jueves, 4 de febrero de 2016

Paro cardiaco y anestesia / Cardiac arrest and anesthesia

Febrero 4, 2016. No. 2227


Incidencia y factores asociados con paro cardiaco perioperatorio dentro de 24 horas de anestesia para cirugía urgente
Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery.
Risk Manag Healthc Policy. 2014 Sep 4;7:155-62. doi: 10.2147/RMHP.S67935. eCollection 2014.
PURPOSE: To determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery. PATIENTS AND METHODS: This retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR) and 95% confidence intervals (CI) were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value <0.05. RESULTS: The incidence (within 24 hours) of perioperative cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03-2.08, P=0.036), ASA physical status classification of 3-4 (RR =5.84, CI =4.20-8.12, P<0.001) and 5-6 (RR =33.98, CI =23.09-49.98, P<0.001), the anatomic site of surgery (upper intra-abdominal, RR =2.67, CI =2.14-3.33, P<0.001; intracranial, RR =1.74, CI =1.35-2.25, P<0.001; intrathoracic, RR =2.35, CI =1.70-3.24, P<0.001; cardiac, RR =3.61, CI =2.60-4.99, P<0.001; and major vascular; RR =3.05, CI =2.22-4.18, P<0.001), respiratory or cardiovascular comorbidities (RR =1.95, CI =1.60-2.38, P<0.001 and RR =1.38, CI =1.11-1.72, P=0.004, respectively), and patients in shock prior to receiving anesthesia (RR =2.62, CI =2.07-3.33, P<0.001). CONCLUSION: The perioperative incidence of cardiac arrest within 24 hours of anesthesia for emergency surgery was high and associated with multiple factors such as young age (≤2 years old), cardiovascular and respiratory comorbidities, increasing ASA physical status classification, preoperative shock, and surgery site. Perioperative care providers, including surgeons, anesthesiologists, and nurses, should be prepared to manage promptly this high risk group of surgical patients.
KEYWORDS: anesthetic care; emergency surgery; perioperative cardiac arrest; retrospective cohort; risk factors
Paro cardiaco intraoperatoria y relacionado con anestesia y su mortalidad en pacientes viejos. Un estudio de 15 años en un hospital de tercer nivel
Intraoperative and anesthesia-related cardiac arrest and its mortality in older patients: a 15-year survey in a tertiary teaching hospital.
PLoS One. 2014 Aug 12;9(8):e104041. doi: 10.1371/journal.pone.0104041. eCollection 2014.
BACKGROUND: Little information is known about factors that influence perioperative and anesthesia-related cardiac arrest (CA) in older patients. This study evaluated the incidence, causes and outcome of intraoperative and anesthesia-related CA in older patients in a Brazilian teaching hospital between 1996 and 2010. METHODS: During the study, older patients received 18,367 anesthetics. Data collected included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, anesthesia type, medical specialty team and outcome. All CAs were categorized by cause into one of four groups: patient's disease/condition-related, surgery-related, totally anesthesia-related or partially anesthesia-related. RESULTS: All intraoperative CAs and deaths rates are shown per 10,000 anesthetics. There were 100 CAs (54.44; 95% confidence intervals [CI]: 44.68-64.20) and 68 deaths (37.02; 95% CI: 27.56-46.48). The majority of CAs were patient's disease-/condition-related (43.5; 95% CI: 13.44-73.68). There were six anesthesia-related CAs (3.26; 95% CI: 0.65-5.87) - 1 totally and 5 partially anesthesia-related, and three deaths, all partially anesthesia-related (1.63; 95% CI: 0.0-3.47). ASA I-II physical status patients presented no anesthesia-related CA. Anesthesia-related CA, absent in the last five years of the study, was due to medication-/airway-related causes. ASA physical status was the most important predictor of CA (odds ratio: 14.52; 95% CI: 4.48-47.08; P<0.001) followed by emergency surgery (odds ratio: 8.07; 95% CI: 5.14-12.68; P<0.001). CONCLUSIONS: The study identified high incidence of intraoperative CAs with high mortality in older patients. The large majority of CAs were caused by factors not anesthesia-related. Anesthesia-related CA and mortality rates were 3.26 and 1.63 per 10,000 anesthetics, with no anesthesia-related CA in the last five years of the study. Major predictors of intraoperative CAs were poorer ASA physical status and emergency surgery. All anesthesia-related CAs were medication-related or airway-related, which is important for prevention strategies.

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