Mortalidad relacionada a la anestesia en pacientes pediátricos: revisión sistemática
Anesthesia-related mortality in pediatric patients: a systematic review.
Gonzalez LP, Pignaton W, Kusano PS, Módolo NS, Braz JR, Braz LG.
Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.
Clinics (Sao Paulo). 2012;67(4):381-7.
Abstract
This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics) and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesia-related mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317253/pdf/cln-67-04-381.pdf
Papel de la unidad de cuidado postanestésico en el manejo de la obstétrica de alto riesgo
The role of the post-anaesthesia care unit in the management of high-risk obstetric patients.
Kostopanagiotou G, Kalimeris K, Pandazi A, Salamalekis G, Chrelias C, Matsota P.
2 Department of Anaesthesiology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece.
Arch Med Sci. 2011 Feb;7(1):123-6. Epub 2011 Mar 8.
Abstract
INTRODUCTION: High-risk obstetric patients in the immediate postpartum period are frequently admitted to the intensive care unit, but the necessity of this practice has recently been doubted. Herein we describe the efficiency of utilizing the post-anaesthesia care unit (PACU) as an intermediate intensive care facility for those patients. MATERIAL AND METHODS: We retrospectively described the reasons for admission, duration of stay, the anaesthetic used, main interventions and outcome for all obstetric admissions in the PACU during a period of 4 years in a university hospital. RESULTS: During the 4-year period 47 women were admitted to the PACU after delivery. The frequency of admission to the PACU was 15.3 per 1000 deliveries, while obstetric cases represented 4.4 per 1000 admissions to the PACU. The majority represented caesarean sections (81%). The main reasons for admission to the PACU were haemorrhage (49%), cardiovascular problems (19%) and preeclampsia/eclampsia (17%). Mean length of stay in the PACU was 14.5 ±11.6 h, being significantly less in women having received epidural anaesthesia (8.2 ±5.6 h) compared to those who delivered with general anaesthesia (19.0 ±13.6 h, p < 0.05). General anaesthesia was used in 85% of cases in which emergency delivery was indicated, but only in 27% of cases without emergency indications for delivery (p < 0.01). No death or admission to the intensive care unit occurred during the study period. CONCLUSIONS: The PACU can offer an intermediate intensive care facility for high-risk obstetric patients, thus reducing unnecessary admissions to the intensive care unit.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258694/pdf/AMS-7-1-123.pdf
Epidemiología de la mortalidad relacionada con anestesia en USA, 199-2005
Epidemiology of anesthesia-related mortality in the United States, 1999-2005.
Li G, Warner M, Lang BH, Huang L, Sun LS.
Center for Health Policy and Outcomes in Anesthesia and Critical Care, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. GL2240@columbia.edu
Anesthesiology. 2009 Apr;110(4):759-65.
Abstract
BACKGROUND: Previous research on anesthesia-related mortality in the United States was limited to data from individual hospitals. The purpose of this study was to examine the epidemiologic patterns of anesthesia-related deaths at the national level. METHODS: The authors searched the International Classification of Diseases, 10th Revision manuals for codes specifically related to anesthesia/anesthetics. These codes were used to identify anesthesia-related deaths from the US multiple-cause-of-death data files for the years 1999-2005. Rates from anesthesia- related deaths were calculated based on population and hospital surgical discharge data. RESULTS: The authors identified 46 anesthesia/anesthetic codes, including complications of anesthesia during pregnancy, labor, and puerperium (O29.0 -O29.9, O74.0-74.9, O89.0-O89.9), overdose of anesthetics (T41.0 -T41.4), adverse effects of anesthetics in therapeutic use (Y45.0, Y47.1, Y48.0 - Y48.4, Y55.1), and other complications of anesthesia (T88.2- T88.5, Y65.3). Of the 2,211 recorded anesthesia-related deaths in the United States during 1999-2005, 46.6% were attributable to overdose of anesthetics; 42.5% were attributable to adverse effects of anesthetics in therapeutic use; 3.6% were attributable to complications of anesthesia during pregnancy, labor, and puerperium; and 7.3% were attributable to other complications of anesthesia. Anesthesia complications were the underlying cause in 241 (10.9%) of the 2,211 deaths. The estimated rates from anesthesia-related deaths were 1.1 per million population per year (1.45 for males and 0.77 for females) and 8.2 per million hospital surgical discharges (11.7 for men and 6.5 for women). The highest death rates were found in persons aged 85 yr and older. CONCLUSION: Each year in the United States, anesthesia/anesthetics are reported as the underlying cause in approximately 34 deaths and contributing factors in another 281 deaths, with excess mortality risk in the elderly and men.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697561/pdf/nihms117911.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Anesthesia-related mortality in pediatric patients: a systematic review.
