Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942004000600002
Brazilian Journal of Anesthesiology
Scientific Article

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

Cardiac arrest during anesthesia at a tertiary teaching hospital: prospective survey from 1996 to 2002

Leandro Gobbo Braz; José Reinaldo Cerqueira Braz; Norma Sueli Pinheiro Módolo; Paulo do Nascimento Júnior; Ana Paula Shuhama; Laís Helena Camacho Navarro

http://dx.doi.org/10.1590/S0034-70942004000600002 Braz J Anesthesiol, vol.54, n6, p.755-768, 2004
PDF Português
PDF English
Downloads: 0
Views: 951

Resumo

JUSTIFICATIVA E OBJETIVOS: A incidência e causas de parada cardíaca (PC) durante a anestesia variam e são difíceis de comparar diante dos diversos métodos usados nos estudos. A pesquisa teve como objetivo estudar todas as PC ocorridas no intra e pós-operatório, durante um período de sete anos, de 1996 a 2002, em hospital de ensino de atendimento terciário para determinar incidência e causas da PC. MÉTODO: A incidência prospectiva de PC ocorrida durante a anestesia em 40.941 pacientes consecutivos foi identificada, utilizando-se um Banco de Dados. Todos os casos de PC e óbito foram revisados por uma Comissão, para determinar o fator desencadeante da PC ou óbito. A incidência de PC foi calculada em relação à idade, sexo, estado físico, segundo a classificação da ASA, tipo de atendimento, fatores desencadeantes, como alteração do estado físico do paciente e complicações cirúrgicas e anestésicas, tipo de anestesia e evolução para óbito. RESULTADOS: Ocorreram 138 PC (33,7:10.000), sendo a maioria em recém-nascidos, crianças até um ano e idosos, no sexo masculino (65,2%), em pacientes com estado físico ASA III ou superior, em atendimento de emergência e durante anestesia geral. Alterações do estado físico foram o principal fator de PC (23,9:10.000), seguidas de complicações cirúrgicas isoladamente (4,64:10.000) ou associadas a alterações do estado físico (2,44:10.000) e da anestesia isoladamente (1,71:10.000) ou associadas a alterações do estado físico (0,98:10.000). O risco de óbito relacionado à anestesia como fator principal ou contributivo foi igual para ambos (0,49:10.000). As principais causas da mortalidade associada à anestesia foram os problemas ventilatórios (45,4%), eventos relacionados à medicação empregada (27,3%), aspiração pulmonar (18,2%) e hidratação excessiva (9,1%). CONCLUSÕES: A incidência de PC durante a anestesia ainda continua elevada. A maioria das PC e óbitos associados à anestesia foi relacionada ao manuseio das vias aéreas e à administração de medicamentos e anestésicos.

Palavras-chave

COMPLICAÇÕES, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Cardiac arrest (CA) incidence and causes during anesthesia are variable and difficult to be compared due design variations of major studies. This survey aimed at evaluating all intra and postoperative CA from 1996 to 2002 at a tertiary teaching hospital to determine CA incidence and causes. METHODS: The prospective incidence of CA during 40,941 anesthesias was identified from a database. All CA and deaths were reviewed by a Committee in order to determine triggering factors. CA cases were studied as to age, gender, ASA physical status, type of treatment, triggering factors, such as changes in patients physical status and surgical and anesthetic complications, type of anesthesia and evolution to death. RESULTS: There were 138 CA (33.7:10,000), being most of them neonates, children aged less than 1 year, elderly people, males (65.2%), physical status ASA III or poorer, in emergency surgeries and during general anesthesia. Physical status changes were the major CA factor (23.9:10,000) followed by surgical complications alone (4.64:10,000) or associated to physical status changes (2.44:10,000) and anesthetic complications alone (1.71:10,000) or associated to physical status changes (0.98:10,000). The risk of anesthesia-related death as major or contributing factor was similar for both (0.49:10,000). Major anesthesia-related death causes were ventilatory problems (45.4%), drug-related events (27.3%), pulmonary aspiration (18.2%) and fluid overload (9.1%). CONCLUSIONS: CA incidence during anesthesia is still high. Most anesthesia-related cardiac arrests and deaths were related to airway management and drug and anesthetic administration.

Keywords

COMPLICATIONS, COMPLICATIONS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

References

Beecher HK, Todd DP. A study of deaths associated with anesthesia and surgery: based on a study of 559,548 anesthesias in ten institutions 1948-1952, inclusive. Ann Surg. 1954;140:2-35.

Hingson RA, Holden WD, Barnes AC. Mechanisms involved in anesthetic deaths; a survery of operating room and obstetric delivery room related mortality in the University Hospitals of Cleveland, 1945-1955. N Y State J Med. 1956;56:230-235.

Clifton BS, Hotten WI. Deaths associated with anaesthesia. Br J Anaesth. 1963;35:250-259.

Bodlander FM. Deaths associated with anaesthesia. Br J Anaesth. 1975;47:36-40.

Minuck M. Cardiac arrest in the operating room - Part I (1965-1974). Can Anaesth Soc J. 1976;23:357-365.

Harrison GG. Death attributable to anaesthesia. A 10 - year survey (1967 - 1976). Br J Anaesth. 1978;50:1041-1046.

Hovi-Viander M. Death associated with anesthesia in Finland. Br J Anaesth. 1980;52:483-489.

Turnbull KW, Fancourt-Smith PF, Banting GC. Death within 48 hours of anaesthesia at the Vancouver General Hospital. Can Anaesth Soc J. 1980;27:159-163.

