Anesthesia-related cardiac arrest in children: the thai anesthesia incidents study (THAI Study)

Abstract

Background and Goal of Study:The use of hypotonic intravenous fluids has been associated with more than 50 international case reports of death or neurological injury in children. In 2003 the Royal College of Anaesthetists warned of the risk of iatrogenic hyponatraemia and water overload developing after the use of sodium chloride 0.18% with glucose 4% in children. A followup survey found less than half of consultant anaesthetists had been aware of this warning. 1 Our audit looked at whether anaesthetists' fluid prescriptions intraoperatively and postoperatively reflected these concerns in our department. Materials and Methods:The audit examined the fluid administration in paediatric operations over a 4 month period. Data collected included the age and weight of the child, the volume, rate and type of fluid prescribed intraoperatively and postoperatively, whether there was any estimate of blood or fluid loss, and whether capillary blood sugar was recorded.We also recorded the current locations of sodium chloride 0.18% with glucose 4%. Results and Discussions: Over the 4 month period, 35 patients received intraoperative fluids: none had a capillary blood sugar recorded and only 1 had an estimate of blood or fluid loss. 31 were given isotonic solutions, at volumes between 3-34 ml/kg. 4 were given hypotonic solutions (2 at 10-20 ml/kg, 2 at greater volumes).Only 17 patients were prescribed postoperative fluids: 13 were given isotonic solutions, of which only 4 were prescribed according to the Holliday and Segar formula. 2 The majority were prescribed at greater rates. 4 were given hypotonic fluids, 1 at the predicted rate, 2 at a greater rate and 1 at almost half the calculated rate. 2 Sodium chloride 0.18% with glucose 4% solution was freely available in all clinical areas. Conclusion(s):There is no restriction in the availability of sodium chloride 0.18% with glucose 4% solution. The majority of paediatric patients are given isotonic fluid intraoperatively. However, despite the concerns about hyponatraemia, post-operatively the majority are being prescribed either hypotonic or excessive rates of fluid.

A review of paediatric anaesthetic-related mortality, serious adverse events and critical incidents

“…11,47,50 Anaesthetic-related mortality increases by a factor of 50-100 in low-income countries, but may be 1 000-fold higher in certain poor countries. 11,18,19,21,[47][48][49][50][51][52][53][54][55] Bainbridge reported a similar trend in adult patients. 19 Unlike the case in high HDI countries, anaesthetic-related mortality in low HDI countries has not declined.…”

“…Anaesthetic-related mortality in middle-income countries is 2-3 times higher than that in developed countries. 11,12,45,[47][48][49] Perioperative mortality trends may initially increase in middleincome countries with increasing access to surgical care, the increased provision of surgery for unwell patients undergoing complex procedures, and more reliable data. 9,11,12,19,29 A 2014 study from Brazil demonstrated this, as 24-hour perioperative mortality increased when compared against the incidence of mortality reported in previous studies.…”

Perioperative morbidity and mortality in the first year of life: a systematic review (1997–2012)

“…In all studies found, the incidence of cardiac arrest and critical/adverse events of various types was higher in children aged less than one year than in older children. 2 3. The frequency of cardiac arrest at the age group referred to in our study is also relevant compared to older children.…”

“…Although many recognize that age <1 year and specifically the neonatal period are associated with higher risk of anesthetic complications, 1,2 there are no studies aimed at this age group. Available data are scattered in studies that cover a wider range of ages, with reports differing from the results in these pediatric groups.…”

Effectiveness of endotracheal-tube size by age-based formula for Thai pediatric cardiac patients: a retrospective study

“…According to the Thai Anesthesia Incidents Study (THAI Study) [2], the incidence of anesthesia-related cardiac arrest in children was 5.1 per 10,000 anesthetics, with 46% mortality rate. Respiratory-related cardiac arrest was the most common cause, and congenital heart disease was the underlying indicator of patient-related risk factors.…”