Mortality associated with anaesthesia

Lunn, J. N.; Mushin, William W.

doi:10.1111/j.1365-2044.1982.tb01824.x

Cited by 189 publications

(56 citation statements)

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“…Virtually all clinical research papers related to aspects of human anaesthesia published in journals of anaesthesia refer to the physical status of the patients under study. In the United Kingdom, ASA grading has become increasingly used since one of the earliest large studies into peri-operative deaths [5].…”

Section: Pimentioning

confidence: 99%

An assessment of the consistency of ASA physical status classification allocation

Haynes¹,

Lawler²

1995

Anaesthesia

338

191

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SummaryThe American Society of Anesthesiologists' (ASA) Physical Status Classification was tested for consistency of use by anaesthetists. A postal questionnaire was sent to 113 anaesthetists of varying experience working in the Northern Region of England. They were asked to allot ASA grades to 10 hypothetical patients. Ninety-seven (85.8%) responded to two mailings. In no case was there complete agreement on ASA grade, and in only one case were responses restricted to two of the Jive possible grades. In one case there was a signijicant diflerence in answers between anaesthetists with the FRCA (or equivalent) qualification, and those without. So much variation was observed between individual anaesthetist's assessments when describing common clinical problems that the ASA grade alone cannot be considered to satisfactorily describe the physical status of a patient.

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Section: Pimentioning

confidence: 99%

An assessment of the consistency of ASA physical status classification allocation

Haynes¹,

Lawler²

1995

Anaesthesia

338

191

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“…In the early 1980s a confidential, anonymous review of mortality associated with anaesthesia was set up in the UK (Lunn and Mushin (1982)). The aim was to assess perioperative information in the hope of improving the anaesthesia and hence patient outcomes.…”

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confidence: 99%

Mortality within 30 days of chemotherapy: a clinical governance benchmarking issue for oncology patients

et al. 2006

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No national benchmark figures exist for early mortality due to chemotherapy unlike for surgical interventions. Deaths within 30 days of chemotherapy during a 6-month period were identified from the Royal Marsden Hospital electronic patient records. Treatment intention -curative or palliative, cause of death and number of previous treatments -were documented. Between April 2005 and September 2005, 1976 patients received chemotherapy with 161 deaths within 30 days of chemotherapy (8.1%). Of these, 124 deaths (77.0%) were due to disease progression. Of the other 37 deaths, 12 (7.5%) were related to chemotherapy, six each for solid tumours and haematological malignancies, of which seven (4.3%) were due to neutropenic sepsis. For the remaining 25 deaths (15.5%) there was insufficient information. There were more deaths after third and subsequent lines of therapy than with first and secondlines of therapy. Only 12 of the 161 deaths occurred in patients who were receiving potentially curative chemotherapy to give a mortality rate in breast and gastrointestinal malignancy of 0.5 and 1.5%, respectively. It is possible to audit mortality within 30 days of chemotherapy and this should become a benchmark for standard practice nationally. Most deaths were due to disease progression in the palliative setting. We practice this form of audit each quarter and feed back to the treating teams so that deaths are discussed and practice monitored.

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“…DESPITE THE AVAILABILITY of aggressive intraoperative cardiac monitoring and therapy, myocardial ischemia and infarction remain common causes of perioperative morbidity and mortality.1 2 The standard surface electrocardiogram (ECG) may not reveal subendocardial ischemia.3 Even severe transmural ischemia may go undetected if only a single electrocardiographic lead is monitored,4 if excessive filtration is used, or if signal standardization is inappropriate. Furthermore, electrocardiographic monitoring for the detection of ischemia may be impossible if certain conduction disturbances or paced rhythms are present.5 6 Nevertheless, the ECG remains the monitor most commonly used to diagnose intraoperative myocardial ischemia.…”

mentioning

confidence: 99%

Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography.

Smith¹,

Cahalan²,

Benefiel³

et al. 1985

Circulation

447

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Because acute segmental wall motion abnormalities (SWMAs) of the left ventricle are highly sensitive and specific indicators of myocardial ischemia, this study compared the incidence and significance of ischemia, as detected by two-dimensional transesophageal echocardiography and surface electrocardiography, during anesthesia and surgery in patients at high risk of myocardial ischemia. During surgery, 24 of the 50 patients studied had new SWMAs, whereas only six had ST segment changes. All patients with ST segment changes also had new SWMAs: in three instances, SWMAs occurred before the ST segment change, and in three instances, they occurred simultaneously. All three patients who had intraoperative myocardial infarctions also had persistent intraoperative SWMAs, whereas only one patient had ST segment changes. Ten healthy patients requiring noncardiovascular surgery were monitored similarly; none of these had SWMAs, ST segment changes, or myocardial infarction. This study demonstrates the superiority of two-dimensional transesophageal echocardiography over electrocardiography for the intraoperative detection of myocardial ischemia. Furthermore, when new SWMAs persist to the conclusion of surgery, myocardial infarction is likely to have occurred.

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Mortality associated with anaesthesia

Cited by 189 publications

References 0 publications

An assessment of the consistency of ASA physical status classification allocation

An assessment of the consistency of ASA physical status classification allocation

Mortality within 30 days of chemotherapy: a clinical governance benchmarking issue for oncology patients

Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography.

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