Perioperative and anesthesia-related cardiac arrest and mortality rates in Brazil: A systematic review and proportion meta-analysis

Abstract

Introduction Studies have shown that both perioperative and anesthesia-related cardiac arrest (CA) and mortality rates are much higher in developing countries than in developed countries. This review aimed to compare the rates of perioperative and anesthesia-related CA and mortality during 2 time periods in Brazil. Methods A systematic review with meta-analysis of full-text Brazilian observational studies was conducted by searching the Medline, EMBASE, LILACS and SciELO databases up to January 29, 2020. The primary outcomes were perioperative CA and mortality rates and the secondary outcomes included anesthesia-related CA and mortality events rates up to 48 postoperative hours. Results Eleven studies including 719,273 anesthetic procedures, 962 perioperative CAs, 134 anesthesia-related CAs, 1,239 perioperative deaths and 29 anesthesia-related deaths were included. The event rates were evaluated in 2 time periods: pre-1990 and 1990–2020. Perioperative CA rates (per 10,000 anesthetics) decreased from 39.87 (95% confidence interval [CI]: 34.60–45.50) before 1990 to 17.61 (95% CI: 9.21–28.68) in 1990–2020 (P < 0.0001), while the perioperative mortality rate did not alter (from 19.25 [95% CI: 15.64–23.24] pre-1990 to 25.40 [95% CI: 13.01–41.86] in 1990–2020; P = 0.1984). Simultaneously, the anesthesia-related CA rate decreased from 14.39 (95% CI: 11.29–17.86) to 3.90 (95% CI: 2.93–5.01; P < 0.0001), while there was no significant difference in the anesthesia-related mortality rate (from 1.75 [95% CI: 0.76–3.11] to 0.67 [95% CI: 0.09–1.66; P = 0.5404). Conclusions This review demonstrates an important reduction in the perioperative CA rate over time in Brazil, with a large and consistent decrease in the anesthesia-related CA rate; however, there were no significant differences in perioperative and anesthesia-related mortality rates between the assessed time periods.

Effect of inhaled anaesthetics gases on cytokines and oxidative stress alterations for the staff health status in hospitals

“…Oxidative stress can be initiated by anaesthetic gases. A study of medical staff exposed to WAGs found the staff exhibited basal DNA damage and elevated IL-17A (Braz et al 2020). The same study also observed these staff had a slightly higher incidence of micronucleus but there no significant change to their levels of oxidative stress biomarkers.…”

“…In the study conducted by Braz et al (2020), young medical residents working in operating rooms that did not have adequate scavenging systems and thus were exposed to high concentrations of WAGs for three years, did not exhibit oxidative stress; however, genomic damage and inflammatory states were detected. Similarly, medical staff exposed to high concentrations of anaesthetic gases, even for short durations were found to have elevated levels of IL-8, a proinflammatory chemokine (Chaoul et al 2015).…”

Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression

“…Perioperative care has a tremendous role in treating a broad spectrum of diseases in the alleviation of human suffering at all ages ranges from a neonate for a congenital anomaly to nonagenarians for cataract surgery [ 1 ]. However, the quality and safety of perioperative care remain poor particularly in low and middle-income countries where anesthesia-related adverse events were persistent over the years [ [2] , [3] , [4] , [5] , [6] , [7] , [8] ].…”

“…Modern anesthesia in otherwise healthy children above one year of age in developed countries has become very safe due to recent advances in pharmacology, intensive education, and training as well as centralization of care while anesthesia in these children in low-income countries is associated with a high risk of mortality due to lack of basic resources and adequate training of health care providers [ 2 , [11] , [12] , [13] , [14] , [15] , [16] ].…”

Litigation in Anesthesia and Intensive Care Units: An Italian Retrospective Study

“…The report by Beecher and Todd helped identify anesthesia safety as a public health problem [14]. The study calls attention to anesthesia mortality risk, as underlined in studies conducted in Europe, Japan, and Brazil [3,[15][16][17].…”