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.

A prospective survey of complications associated with anaesthesia was carried out in France from 1978 to 1982 in a representative sample of 198,103 anaesthetics performed in 460public and private institutions chosen at random in the country as a whole. There were 268 major complications associated with anaesthesia occurring during or within 24 hours of anaesthesia (one per 739 anaesthetics), among which 67 were followed by death within 24 hours and 16 by coma persistent after the 24th hour. The incidence of death and coma was one per 2387 anaesthetics. The incidence of death and coma totally attributable to anaesthesia was one per 7924 anaesthetics. Fifty-eight per cent of complications occurred during anaesthesia while 42 per cent were observed during the recovery period. Mortality was lower following complications during anaesthesia than for those during the recovery period. Half of the deaths and cases of coma totally attributable to anaesthesia were due to postanaesthetie respiratory depression. The rate of complications appeared to be dependent upon several risk factors: the patient' s age, the number of assoclated diseases, the pre-operative status, whether the operation was an emergency and the duration of procedure.

These data indicate that prolonged endotracheal intubation impairs the swallowing reflex, with improvement within 1 wk. This phenomenon could contribute to microinhalations and aspiration pneumonia after extubation.

Background-Differences in vascular reactivity to phenylephrine (PE) responsiveness have been largely evidenced in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Because nitric oxide (NO) strongly affects modulation of the vascular tone in response to vasopressor agents, we hypothesized that the G894T polymorphism of the endothelial NO synthase gene (eNOS) could be related to changes in the pressor response to PE. Methods and Results-The protocol was performed in 68 patients undergoing coronary artery bypass grafting (nϭ33) or valve surgery (nϭ35) in whom mean arterial pressure decreased below 65 mm Hg during normothermic CPB. Under constant and nonpulsatile pump flow conditions (2 to 2.4 L ⅐ min Ϫ1 ⅐ m Ϫ2 ), a PE dose-response curve was generated by the cumulative injection of individual doses of PE (25 to 500 g). The G894T polymorphism of the eNOS gene was determined, and 3 groups were defined according to genotype (TT, GT, and GG). Groups were similar with regard to perioperative characteristics. The PE dose-dependent response was significantly higher in the allele 894T carriers (TT and GT) than in the homozygote GG group (Pϭ0.02), independently of possible confounding variables. Conclusions-These results evidenced an enhanced responsiveness to ␣-adrenergic stimulation in patients with the 894T allele in the eNOS gene. (Circulation. 1999;99:3096-3098.)