European Journal of Anaesthesiology:
Pignaton, W.; Módolo, M.; Braz, J. R.C.; Braz, L. G.; Anaesthesia‐related Cardiac Arrest and Death Study Group
UNESP ‐ Univ Estadual Paulista, Dept of Anaesthesiology, Botucatu, Brazil
Background and Goal of Study: Two previous studies in our institution demonstrated intraoperative anaesthesia‐related mortality ranging between 0.85 and 1.12 per 10,000 anaesthetics.1,2 This survey evaluated the incidence and causes of cardiac arrest (CA) and death related to anaesthesia in a Brazilian tertiary teaching hospital between January 2005 and December 2010.
Materials and Methods: There were 42,221 consecutive anaesthetics in the study period. The incidence of CA and death during anaesthesia was prospectively identified from an anaesthesia database of operating room and post‐anaesthesia care unit CA and death. Collected data included patient demographics, surgical procedures (elective, urgent or emergency), ASA physical status classification, anaesthesia provider information, type of surgery, surgical areas and outcome. All CA and death were reviewed and grouped by cause into one of four groups: totally anaesthesia‐related, partially anaesthesia‐related, totally surgery‐related or totally patient disease/condition‐related.
Results and Discussion: One hundred eleven CA (26.3 per 10,000 anaesthetics) and 72 deaths (17 per 10,000 anaesthetics) were found. The major incidence of CA were children under 1 yr and the elderly (P=0.02), ASA physical status of III or poorer (p=0.02), emergency surgery (p=0.02) and general anaesthesia (p=0.03). Sepsis with multiple organ dysfunction syndrome was the main cause of CA, followed by ruptured aneurisms (p< 0.03). The majority of the perioperative CA and death were patient disease/condition‐related (p< 0.0001). There were 5 partially anaesthesia‐related CA without anaesthesiarelated mortality (p< 0.0001). The main causes of anaesthesia‐related CA were respiratory events.
Conclusions: Anaesthesia‐related CA and death were 1.2 and 0.0 per 10,000 anaesthetics, respectively. All anaesthesia‐related CA were related to airway management. The expressive decrease in mortality incidence indicates that anaesthesia safety in all ages has dramatically improved over the past two decades in our institution following a global trend.
1. Braz JRC, Silva ACM, Carlos E et al. Rev Bras Anestesiol. 1999;49:257-62.
2. Braz LG, Módolo NSP, Nascimento Jr P, et al. Br J Anaesth. 2006;96:569-75.
Acknowledgements: W. Pignaton was granted a scholarship from CAPES and M. P. Módolo was granted a scholarship from PIBIC/CNPq.