analysis to identify the potential favourable effects of local anaesthesia plus sedation (LAS) compared with general anaesthesia (GA) in transcatheter aortic valve implantation (TAVI).

METHODS

Electronic databases (PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials) and the reference lists of eligible publications were screened for randomised controlled trials (RCTs) and observational studies published between 1 January 2006 and 26 June 2016 that compare LAS to GA in an adult study population undergoing TAVI. We conducted study quality assessments using the Cochrane risk of bias tool and structured the review according to PRISMA. A meta-analysis calculating the pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) under the assumption of a random-effects model was performed. Statistical heterogeneity was evaluated using the I² statistic and Cochran's Q-test.

RESULTS

After database screening, one RCT and 19 observational studies were included in the review. We found no differences between LAS and GA in terms of 30-day mortality, in-hospital mortality and other endpoints that addressed safety and complication rates. LAS was associated with a shorter ICU and hospital stay and with lower rates of catecholamine administration and red blood cell transfusion. New pacemaker implantations occurred more frequently under LAS. The overall conversion rate from LAS to GA was 6.2%.

CONCLUSION

For TAVI, both LAS and GA are feasible and safe. LAS may have some benefits such as increased haemodynamic stability and shorter hospital and ICU stays, but it does not impact 30-day mortality. Since there is a paucity of randomised trial data and the findings are mainly based on observational study data, this review should be considered as a hypothesis-generating article for subsequent RCTs that are required to confirm the potential favourable effects we detected for LAS.

REGISTRATION NUMBER

CRD42016048398 (PROSPERO).

Rigorous anaesthesia management protocol for patients with intracranial arterial stenosis: a prospective controlled-cohort study

OBJECTIVES

Reducing variability is integral in quality management. As part of the ongoing Encephaloduroarteriosynangiosis Revascularisation for Symptomatic Intracranial Arterial Stenosis (ERSIAS) trial, we developed a strict anaesthesia protocol to minimise fluctuations in patient parameters affecting cerebral perfusion. We hypothesise that this protocol reduces the intraoperative variability of targeted monitored parameters compared to standard management.

DESIGN

Prospective cohort study of patients undergoing encephaloduroarteriosynangiosis surgery versus standard neurovascular interventions. Patients with ERSIAS had strict perioperative management that included normocapnia and intentional hypertension. Control patients received regular anaesthetic standard of care. Minute-by-minute intraoperative vitals were electronically collected. Heterogeneity of variance tests were used to compare variance across groups. Mixed-model regression analysis was performed to establish the effects of treatment group on the monitored parameters.

SETTING

Tertiary care centre.

PARTICIPANTS

24 participants: 12 cases (53.8 years ± 16.7 years; 10 females) and 12 controls (51.3 years ± 15.2 years; 10 females). Adults aged 30-80 years, with transient ischaemic attack or non-disabling stroke (modified Rankin Scale <3) attributed to 70-99% intracranial stenosis of the carotid or middle cerebral artery, were considered for enrolment. Controls were matched according to age, gender and history of neurovascular intervention.

MAIN OUTCOME MEASURES

Variability of heart rate, mean arterial blood pressure (MAP), systolic blood pressure and end tidal CO2 (ETCO2) throughout surgical duration.

RESULTS

There were significant reductions in the intraoperative MAP SD (4.26 vs 10.23 mm Hg; p=0.007) and ETCO2 SD (0.94 vs 1.26 mm Hg; p=0.05) between the ERSIAS and control groups. Median MAP and ETCO2 in the ERSIAS group were higher (98 mm Hg, IQR 23 vs 75 mm Hg, IQR 15; p<0.001, and 38 mm Hg, IQR 4 vs 32 mm Hg, IQR 3; p<0.001, respectively).

CONCLUSIONS

The ERSIAS anaesthesia protocol successfully reduced intraoperative fluctuations of MAP and ETCO2. The protocol also achieved normocarbia and the intended hypertension.

TRIAL REGISTRATION NUMBER

NCT01819597; Pre-results.

