Anesthesia Safety: Model or Myth?

Lagasse, Robert S.

doi:10.1097/00000542-200212000-00038

Cited by 291 publications

(52 citation statements)

References 30 publications

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“…our reanalysis of data from Miralbell et al that additionally took into account neutrons) revealed the lifetime risk of second cancer incidence was approximately 4.4% following IMPT, 5.1% following PSPT, 31% following IMRT and 55% following CRT. To place the risks associated with proton therapy in context, they are much larger than the risk of anesthesia-related (2.2 deaths per 10 000 procedures, or 0.02% incidence (Lagasse 2002)) and slightly larger than lifetime occupational risks faced by healthy workers in various ‘safe’ industries, e.g. trade, government, agriculture (0.2–1.8% lifetime incidence of fatal accident, assuming a 40 year working career (NCRP 1993)).…”

Section: Resultsmentioning

confidence: 99%

The risk of developing a second cancer after receiving craniospinal proton irradiation

et al. 2009

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The purpose of this work was to compare the risk of developing a second cancer after craniospinal irradiation using photon versus proton radiotherapy by means of simulation studies designed to account for the effects of neutron exposures. Craniospinal irradiation of a male phantom was calculated for passively-scattered and scanned-beam proton treatment units. Organ doses were estimated from treatment plans; for the proton treatments, the amount of stray radiation was calculated separately using the Monte Carlo method. The organ doses were converted to risk of cancer incidence using a standard formalism developed for radiation protection purposes. The total lifetime risk of second cancer due exclusively to stray radiation was 1.5% for the passively scattered treatment versus 0.8% for the scanned proton beam treatment. Taking into account the therapeutic and stray radiation fields, the risk of second cancer from intensity-modulated radiation therapy and conventional radiotherapy photon treatments were 7 and 12 times higher than the risk associated with scanned-beam proton therapy, respectively, and 6 and 11 times higher than with passively scattered proton therapy, respectively. Simulations revealed that both passively scattered and scanned-beam proton therapies confer significantly lower risks of second cancers than 6MV conventional and intensity-modulated photon therapies.

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Section: Resultsmentioning

confidence: 99%

The risk of developing a second cancer after receiving craniospinal proton irradiation

et al. 2009

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“…According to a recent review,3 the literature reports a wide range of perioperative mortality rates, which is probably due to variable methodologies and differences in operational definitions and reporting sources, as well as a lack of appropriate risk stratification. Numerous studies have examined perioperative mortality 3–31.…”

Section: Introductionmentioning

confidence: 99%

Mortality in Anesthesia: A Systematic Review

Braz

Cruz

et al. 2009

Clinics

117

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This systematic review of the Brazilian and worldwide literature aims to evaluate the incidence and causes of perioperative and anesthesia-related mortality. Studies were identified by searching the Medline and Scielo databases, followed by a manual search for relevant articles. Our review includes studies published between 1954 and 2007. Each publication was reviewed to identify author(s), study period, data source, perioperative mortality rates, and anesthesia-related mortality rates. Thirty-three trials were assessed. Brazilian and worldwide studies demonstrated a similar decline in anesthesia-related mortality rates, which amounted to fewer than 1 death per 10,000 anesthetics in the past two decades. Perioperative mortality rates also decreased during this period, with fewer than 20 deaths per 10,000 anesthetics in developed countries. Brazilian studies showed higher perioperative mortality rates, from 19 to 51 deaths per 10,000 anesthetics. The majority of perioperative deaths occurred in neonates, children under one year, elderly patients, males, patients of ASA III physical status or poorer, emergency surgeries, during general anesthesia, and cardiac surgery followed by thoracic, vascular, gastroenterologic, pediatric and orthopedic surgeries. The main causes of anesthesia-related mortality were problems with airway management and cardiocirculatory events related to anesthesia and drug administration. Our systematic review of the literature shows that perioperative mortality rates are higher in Brazil than in developed countries, while anesthesia-related mortality rates are similar in Brazil and in developed countries. Most cases of anesthesia-related mortality are associated with cardiocirculatory and airway events. These data may be useful in developing strategies to prevent anesthesia-related deaths.

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“…Propofol is therefore recommended as the first choice over midazolam in currently published international guidelines 10 11 12. Also many editorials for sedation in gastrointestinal endoscopy have been published over the last decade, showing that non-anesthesiologist propofol sedation (NAPS) and in particular nurse-administered propofol sedation (NAAP) is safe when performed by trained staff 13 14 also when compared to anesthesiologist-administered sedation in a low-risk population 15 16. Results of the trial by Sathanantha et al 17, published in the current issue of Endoscopy International Open, also confirm the safety of physician-directed nurse-administered propofol sedation (here combined with midazolam) in low-risk patients undergoing endoscopy and colonoscopy.…”

mentioning

confidence: 99%

NAPS in 2016: why not everywhere?

Riphaus

2017

Endosc Int Open

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Anesthesia Safety: Model or Myth?

Cited by 291 publications

References 30 publications

The risk of developing a second cancer after receiving craniospinal proton irradiation

The risk of developing a second cancer after receiving craniospinal proton irradiation

Mortality in Anesthesia: A Systematic Review

NAPS in 2016: why not everywhere?

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