Morbidity and mortality associated with anaesthesia

Abstract

The incidence of serious complications associated with Anaesthesia appears to have decreased in recent years. There are many reasons for this—better anaesthetic drugs and equipment, widespread availability of modern monitoring devices, improved standards of pre‐, intra‐ and postoperative care, increasing interest in techniques to identify and control common risk factors and increased number of qualified anaesthetists. Nevertheless, accidents continue to occur. The most common cause of death or serious injury is still failure to ventilate the patient. All recent studies agree that the majority of accidents in modern practice are the consequence, not of equipment failure or adverse drug reactions, but of human error. Mistake, lack of vigilance, inexperience, inadequate supervision and failure of communication are identified as recurring problems. These problems need to be addressed if anaesthesia‐related complications are to be further decreased. It seems reasonable to suggest that the use of anaesthesia simulators to train and test anaesthetists in difficult situations should be given a higher priority—both in basic training and in continued postgraduate education. Furthermore, since anaesthesia‐related adverse outcomes are rare, strict safety procedures must be applied to thousands of patients in order to prevent one catastrophe. During times of increasing competition for health care money, anaesthetists must be resolute in defending and improving standards of training, monitoring and clinical care. Otherwise the substantial improvement in anaesthesia practice accomplished over recent years may quickly be lost again.

Serious intraoperative problems — a five-year review of 83,844 anesthetics

“…For example most airway problems are treated without sequel, but still have the potential for catastrophic outcome. 21 It is important to evaluate the potential for disaster as well as the actual morbidity.…”

Incidência de parada cardíaca durante anestesia, em hospital universitário de atendimento terciário: estudo prospectivo entre 1996 e 2002

“…A ocorrência de parada cardíaca está relacionada ao pior estado físico do paciente (ASA III a V) e ao grau de urgência e principalmente de emergência do procedimento. Assim, a taxa de mortalidade, em pacientes submetidos à cirurgias de emergência é sempre mais elevada do que a observada em cirurgias eletivas 7,11,13,16,19,[21][22][23]31,32 , assim como em pacientes ASA IV ou V 11,16,-23,25 . Observou-se ainda na presente pesquisa, incidência 12 vezes maior de parada cardíaca em cirurgia de emergência do que em relação à cirurgia de rotina (Tabela V) e de 227 vezes maior em pacientes ASA IV do que em pacientes ASA I (Tabela IV).…”

“…Os estudos demonstraram que pacientes nas faixas etárias extremas são os mais predispostos a sofrer parada cardíaca. Assim, os recém-nascidos e as crianças, principalmente no primeiro ano de vida 20,21,[23][24][25][26][27][28][29][30][31][32] , apresentam incidência de parada cardíaca durante a anestesia, três a sete vezes maior do que a do adulto jovem 11,13,22,23,28,30 . Nos recém-nascidos e nas crianças até um ano de idade, a ocorrência de prematuridade, doença cardíaca congênita, doença neurológica congênita e outras alterações congênitas parece colocá-los em situação de maior risco anestésico em relação às crianças mais velhas e aos adultos jovens 23 , têm verificado a ocorrência de menor número de paradas cardíacas e óbitos em crianças de 1 a 12 anos.…”

“…Cardiac arrest is related to poorer physical status (ASA III to V) and to the level of urgency and especially emergency of the procedure. So, mortality rates in patients submitted to emergency surgeries are always higher as compared to elective surgeries 7,11,13,16,19,[21][22][23]31,32 , the same being true for ASA IV or V patients 11,16,23,25 . Our study has also observed a 12-fold higher incidence of cardiac arrest in emergency surgeries as compared to routine surgeries (Table V) and 227-fold lower incidence in ASAIV patients as compared to ASAI (Table IV).…”

“…Computando-se somente os óbitos associados à anestesia, teve-se a taxa de mortalidade de 0,85:10.000 anestesias. Estudos realizados em outros países mostraram que a incidência da parada cardíaca durante a anestesia é menor do que em nosso meio, de 1,1 a 30:10.000 anestesias 5,9, 10,13,20,21,24,25,30,31 .…”