Incidence and Causes of Adverse Events in Diagnostic Radiological Studies Requiring Anesthesia in the Wake-Up Safe Registry

Khawaja, Asad A.; Tumin, Dmitry; Beltran, Ralph J; Tobias, Joseph D.; Uffman, Joshua C.

doi:10.1097/pts.0000000000000469

Cited by 11 publications

(11 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The data reported on all anesthetics present additional limitations to drawing conclusions. Specifically, while case types (reported as CPT codes) are reported by each institution, only some cases can be attributed to specific service locations based on CPT codes, whereas for other cases, determining the service location based on CPT codes may be inconclusive. With the exception of the cardiac catheterization suite, cases occurring at off‐site locations are typically less invasive than cases in operating rooms, which could explain why adverse events do not reach a severe outcome in these locations, regardless of potential differences between locations in rescue capabilities.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Severe outcomes of pediatric perioperative adverse events occurring in operating rooms compared to off‐site anesthetizing locations in the Wake Up Safe Database

Uffman

Tumin

Beltran

et al. 2018

Pediatric Anesthesia

Self Cite

View full text Add to dashboard Cite

Summary Background Anesthesia services are frequently provided outside of the traditional operating room environment for children. It is unclear if adverse events which occur in off‐site anesthetizing locations result in more severe outcomes compared to events in traditional operating rooms. Aim We used a multi‐institutional registry of pediatric patients to compare outcomes of perioperative adverse events between location types. Methods De‐identified data from 24 pediatric tertiary care hospitals participating in the Wake Up Safe registry during 2010‐2015 were analyzed. Peri‐procedural adverse events occurring in operating rooms or off‐site locations were included. The primary outcome was whether the adverse event was severe, defined as requiring escalation of care or resulting in temporary or significant harm. Multivariable logistic regression was used to compare location type (operating room vs. off‐site) and the likelihood of a severe outcome among reported events. Results There were 1594 adverse events, of which 362 were associated with off‐site anesthetizing locations. In multivariable logistic regression, off‐site location was associated with greater odds of severe adverse event outcome (adjusted odds ratio, 1.31; 95% confidence interval: 1.01, 1.69; P = 0.044). Comparing adverse events in cardiac catheterization suites to events in operating rooms confirmed higher odds of severe outcome in the former group (adjusted odds ratio = 1.48; 95% confidence interval: 1.05, 2.08; P = 0.025), while this difference was not found for other off‐site locations. Conclusion Multivariable analysis of a large registry revealed a greater likelihood of severe outcome for adverse events occurring in cardiac catheterization suites (but not other out of the OR sites), compared to adverse events occurring in the operating room. Additional prospective studies are needed which better control for patient and environmental characteristics and their effect on severe outcomes after anesthesia.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Severe outcomes of pediatric perioperative adverse events occurring in operating rooms compared to off‐site anesthetizing locations in the Wake Up Safe Database

Uffman

Tumin

Beltran

et al. 2018

Pediatric Anesthesia

Self Cite

View full text Add to dashboard Cite

show abstract

“…Before inclusion, reporting institutions analyze each event using a standardized root cause analysis method to evaluate the reasons responsible for the adverse event and determine the degree of preventability. Published data using WUS registry have included medication errors, cardiac arrests in the postanesthesia care unit (PACU), and severe adverse events in off‐site locations 7‐12 …”

Section: Methodsmentioning

confidence: 99%

Perioperative anaphylaxis in children: A report from the Wake‐Up Safe collaborative