Gonzalez LP, Pignaton W, Kusano PS, Módolo NS, Braz JR, Braz LG.
Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.
Clinics (Sao Paulo). 2012;67(4):381-7.
Abstract
This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics) and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesia-related mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317253/pdf/cln-67-04-381.pdf
Papel de la unidad de cuidado postanestésico en el manejo de la obstétrica de alto riesgo
The role of the post-anaesthesia care unit in the management of high-risk obstetric patients.
Kostopanagiotou G, Kalimeris K, Pandazi A, Salamalekis G, Chrelias C, Matsota P.
2 Department of Anaesthesiology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece.
Arch Med Sci. 2011 Feb;7(1):123-6. Epub 2011 Mar 8.
Abstract
INTRODUCTION: High-risk obstetric patients in the immediate postpartum period are frequently admitted to the intensive care unit, but the necessity of this practice has recently been doubted. Herein we describe the efficiency of utilizing the post-anaesthesia care unit (PACU) as an intermediate intensive care facility for those patients. MATERIAL AND METHODS: We retrospectively described the reasons for admission, duration of stay, the anaesthetic used, main interventions and outcome for all obstetric admissions in the PACU during a period of 4 years in a university hospital. RESULTS: During the 4-year period 47 women were admitted to the PACU after delivery. The frequency of admission to the PACU was 15.3 per 1000 deliveries, while obstetric cases represented 4.4 per 1000 admissions to the PACU. The majority represented caesarean sections (81%). The main reasons for admission to the PACU were haemorrhage (49%), cardiovascular problems (19%) and preeclampsia/eclampsia (17%). Mean length of stay in the PACU was 14.5 ±11.6 h, being significantly less in women having received epidural anaesthesia (8.2 ±5.6 h) compared to those who delivered with general anaesthesia (19.0 ±13.6 h, p < 0.05). General anaesthesia was used in 85% of cases in which emergency delivery was indicated, but only in 27% of cases without emergency indications for delivery (p < 0.01). No death or admission to the intensive care unit occurred during the study period. CONCLUSIONS: The PACU can offer an intermediate intensive care facility for high-risk obstetric patients, thus reducing unnecessary admissions to the intensive care unit.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258694/pdf/AMS-7-1-123.pdf
Epidemiología de la mortalidad relacionada con anestesia en USA, 199-2005
Epidemiology of anesthesia-related mortality in the United States, 1999-2005.
Li G, Warner M, Lang BH, Huang L, Sun LS.
Center for Health Policy and Outcomes in Anesthesia and Critical Care, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. GL2240@columbia.edu
Anesthesiology. 2009 Apr;110(4):759-65.
Abstract
BACKGROUND: Previous research on anesthesia-related mortality in the United States was limited to data from individual hospitals. The purpose of this study was to examine the epidemiologic patterns of anesthesia-related deaths at the national level. METHODS: The authors searched the International Classification of Diseases, 10th Revision manuals for codes specifically related to anesthesia/anesthetics. These codes were used to identify anesthesia-related deaths from the US multiple-cause-of-death data files for the years 1999-2005. Rates from anesthesia- related deaths were calculated based on population and hospital surgical discharge data. RESULTS: The authors identified 46 anesthesia/anesthetic codes, including complications of anesthesia during pregnancy, labor, and puerperium (O29.0 -O29.9, O74.0-74.9, O89.0-O89.9), overdose of anesthetics (T41.0 -T41.4), adverse effects of anesthetics in therapeutic use (Y45.0, Y47.1, Y48.0 - Y48.4, Y55.1), and other complications of anesthesia (T88.2- T88.5, Y65.3). Of the 2,211 recorded anesthesia-related deaths in the United States during 1999-2005, 46.6% were attributable to overdose of anesthetics; 42.5% were attributable to adverse effects of anesthetics in therapeutic use; 3.6% were attributable to complications of anesthesia during pregnancy, labor, and puerperium; and 7.3% were attributable to other complications of anesthesia. Anesthesia complications were the underlying cause in 241 (10.9%) of the 2,211 deaths. The estimated rates from anesthesia-related deaths were 1.1 per million population per year (1.45 for males and 0.77 for females) and 8.2 per million hospital surgical discharges (11.7 for men and 6.5 for women). The highest death rates were found in persons aged 85 yr and older. CONCLUSION: Each year in the United States, anesthesia/anesthetics are reported as the underlying cause in approximately 34 deaths and contributing factors in another 281 deaths, with excess mortality risk in the elderly and men.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697561/pdf/nihms117911.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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