Lunn JN, Mushin WW. Mortality Associated With Anaesthesia. 1982.

Keenan RL, Boyan CP. Cardiac arrest due to anesthesia. A study of incidence and causes. JAMA. 1985;253:2373-2377.

Tiret L, Desmonts JM, Halton F. Complications associated with anaesthesia - a prospective survey in France. Can Anaesth Soc J. 1986;33:336-344.

Ruiz Neto PP, Amaral RVG. Parada cardíaca durante a anestesia em um complexo hospitalar. Estudo descritivo. Rev Bras Anestesiol. 1986;36:149-158.

Olsson GL, Hallen B. Cardiac arrest during anaesthesia. A computer-aided study in 250,543 anaesthetics. Acta Anaesthesiol Scand. 1988;32:653-664.

Warden JC, Borton CL, Horan BF. Mortality associated with anaesthesia in New South Wales, 1984-1990. Med J Aust. 1994;161:585-593.

Pedersen T. Complications and death following anaesthesia. A prospective study with special reference to the influence of patient-anaesthesia and surgery-related risk factors. Dan Med Bull. 1994;41:319-331.

Eagle CC, Davis NJ. Report of the Anaesthetic Mortality Committee of Western Australia 1990-1995. Anaesth Intensive Care. 1997;25:51-59.

Cicarelli DD, Gotardo AOM, Auler Jr JOC. Incidência de óbitos anestésicos-cirúrgicos nas primeiras 24 horas. Revisão de prontuários de 1995 no Hospital das Clínicas da FMUSP. Rev Bras Anestesiol. 1998;48:289-294.

Braz JRC, Silva ACM, Carlos E. Parada cardíaca durante anestesia em Hospital Universitário de atendimento terciário (1988 a 1996). Rev Bras Anestesiol. 1999;49:257-262.

Arbous MS, Grobbee DE, van Kleef JW. Mortality associated with anaesthesia: a qualitative analysis to identify risk factors. Anaesthesia. 2001;56:1141-1153.

Biboulet P, Aubas P, Dubourdieu J. Fatal and non fatal cardiac arrests related to anesthesia. Can J Anesth. 2001;48:326-332.

Newland MC, Ellis SJ, Lydiatt CA. Anesthetic-related cardiac arrest and its mortality: a report covering 72,959 anesthetics over 10 years from a US teaching hospital. Anesthesiology. 2002;97:108-115.

Lagasse RS. Anesthesia safety: model or mith? A review of the published literature and analysis of current original date. Anesthesiology. 2002;97:1609-1617.

Chan RPC, Auler Jr JOC. Estudo restrospectivo da incidência de óbitos anestésico-cirúrgicos nas primeiras 24 horas. Revisão de 82.641 anestesias.. Rev Bras Anestesiol. 2002;52:719-727.

Kawashima Y, Takahashi S, Suzuki M. Anesthesia - related mortality and morbidity over a 5-year period in 2,363,038 patients in Japan. Acta Anaesthesiol Scand. 2003;47:809-817.

Sprung J, Warner ME, Contreras MG. Predictors of survival following cardiac arrest in patients undergoing noncardiac surgery: a study of 518,294 patients at a tertiary referral center. Anesthesiology. 2003;99:259-269.

Pottecher T, Tiret L, Desmonts JM. Cardiac arrest related to anaesthesia; a prospective survey in France (1978-1982). Eur J Anaesthesiol. 1984;1:305-318.

Warden JC, Borton CL, Horan BF. Mortality associated with anaesthesia in New South Wales, 1984 - 1990. Med J Aust. 1994;161:585-593.

Cohen MM, Cameron CB, Duncan PG. Pediatric anesthesia morbidity and mortality in the perioperative period. Anesth Analg. 1990;70:160-167.

Caplan RA, Posner KL, Ward RJ. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology. 1990;72:828-833.

Morray JP, Geiduschek JM, Ramamoorthy C. Anesthesia-related cardiac arrest in children: initial findings of the Pediatric Perioperative Cardiac Arrest (POCA) Registry. Anesthesiology. 2000;93:6-14.

Sigurdsson GH, McAteer E. Morbidity and mortality associated with anaesthesia. Acta Anaesthesiol Scand. 1996;40:1057-1063.

Dupont H, Mezzarobba P, Degremont AC. Early perioperative mortality in a multidisciplinary hospital. Ann Fr Anesth Reanim. 1998;17:755-763.

Tikkanen J, Hovi-Viander H. Death associated with anaesthesia and surgery in Finland in 1986 compared to 1975. Acta Anaesthesiol Scand. 1995;39:265-267.

Auroy Y, Benhamou D, Bargued L. Major complications of regional anesthesia in France: the SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002;97:1274-1280.

Beecher HK, Todd DP. A study of the deaths associated with anesthesia and surgery: based on a study of 599,548 anesthesias in ten institutions 1948-1952. Ann Surg. 1954;140:2-35.

Clergue F, Auroy Y, Pequignot F. French survey of anesthesia in 1996. Anesthesiology. 1999;91:1509-1520.

Gaba DM. Anaesthesiology as a model for patient safety in health care. BMJ. 2000;320:785-788.

Cooper JB, Gaba D. No mith: anesthesia is a model for adressing patient safety. Anesthesiology. 2002;97:1335-1337.

Macintosh R. Deaths under anaesthetics. Br J Anaesth. 1948;21:107-136.

5dd6db590e8825981713f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections