Incidência de parada cardíaca e mortalidade pediátrica durante a anestesia em hospital universitário de atendimento terciário no período de 2005 a 2010 / Pediatric cardiac arrest and mortality incidence in pediatric patients during anesthesia in a tertiary care university hospital from 2005 to 2010

A população pediátrica apresenta incidência mais elevada de parada cardíaca e de óbito perioperatório em relação à adulta. O objetivo do presente estudo foi avaliar a incidência, os fatores desencadeantes e as causas de parada cardíaca e de óbito em pacientes pediátricos durante a anestesia em hospital universitário de atendimento terciário no período de 2005 a 2010. Por meio de um Banco de Dados, o estudo prospectivo identificou a incidência de parada cardíaca e de óbito em 10.649 anestesias pediátricas. As incidências foram calculadas em relação aos atributos: faixa etária, sexo, estado físico segundo a ASA, tipo de atendimento, especialidade cirúrgica, técnica anestésica empregada e fatores desencadeantes (doença/condição do paciente, cirurgia e anestesia como fator principal ou fator contributivo). Foram identificadas 22 paradas cardíacas na sala de operações em crianças sendo que 11 evoluíram ao óbito. Maiores incidências de parada cardíaca ocorreram em pacientes neonatais e lactentes com estado físico ASA IV e V, em cirurgia de emergência durante anestesia geral ou em cuidados de monitorização e suporte e durante cirurgias cardíaca e vascular. A doença/condição do paciente foi o principal fator de parada cardíaca e de óbito. O índice de letalidade foi maior em crianças de 31 dias a um ano de idade, com estado físico ASA V, em cirurgia de emergência e em pacientes ASA V sob cuidados de monitorização e suporte e relacionado ao fator doença/condição do paciente. Ocorreram três paradas cardíacas por fator anestésico contributivo (2,81:10.000) todas em razão de causas respiratórias. Não houve óbito por fator anestésico. Em hospital de ensino de atendimento terciário, a incidência de parada cardíaca (20,65:10.000 anestesias) e de óbito (10,32:10.000 anestesias) em pacientes pediátricos durante a anestesia foi elevada...

Perioperative cardiac arrest and mortality incidences in children are higher than in adults. This study aimed to evaluate the incidence, causes, and outcomes of cardiac arrest and death in a pediatric surgical population during anesthesia in a tertiary care university hospital from 2005 to 2010. Cardiac arrest and death incidences during anesthesia in 10,649 anesthetics performed in children were identified from an anesthesia database. Cardiac arrest and death rates were calculated in relation to age, gender, ASA physical status classification, anesthesia provider information, surgical speciality, type of procedure and triggering factors (totally anesthesia-related; partially anesthesia-related; totally surgery-related; or totally child disease/condition-related). There were 22 cardiac arrests and 11 deaths in children during anesthesia. Major cardiac arrest and death incidences were observed in children under one year age; emergency surgery; ASA physical status IV or V; monitoring care and support in ASA V patients; and in cardiac and vascular procedures. Child disease/condition was the major cause of cardiac arrest or death. Lethality calculated rates were higher in 31 days - 1 year age children; emergency surgery; ASA V physical status; monitoring care and support in ASA V patients; and child disease/condition related. There were three cardiac arrests partially anesthesia-related (2,81:10.000). There were no anesthesia-related deaths. Respiratory classified events were the most common causes of anesthesia-related cardiac arrest. Cardiac arrest (20.65 per 10,000 anesthetics) and mortality (10.32 per 10,000 anesthetics) incidences were increased over a 6-year period in a tertiary teaching hospital. Anesthesia-related cardiac arrest incidence was 2.81 per 10,000 anesthetics...

Anesthesia-related mortality in pediatric patients: a systematic review

This systematic review of the Brazilian and worldwide literature aimed to evaluate the incidence and causes of perioperative and anesthesia-related mortality in pediatric patients. Studies were identified by searching EMBASE (1951-2011), PubMed (1966-2011), LILACS (1986-2011), and SciElo (1995-2011). Each paper was revised to identify the author(s), the data source, the time period, the number of patients, the time of death, and the perioperative and anesthesia-related mortality rates. Twenty trials were assessed. Studies from Brazil and developed countries worldwide documented similar total anesthesia-related mortality rates (<1 death per 10,000 anesthetics) and declines in anesthesia-related mortality rates in the past decade. Higher anesthesia-related mortality rates (2.4-3.3 per 10,000 anesthetics) were found in studies from developing countries over the same time period. Interestingly, pediatric perioperative mortality rates have increased over the past decade, and the rates are higher in Brazil (9.8 per 10,000 anesthetics) and other developing countries (10.7-15.9 per 10,000 anesthetics) compared with developed countries (0.41-6.8 per 10,000 anesthetics), with the exception of Australia (13.4 per 10,000 anesthetics). The major risk factors are being newborn or less than 1 year old, ASA III or worse physical status, and undergoing emergency surgery, general anesthesia, or cardiac surgery. The main causes of mortality were problems with airway management and cardiocirculatory events. Our systematic review of the literature shows that the pediatric anesthesia-related mortality rates in Brazil and in developed countries are similar, whereas the pediatric perioperative mortality rates are higher in Brazil compared with developed countries. Most cases of anesthesiarelated mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.