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One of the most frequent questions asked of a pediatric anesthesiologist is "What are the risks of anesthesia for my child?" Unfortunately, few studies have examined the consequences of general anesthesia in children. We used data from a large pediatric anesthesia follow-up program at Winnipeg Children's Hospital (1982-1987) to determine rates of perioperative adverse events among children of different ages. A check-off form was completed by a pediatric anesthesiologist for each case (n = 29,220) and a designated follow-up reviewer examined all anesthesia forms and hospital charts to ascertain adverse effects for children less than 1 mo, 1-12 mo, 1-5 yr, 6-10 yr, and 11-16 yr of age in the intraoperative, recovery room, and postoperative periods. The majority of the children were healthy, and 70% had no preoperative medical conditions. Infants less than 1 mo old were more likely to be undergoing major cardiac or vascular procedures, whereas the older children had mainly orthopedic or otolaryngologic procedures. Infants less than 1 mo old had the highest rate of adverse events both intraoperatively and in the recovery room. The main problem in this age group was related to the respiratory and cardiovascular systems. In children over 5 yr of age, postoperative nausea and vomiting was very frequent, with about one-third of the children experiencing this problem. When all events were considered (both major and minor), there was a risk of an adverse event in 35% of the pediatric cases. This contrasts with 17% for adults. This morbidity survey helps to focus on areas of intervention and for further study.

This paper describes the outcome of a nine-year post-anaesthetic followup program in a large teaching hospital (N = 112,721 anaesthetics). Between time periods 1975-78 and 1979-83, more seriously ill patients (higher ASA physical status) were being treated. Anaesthetic practice also changed, with an increased use of balanced (multiple drug) anaesthetic procedures, a decrease in the use of halothane and an increase in the use of monitoring. Nonfatal anaesthetic compl&ationsintraoperative, recovery room and postoperative-were rare but there was an increase in the reported complication rate over time. From 1975-78, 7.6per cent of aU cases had at least one intraoperative complication and from 1979-83, this rose to 10.6 per cent of aU cases. For recovery room complications, there was an increase to 5.9 per cent in 1979-83from 3.1 per cent in 1975-78. In time period 2 there was a 9.4 per cent chance of having a postoperative anaesthetic-related complication, and a 0.45 per cent chance of a significant morbidity as a result. This represents an increase over time period 1 (8.9 and 0.40 per cent respectively). It is concluded that the anaesthetic experience, while associated with low mortality rates in recent years, is still associated with significant morbidity. It is conjectural at present whether this is reflective of preoperative patient status, anaesthetic practice, or other undefined variables associated with an operative experience.

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Most studies of postoperative nausea and vomiting have concentrated on single etiologic factors and have not detailed the method of assessing these symptoms. This study used postoperative interview data from patients at four teaching hospitals during 1988-89, to determine 1) risk factors for nausea/vomiting, 2) whether the type of surgery affected the rate of nausea/vomiting among female patients, 3) whether differences in rates across hospitals were due to differences in patient case-mix, and 4) whether there were differences in the rate of nausea/vomiting among the patients of individual anesthesiologists. Research nurses performed 16,000 interviews (59% of all inpatients) from a closed-question standardized format. With a multiple logistic regression that controlled simultaneously for all risk factors, factors associated with increased risk for nausea/vomiting for all patients included younger age, female, lower physical status score, no preoperative medical conditions, nonsmokers, elective procedures, longer duration of anesthesia, inhaled anesthetics, use of intraoperative opioids, and gynecologic or ophthalmologic operations. Among women, risk factors were similar, with minor gynecologic surgery associated with increased risk (relative odds = 2.30). We found marked variations in the rate of nausea/vomiting across hospitals (range, 39% to 73%), and these variations were not explained by the case-mix of patients. The rate of nausea/vomiting varied substantially across anesthesiologists in each hospital and the differences were not explained by differences in the patients they managed. Thus in the time period immediately preceding the introduction of newer antiemetic drugs, we found that the rates of this common problem were persistently high as perceived from the patients' point of view.

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