Cardiac arrest during anaesthesia. A computeraided study in 250 543 anaesthetics

Abstract

With the aid of a computer-based anaesthetic record-keeping system, all cardiac arrests during anaesthesia at the Karolinska Hospital between July 1967 and December 1984 were retrieved. There were a total of 170 cardiac arrests and 250,543 anaesthetics in the data file, which gives an incidence of 6.8 cardiac arrests per 10,000 anaesthetics. Sixty patients died, constituting a mortality of 2.4 per 10,000 anaesthetics: 42 were considered as inevitable deaths (rupture of aortic or cerebral aneurysm, multitrauma, etc.); 13 cases of cardiac arrest were considered as non-anaesthetic, i.e. complications due to surgery and other procedures. Nine of these patients died. 115 cases of cardiac arrest were considered as caused by the anaesthetic and nine of these patients died. Thus mortality caused by anaesthesia was 0.3 per 10,000 anaesthetics. The most common cause of cardiac arrest due to anaesthesia was hypoxia because of ventilatory problems (27 patients), postsuccinylcholine asystole (23 patients) and post-induction hypotension (14 patients). The highest mortality was seen when spinal or epidural anaesthetics were given to patients with impaired physical status including hypovolaemia. The incidence of cardiac arrest has declined considerably during the period studied, and this coincides with an increasing number of qualified anaesthetists employed in the department during the same period.

The Effect of Preoperative Oral Carbohydrate Loading on Stress Response in Patients Undergoing Major or Minor Surgery

“…1,2 Bu na kar şın yıl lar için de elek tif gi rişim ler de ka tı aç lık ku ral la rı nın as pi ras yon ris ki ni et ki le me di ği yö nün de so nuç lar bil di ril me si ile özel-lik le ber rak sı vı alı mı ile il gi li ku ral lar de ğiş me ye baş la mış tır. Ran do mi ze kon trol lü ça lış ma lar ve meta a na liz ler de su ve di ğer ber rak sı vı la rın anes te zi in dük si yo nun dan iki sa at ön ce si ne ka dar alın ma sı -nın, gas trik sı vı hac mi ve asi di te si ni art tır ma dı ğı ve as pi ras yon açı sın dan sa kın ca lı ol ma dı ğı bil di rilmiş tir.…”

Complete reversal of acid-induced acute lung injury by blocking of platelet-neutrophil aggregation

“…Sepsis, trauma, and massive transfusion are all extrapulmonary causes of ALI whereas pneumonia and acid aspiration are typical causes of intrapulmonary ALI. Aspiration is a regular complication of general anesthesia (2,3) and can also occur in critically ill patients and unconscious patients (4). Acid aspiration in WT mice, which mimics human ALI (5-7), can be induced experimentally by inflicting HCl-induced chemical damage of the alveolar-capillary membrane (8), resulting in polymorphonuclear neutrophil (PMN) recruitment (9), pulmonary edema, and impairment of gas exchange (7).…”

Anesthetic Management of the Newborn Surgical Patient

“…Risk factors for aspiration in the perianesthetic period include neurologic abnormality, emergency surgery, intestinal obstruction or increased abdominal pressure, light anesthesia, and the skill of the anesthesia provider [16,17]. Infants and young children are particularly prone to regurgitation and aspiration for a variety of reasons including air swallowing while crying and decreased lower esophageal sphincter incompetence.…”