Effect of pulse width on transesophageal atrial pacing in dogs

OBJECTIVE

To determine the impact of stimulus pulse width (PW) on pacing threshold (PT), zone of capture (ZOC) and extraneous muscular stimulation (EMS).

STUDY DESIGN

Experimental trial in client-owned dogs.

ANIMALS

Seventeen dogs, median weight 16.1 kg (interquartile range: 11.4-21.5).

METHODS

Transesophageal atrial pacing (TAP) involved a 6 Fr pacing catheter inserted trans-orally into the esophagus to a position aboral to the heart in anesthetized dogs. The catheter was slowly withdrawn until atrial pacing was noted on an electrocardiogram. The catheter was withdrawn in 1 cm increments until TAP could not be achieved. PTs were recorded at each pacing site using PWs of 10.0, 5.0, 2.0 and 1.8 ms, always in that order.

RESULTS

The overall lowest mean PTs for all dogs were 6 ± 3 mA, 9 ± 4 mA, 11 ± 5 mA and 13 ± 5 mA at PWs of 10.0, 5.0, 2.0 and 1.8 ms, respectively. A significant decrease in overall minimum PT was noted using a PW of 10.0 ms compared with either 2.0 or 1.8 ms (p = 0.043 and p = 0.001, respectively) and pacing using 5.0 ms compared with 1.8 ms (p = 0.028). A significant increase in ZOC was noted using a PW of 10.0 ms compared with PWs of 5.0, 2.0 and 1.8 ms (p = 0.0047, p = 0.0006 and p = 0.0003, respectively), using a PW of 5.0 ms compared with PWs of 2.0 and 1.8 ms (p = 0.0011 and p = 0.0003, respectively) and using a PW of 2.0 compared with one of 1.8 ms (p = 0.0084).

CONCLUSIONS AND CLINICAL RELEVANCE

Use of 10.0 or 5.0 ms PW to perform TAP minimized the power required to pace the atria, while a PW of 10.0 ms maximized the size of the ZOC.

Effect of hypertonic saline on hypotension following induction of general anesthesia: A randomized controlled trial

Background:

The aim of this study was to examine the effects of preoperatively administered i.v. hypertonic saline on hypotension following induction of general anesthesia.

Materials and Methods:

Fifty-four patients who scheduled for elective surgery were randomly allocated to two groups of 27 patients who received hypertonic saline 5% (2.3 ml/kg) or received normal saline (13 ml/kg). Infusion of hypertonic saline was done half an hour before induction of anesthesia during 30 minutes. Anesthesia was conducted in a standard protocol for all patients. Age, sex, body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), heart rate (HR) and mean arterial pressure (MAP) were assessed in all patients.

Results:

The mean age of patients was 36.68 ± 10.8 years. Forty percent of patients were male. The mean SBP at min 2 and min 5, mean of DBP at min 2, 5, and 15, mean of HR at all time points and mean of MAP at min 2 and 15 between groups were no significantly different (P > 0.05), but mean of SBP at min 10 and 15, mean of DBP at min 10, and mean of MAP at min 5 and 10 in hypertonic saline group was significantly more than the normal group (P < 0.05). Trend of SBP, DBP, HR and MAP between groups were not significantly different (P > 0.05).

Conclusions:

Infusion of hypertonic saline 5% (2.3 mg/kg) before the general anesthesia led to a useful reduction in MAP and reduced heart rate, with no episodes of severe hypotension.

Comparison of mean heart rate in anaesthetized dachshunds and other breeds of dog undergoing spinal magnetic resonance imaging

OBJECTIVE

Clinical experience suggests that dachshunds are prone to bradycardia during general anaesthesia (GA). The study investigated mean heart rates in anaesthetized dachshunds and other breeds of dog.

STUDY DESIGN

Retrospective clinical study.

ANIMALS

Sixty one dachshunds and 62 dogs of other breeds met inclusion criteria.

