Pediatric Anesthesia Severe Adverse Events Leading to Anesthetic Morbidity and Mortality in a Tertiary Care Center in a Low- and Middle-Income Country: A 25-Year Audit
| Autor: | Nasir Khoso, Fauzia Anis Khan, Waleed B Ghaffar, Shemila Abassi |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Heart disease MEDLINE Severity of Illness Index Cohort Studies Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Anesthesiology medicine Humans Anesthesia Hospital Mortality Child Intraoperative Complications Adverse effect Poverty business.industry Infant Newborn Infant Perioperative medicine.disease Confidence interval Anesthesiology and Pain Medicine Child Preschool Anesthetic Female Morbidity Pediatric anesthesia business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Anesthesia & Analgesia. 132:217-222 |
| ISSN: | 0003-2999 |
| DOI: | 10.1213/ane.0000000000005162 |
| Popis: | Background The analysis of adverse events, including morbidity and mortality (M&M), helps to identify subgroups of children at risk and to modify clinical practice. There are scant data available from low- and middle-income countries. Our aim was to estimate the proportion of pediatric patients with various severe adverse events in the perioperative period extending to 48 hours and to describe the clinical situations and causes of those events. Methods We reviewed the M&M database of the Department of Anesthesiology between 1992 and 2016. A data collection tool was developed, and the outcomes were standardized. Each case was reviewed independently and subsequently discussed between 2 reviewers to identify a major primary causative factor. Results The total number of pediatric cases during this period was 48,828. Seventy-six significant adverse events were identified in 39 patients (8 patients [95% confidence interval {CI}, 5.7-10.9] per 10,000). Thirteen patients had multisystem involvement, and hence the total number of events exceeded the number of patients. Respiratory events were the most common (33.5%). Thirteen patients had perioperative cardiac arrest within 48 hours of surgery (2.6 [95% CI, 1.3-4.3] per 10,000), 7 of these were infants (54%), 5 of whom had congenital heart disease (CHD). Eleven of these 39 patients died within 48 hours (2.0 [95% CI, 1.1-4.0] per 10,000). In 13 cases, anesthesia was assessed to be the predominant cause of morbidity (2.6 per 10,000), whereas in 26 cases, it contributed partially (5.32 per 10,000). There was only 1 death solely related to anesthesia (0.2 per 10,000), and this death occurred before the start of surgery. Conclusions Adverse events were uncommon. Respiratory complications were the most frequent (33%). Infants, especially those with CHD, were identified as at a higher risk for perioperative cardiac arrest, but this association was not tested statistically. Twenty-eight percent of the patients who suffered events died within 48 hours. Increased access to anesthesia drugs and practice improvements resulted in a decline in perioperative cardiac arrests. |
| Databáze: | OpenAIRE |
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