Anestesia: morbilidad y mortalidad perioperatorias Hospital de San José, octubre y noviembre de 2007 / Anesthesia morbidity and mortality in the perioperative period San José Hospital, October and November 2007

Antecedentes: el Hospital de San José no tiene registros sobre morbimortalidad relacionada con anestesia en las cirugías realizadas en esta institución. Objetivo: describir la morbilidad y mortalidad perioperatorias relacionadas con la anestesia en pacientes sometidos a cirugía electiva en el Hospital de San José durante octubre y noviembre de 2007. Métodos: estudio observacional descriptivo longitudinal, donde los desenlaces de interés fueron morbilidad y mortalidad perioperatorias relacionadas con anestesia. Resultados: se incluyeron 727 pacientes programados para cirugía electiva. La edad promedio fue 44.5 años (DE 16.0), se caracterizaron por ser clase funcional I (69,9%), clasificación ASA I en 51,1%, vía aérea fácil en 85% de los pacientes y sometidos a cirugía electiva categoría quirúrgica A (50,7%) y B (43%). No se presentó mortalidad y el evento adverso más frecuente fue arritmia (23 casos) 3,1%, la mayoría en pacientes en buenas condiciones clínicas. Conclusiones: las arritmias y demás eventos adversos observados en pacientes con buenas condiciones clínicas preanestésicas, sugieren profundizar estrategias como la mejor evaluación preanestésica, para disminuir la morbilidad relacionada con anestesia.

Antecedents: Hospital de San José has no records on anesthesia-related morbidity and mortality rates in surgical procedures conducted at this institution. Objective: to describe anesthesia-related morbidity and mortality rates in the perioperative period of patients who underwent elective surgical procedures at Hospital de San José during October and November 2007. Methods: a longitudinal obsevational descriptive study was conducted. Outcomes of interest were the anesthesia-related morbidity and mortality rates during the perioperative period. Results: a sample of 727 patients scheduled for elective surgical procedures was included. The mean age was 44.5 years (OF 16.0) and patients were categorized in, functional class I (69,9%), ASA classification I 51,1%, easy airway management 85% and those who underwent elective surgery category A (50,7%) and B (43%). No mortality occured and the main adverse event was arrythmia (23 cases) 3,1%, the majority in healthy patients. Conclusions: arrhytmias and other adverse events observed in patients in good preanesthetic medical condition suggest in-depth assessment strategies as the best preanesthetic evaluation in order to ameliorate anesthesia-related morbidity.

Mortality in anesthesia: a systematic review

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.

Operating Room Deaths

A ten-year retrospective survey of the rate and pattern of death of patients within the operating theatre suites was carried out at the University of Benin Teaching Hospital; Benin City; Nigeria. Of the 12;743 patients who were admitted to the operating theatre suites in the period; excluding obstetric cases; 47 (i.e. 0.37) deaths were recorded; consisting of 24 males and 23 females; aged between 5 months and 72 years. Thirty-two (68) of the deaths were associated with emergency procedures; and fifteen (32) were elective. Thirty-six of the patients (76.6); had general anaesthesia. The patients' medical condition contributed to 51of the deaths; followed by anesthesia (38.3) and surgery (8.5). Twenty-four of the deceased (51.1); were booked for abdominal surgery; while head/neck procedures accounted for 14 (29.8). The death rate of 37 per 10;000 seems high; when compared to western values; but is akin to figures from similar institutions in developing countries like ours

Como prevenir e tratar as complicações da isquemia miocárdica no perioperatório de cirúrgias não-cardíacas? / How to prevent and treatnment and treat the perioperative myocardial ischaemic complications of noncardiac surgery?

A isquemia é a causa mais importante de morbidade e mortalidade cardiovasculares no perioperatório de cirurgias não-cardíacas. Os autores analisam as estratégias não-farmacológicas e farmacológicas que podem ser aplicadas previamente ao procedimento cirúrgico. Os pacientes de alto risco submetidos a procedimentos cirúrgicos de grande porte devem ser monitorizados em Unidade de Tratamento Intensivo, utilizando marcadores biológicos e eletrocardiografia seriados para detecção de isquemia miocárdica. A correção dos gatilhos de isquemia no pós-operatório deve ser precoce. A presença de isquemia miocárdica no pós-operatório deve ser tratada agressivamente. As orientações e o seguimnento após a alta hospitalar têm importante papel na evolução clínica cardiovascular.

Morbilidad miocárdica perioperatoria en cirugía no cardíaca - Segundo Premio Juan Marín

Se realizó un estudio retrospectivo y descriptivo, para establecer la prevalencia de las complicaciones miocárdicas perioperatorias, factores predictores preoperatorios y de riesgo coronario asociados, así como los eventos intraoperatorios desencadenantes de estas complicaciones, en una población de 147 pacientes hospitalizados en la Unidad de Cuidado Intensivo del Hospital Militar Central, entre enero de 1985 y septiembre de 1992, incluyéndose sólo los pacientes con eventos ocurridos en el intraoperatorio y hasta 72 horas postoperatorias. Cumplieron criterios de inclusión 95 pacientes, 53 hombres y 42 mujeres, encontrándose una prevalencia de 0,09 por ciento, con una edad promedio de 63 años, entre quienes la complicación más frecuente fue la isquemia miocárdica postoperatoria (47.4 por ciento), facilitada por taquicardia (27.4 por ciento) e hipotensión (40 por ciento) y que presentaban como antecedentes importantes infarto miocárdico antiguo (15,8 por ciento), historia de angina (20 por ciento) y anormalidades del ritmo cardíaco (21.1 por ciento), con electrocardiograma preoperatorio anormal (46,3 por ciento), en el que predominaba la hipertrofia ventricular izquierda (14,7 por ciento), seguida de la presencia de onda Q en el mismo 13,7 por ciento) y que tenían factores de riesgo coronario mayores (HTA 41 por ciento, diabetes 11,5 por ciento y tabaquismo 38,9 por ciento). Se presentó un número considerable de historias clínicas incompletas (27,4 por ciento), pero se pudo documentar el perfil del paciente de riesgo cardiovascular perioperatorio dentro de nuestra institución