Complications Related to Anaesthesia in Infants and Children

Abstract

A prospective survey of anaesthesia-related mortality and morbidity in infants and children was carried out in a representative sample of anaesthetics performed in 440 institutions chosen at random in France. A total of 40240 anaesthetics were administered to patients younger than 15 yr, 2103 (5%) involving infants (younger than 1 yr). Twenty-seven major complications related to anaesthesia occurred during or within 24 h of the anaesthesia--an incidence of 0.7 per 1000 anaesthetics. Nine, of which four were associated with cardiac arrest, were observed in infants, whereas in children there were 18 complications of which eight were associated with cardiac arrest, one with fatal outcome. The risk of complications was significantly higher (P less than 0.001) in infants (4.3 per 1000) than in children (0.5 per 1000). Accidents observed in infants mainly occurred during maintenance of anaesthesia and were the result of respiratory failure. In children, circulatory failure was as frequent as respiratory failure and complications were observed almost equally during induction and maintenance and on recovery. The rate of complications increased significantly with the ASA score and the number of co-existing diseases. The incidence was also higher when a previous history of anaesthesia was present, when the procedure was an emergency, and when the duration of preoperative fasting was less than 8 h.

Is there an ideal age for hypospadias repair? A pilot study

“…Yet, this issue is not specific for hypospadias patients and large series with children undergoing general anesthesia have been published to assess eventual age related risks. In multiple earlier and recent studies it has clearly been shown that neonates and infants (age < 1 year) have a significantly higher perioperative anesthetic morbidity and mortality (20)(21)(22)(23)(24)(25)(26)(27). Part of this morbidity can be explained by major life threatening malformations; however reduced respiratory and cardiovascular reserves in this age group have a significant negative effect making anesthesia of children < 1 year more demanding.…”

Esvaziamento gástrico após administração oral de contraste em tomografia computadorizada do abdômen: descrição de seis casos

“…Apresentado (Submitted) em 09 estômago e as características deste resíduo, como seu pH, presença de partículas, colonização etc. Em adultos, configura situação crítica, resíduo gástrico igual ou superior a 25 ml 2 em pH igual ou inferior a 2,5 3 , embora o valor preditivo de tais critérios para aspiração sejam questionáveis e desconsiderem outros fatores que contribuem para a patogêne-se e prevenção da aspiração 4 .…”

New guidelines for preoperative fasting

“…27 In one prospective study in children, who are considered to be at higher risk, the incidence of clinically'important aspiration was 1:40,000. 28 For clinically important pulmonary damage to occur, the following factors must all be present: 1 Gastric contents must be of sufficient volume and acidity to cause pulmonary damage. 2 Intragastric pressure must be greater than resistance of the lower oesophageal sphincter.…”

“…27 Lors d'une &ude r6alis6e chez des enfants, qu'on consid+re ~ plus haut risque, l'incidence d'aspiration cliniquement d6celable n'est que de 1:40,000. 28 Pour qukme atteinte pulmonaire clinique significative puisse survenir, tousles facteurs suivants doivent ~tre prtsents: 1 Le contenu gastrique doit ~tre en quantit6 et d'acidit6 suffisantes pour causer une atteinte pulmonaire. 2 La pression inla'agastrique doit ~tre plus 61evte que celle du sphincter inftrieur de l'oesophage.…”