miércoles, 1 de enero de 2014

Paro cardiaco/Cardiac arrest

Paro cardiaco durante anestesia en un hospital universitario en Nigeria

Cardiac arrest during anesthesia at a university Hospital in Nigeria
Rukewe A, Fatiregun A, Osunlaja T O.
Niger J Clin Pract [serial online] 2014 [cited 2013 Dec 10];17:28-31.
Background: We assessed the incidence and outcomes of cardiac arrest during anesthesia in the operating room at our university hospital. A previous study on intraoperative cardiac arrests covered a period from 1994-1998 and since then; anesthetic personnel, equipment, and workload have increased remarkably. Materials and Methods: After obtaining institutional ethics approval, we retrospectively reviewed patients' hospital records such as anesthetic charts and register and ICU admission charts between 1 st July 2005 and 30 th June 2010. The cardiac arrests encountered during anesthesia was identified from anesthetic charts and followed-up in the intensive care unit (ICU) for the first 24 h postoperatively. We consider that cardiac arrest occurred in any patient under anesthesia with asystole or ventricular fibrillation requiring cardiac compression or electrical defibrillation. We define recovery as an alive and non-comatose patient 24-h after the cardiac arrest. Results: During the study period, a total of 12,143 surgeries were done; the median age of all the patients was 30 years (range: 1 day-119 years). A total of 31 cardiac arrests identified (frequency 25.5:10,000; 95% confidence interval (CI) 17.7-35.8) out of which 17 were nonfatal. Mortality related to anesthesia was 11.5:10,000 (95% CI 6.5-18.9). The median age of patients with cardiac arrests was 39 years (range: 2 months-78 years). Overall, 80.7% cardiac arrests occurred in the American Society of Anesthesiologists' (ASA) physical status 3-5. Cardiothoracic and neurosurgical operations accounted for 54.8% of the total cardiac arrests. The known risk factors identified among those who had cardiac arrest were, ASA physical status 3-5 (80.7%), procedures performed out-of-work hours (60%), and manually ventilating patients during general anesthesia (39%). Conclusion: Cardiac arrest during anesthesia is higher in poor risk patients (ASA 3-5) who are manually ventilated under general anesthesia and operated during out-of-work hours.
Keywords: Anesthesia, cardiac arrest, fatal, nonfatal, outcome


Riesgo de muerte cardiaca súbita

Risk of sudden cardiac death.
Sadeghi R, Adnani N, Sohrabi MR, Alipour Parsa S.
ARYA Atheroscler. 2013 Sep;9(5):274-9.
BACKGROUND:The aim of this study was to determine characteristics of patients with sudden cardiac arrest (SCA) and/or sudden cardiac death (SCD). We need an effective risk stratification method for SCD in patients without low left ventricular ejection fraction (LVEF). METHODS:The study population of this cross-sectional study consisted of 241 patients with SCA or SCD who were admitted to an academic hospital, in Tehran, Iran, from 2011 through 2012. SCD was defined as unexpected death from cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute changes in cardiovascular status, or an unobserved death in which the patient was seen and known to be doing well within the previous 24 hours. Survivors of aborted SCD were also included in the study. Clinical and paraclinical characteristics as well as emergency department complications of patients were recorded. RESULTS:The mean age of population was 66.0 ± 16.5 (17 to 90 years). Among the patients, 166 (68.9 %) were male, 50 (20.7%) were smoker, 77 (32.0%) had hypertension, 47 (19.5%) had diabetes mellitus, 21 (8.7%) had hyperlipidemia, and 32 (13.3%) had renal insufficiency. According to New York Health Association (NYHA) functional class, 31 (12.9%) patients were asymptomatic, 42 (17.4) and 99 (41.1%) subjects were in NYHA I and II, respectively and only 69 (28.6%) patients were in NYHA III or IV. In this study, presenting arrhythmia was pulseless electrical activity or asystole which was observed in 130 (53.9%) subjects. Ventricular tachycardia (VT) or ventricular fibrillation (VF) was seen in 53 (22%) patients. Cardiopulmonary resuscitation in emergency room was successful only in 46 (19.1%) subjects. CONCLUSION:Low ejection fraction (EF) may be an independent predictor of sudden cardiac death in patients, but it is not enough. While implantable cardioverter defibrillators can save lives, we are lacking effective risk stratification and prevention methods for the majority of patients without low EF who will experience SCD.
KEYWORDS:Death, Sudden Cardiac Arrest, Sudden Cardiac Death


Error humano y Paro Cardiaco Intraoperatorio. ¿Un Problema Actual?
Dra. Marina Beatriz Vallongo Menéndez
Anest Mex 2009:21: 107-111

Errar es parte de nuestra naturaleza humana. Ha sido demostrado que en medicina, y en especial en anestesiología, los errores son más frecuente de lo debido y son causa importante de evolución perianestesiológica inadecuada, que en ocasiones pueden producir paro cardiaco y muerte. Las principales causas de paro cardiaco secundario a la anestesia son los reflejos vagales que se presentan en la anestesia neuroaxial y que no son corregidos a tiempo, el error en la medicación anestésica o coadyuvante administrados, la falta de reposición de volumen, estimación inapropiada del riesgo anestésico, errores o dificultad en el manejo de la vía aérea, la desatención por monitoreo inadecuado o falta de comunicación, equipo disfuncional, fatiga, prisa. La mayor parte de estos errores se pueden prevenir con oportunidad. Por otra parte, el manejo oportuno del paro cardiaco puede revertir la mayoría de casos.
Palabras clave: Paro cardiaco, anestesia, error humano.


Paro cardíaco y anestesia
Dr. Fco. Javier Molina-Méndez
Rev Mex Anestesiol Vol. 29. Supl. 1, Abril-Junio 2006
pp S189-S192


Paro cardiaco asociado a la combinación de ranitidina y ondansetron en cirugía ambulatoria ginecológica

Cardiac arrest associated with ranitidine and ondansetron combination in day care gynecologic surgery.
Srivastava VK, Jaisawal P, Agrawal S, Kumar D.
J Anaesthesiol Clin Pharmacol. 2013 Oct;29(4):563-4. doi: 10.4103/0970-9185.119136.


Anestesiología y Medicina del Dolor

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