METHODS

Clinical records of small breed dogs undergoing GA for spinal Magnetic Resonance Imaging between September 2008 and March 2010 were identified and examined. Data collected included drugs administered, baseline heart (HR) and respiratory (f(R) ) rates and rectal temperature. The following information was noted from anaesthetic records: HR, f(R) , mean non-invasive arterial pressure and end-tidal carbon dioxide (Pe'CO(2)) and anaesthetic agent (Fe'agent) during the first 60 minutes of anaesthesia; rectal temperature at a time closest to the cessation of anaesthesia, ventilatory mode (spontaneous/mechanical) and fluid infusion rate. Univariate analysis with Student t-test and Fisher's test identified parameters significant in predicting a lowered HR. A multivariate analysis investigated their effect on the mean HR during GA.

RESULTS

No differences were found between groups regarding: age, baseline HR, baseline temperature, incidence of hypotension, Fe'agent, mean Pe'CO(2) and fluid infusion rate. Body mass was smaller for dachshunds (6.7 ± 1.5 kg) compared to other breeds (7.8 ± 1.8 kg) (p = 0.0005). The lowest HR recorded was lower in dachshunds (64 ± 19 beats minute(-1)) compared to other breeds (72 ± 21 beats minute(-1)) (p = 0.03). Mean HR was lower in dachshunds (75 ± 21 beats minute(-1)) compared to other breeds (84 ± 21 beats minute(-1)) (p = 0.02). Post-procedural temperature (°C) was lower in dachshunds (35.5 ± 1.1) compared to other breeds (36.1 ± 1.2) (p = 0.007) and anticholinergics were also administered more frequently (p = 0.026). Multivariate analysis identified that breed and mean Pe'CO(2) affected mean HR during anaesthesia.

CONCLUSION

This study supported our hypothesis that dachshunds have a lower mean HR under GA than other small breed dogs.

Severe hypotension following urethral catheterization during general anesthesia in a patient with bladder cancer -A case report-

The process of micturition is related to activation of the cardiovascular autonomic nervous system. Hypotension with bradycardia often occurs during or immediately after micturition. We experienced a case of sudden severe hypotension and bradycardia following urethral catheterization in a patient who underwent an urethral dilatation and transurethral resection of bladder tumor while under general anesthesia. The patient was treated with inotropics and intravenous fluids, and he recovered without any complications. The characteristics of this case are similar to the physiologic changes that occur in micturition syncope. Therefore, it is presumed that the autonomic reflex that was triggered by the urethral catheterization caused the hypotension and bradycardia.

Perioperative cardiac arrests in children at a university teaching hospital of a developing country over 15 years

OBJECTIVE/AIM

To study the incidence, causes, and outcome of perioperative cardiac arrests in children at a university teaching hospital with an aim of improving quality of care.

BACKGROUND

Analysis of anesthesia-related complications is routinely performed by most anesthesia departments to make prevention strategies.

METHODS

All perioperative cardiac arrests in children up to 18 years from induction of anesthesia to postanesthesia care unit discharge or ICU admission during noncardiac surgery from January 1992 to December 2006 were analyzed. Outcome variable was noted as survival to discharge. Anesthesia-related cardiac arrests were identified and their causes analyzed.

RESULTS

Ten cardiac arrests occurred among 20216 patients. Overall incidence was 4.95 per 10000 (95% CI: 1.88-8.01). Six (6.53/10000) were females. Seven (19.44/10000) patients belonged to the classification III-IV of ASA physical status, eight (18.28/10000) were below 1 year, and two (1.26/10000) above 1 year. Three patients (6.53/10000) were undergoing emergency surgery. Anesthesia was primarily responsible in four cases. The causes of anesthesia-related arrests were medication-related (two), airway-related (one), and under-replacement of fluids (one). Seven patients died during the arrest and three were discharged home. The event was considered avoidable in seven (70%) cases.

CONCLUSION

Perioperative cardiac arrests were higher in patients with poor physical status, in those under 1 year of age, and in female patients. Anesthesia-related cardiac arrests were mainly due to medication- or airway-related causes. The majority of arrests were avoidable indicating the importance of prevention strategies.