Wakimoto

Miller

Kim

et al. 2021

Pediatric Anesthesia

Self Cite

View full text Add to dashboard Cite

Background Anaphylactic reactions to antigens in the perioperative environment are uncommon, but they have a potential to lead to serious morbidity and/or mortality. The incidence of anaphylactic reactions is 1:37 000 pediatric anesthetics, and substantially less than the 1:10 000 to 1:20 000 incidence in the adult population. Neuromuscular blocking agents, latex, and antibiotics are the most frequently cited triggers. To date, there is no comprehensive report on perioperative anaphylactic reactions in children in the United States. Using the Wake‐up Safe database, we examined the incidence and consequences of reported perioperative anaphylaxis events. Methods We reviewed the Wake‐up Safe database from 2010 to 2017 and identified all reported instances of anaphylaxis. The triggering agent, timing, and location of the registered event, severity of patient harm, and preventability were identified. Narrative review of free‐text comments entered by reporting centers was performed to determine presenting symptoms, and interventions required. Type of case was identified from procedure codes provided in mandatory fields. Results Among 2 261 749 cases reported to the Wake‐up Safe database during the study period, perioperative anaphylactic reactions occurred in 1:36 479 (0.003%). Antibiotics, neuromuscular blocking agents, and opioid analgesics were the main triggers. Forty‐nine cases (79%) occurred in the operating room, and 13 cases (21%) occurred in off‐site locations. Seven (11%) patients required cardiopulmonary resuscitation following the onset of symptoms. Thirty‐five (57%) patients were treated with epinephrine or epinephrine plus other medications, whereas 5% were managed only with phenylephrine. Most cases (97%) required escalation of care after the event. Regarding case preventability, 91% of cases were marked as either “likely could not have been prevented” or “almost certainly could not have been prevented.” Conclusion The estimated incidence of anaphylaxis and inciting agents among the pediatric population in this study were consistent with the most recent published studies outside of the United States; however, new findings included need for cardiopulmonary resuscitation in 11% of cases, and estimated fatality of 1.6%. The management of perioperative anaphylaxis could be improved for some cases as epinephrine was not administered, or its administration was delayed. Fewer than half of reported cases had additional investigation to formally identify the responsible agent.

show abstract

“…Note that for the purposes of this review we will use the term "sedation" to include both moderate and deep conscious sedation and general anesthesia. The use of sedation presents additional risks to the patient, increases the overall cost of the examination, increases length of recovery time in the hospital, and also interrupts the patient flow in the pediatric MRI suite . Avoiding sedation whenever possible is therefore beneficial not only to the patient and the institution, but also the parents, who will potentially be spared significant anxiety and additional cost.…”

mentioning

confidence: 99%

“…The use of sedation presents additional risks to the patient, increases the overall cost of the examination, increases length of recovery time in the hospital, and also interrupts the patient flow in the pediatric MRI suite. [4][5][6] Avoiding sedation whenever possible is therefore beneficial not only to the patient and the institution, but also the parents, who will potentially be spared significant anxiety and additional cost. Several strategies have been developed to limit the use of sedation while imaging the pediatric population.…”

mentioning

confidence: 99%

Free‐breathing unsedated MRI in children: Justification and techniques

Janos

Schooler

Ngo

et al. 2019

Magnetic Resonance Imaging

View full text Add to dashboard Cite

One of the more common and important challenges in the imaging of children is minimizing image degradation caused by motion. This is especially important in MRI, which is often preferable in the pediatric population due to better tissue characterization and lack of ionizing radiation. However, due to the length of time needed for most examinations, MRI is among the most sensitive to disruption by patient motion. Traditionally, deep conscious sedation or general anesthesia was the most common method of reducing motion in children who are unable or unwilling to follow direction. As the drawbacks and risks of anesthesia in children become more known and accepted, the development and optimization of means of mitigating motion and anxiety in children without the use of sedation or anesthesia becomes more urgent. In this article we describe the risks of sedation in the pediatric population and explore current methods of reducing both patient anxiety and imaging degradation from motion in the unsedated, free‐breathing child. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:365–376.

show abstract

Incidence and Causes of Adverse Events in Diagnostic Radiological Studies Requiring Anesthesia in the Wake-Up Safe Registry

Cited by 11 publications

References 27 publications

Severe outcomes of pediatric perioperative adverse events occurring in operating rooms compared to off‐site anesthetizing locations in the Wake Up Safe Database

Severe outcomes of pediatric perioperative adverse events occurring in operating rooms compared to off‐site anesthetizing locations in the Wake Up Safe Database

Perioperative anaphylaxis in children: A report from the Wake‐Up Safe collaborative

Free‐breathing unsedated MRI in children: Justification and techniques

Contact Info

Product

Resources

About