Anesthesia-related mortality in pediatric patients: a systematic review

Abstract

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 anesthesia-related mortality are associated with airway and cardiocirculatory events. The data regarding anesthesia-related and perioperative mortality rates may be useful in developing prevention strategies.

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

“…Anaesthetic-related causes are conversely infrequent. 11,12 It may not be meaningful for patients to separate anaesthetic-related mortality and serious adverse events from other causes, yet the narrow-outcome focus remains important because:…”

Anaesthesia for paediatric patients: Minimising the risk

“…Subsequent advances in anaesthetic techniques, training, medication and monitoring have contributed significantly to a decline in anaesthesia-related mortality and morbidity. [1,2] The development of dedicated paediatric centres and paediatric specialties has also led to the improvement in outcomes seen in paediatric surgery. [3] The American Academy of Pediatrics Guidelines for the Pediatric Perioperative Anesthesia Environment suggest that a number of requirements should be met to minimise perioperative risk.…”

“…Standard vaporisers allow for seven times the effective dose of halothane to be delivered, which explains the high incidence of intraoperative cardiac arrests owing to overdose of inhalational agents reported in the older literature. [1,2] It should be noted that sevoflurane overdose can also result in cardiac arrest, and 8% sevoflurane should be used with caution.…”

“…[1] Respiratory episodes are frequently responsible for unexpected intensive care unit admissions and cardiac arrest. [2,12] A history of URTI or atopy, surgery to the neck and airway, and younger age (˂6 years) increases the risk of adverse respiratory episodes.…”

“…A study showed that insufficient practical application of techniques contributed more to critical events than lack of knowledge. [1] A retrospective analysis by Marcus [17] highlighted the significant role of poor clinical decision-making, inadequate checking, practical task failures, lack of experience, poor communication and distraction with regard to adverse events.…”