Tay C L, Tan G M, Ng S B
Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.
Paediatr Anaesth. 2001 Nov;11(6):711-8. doi: 10.1046/j.1460-9592.2001.00767.x.
We undertook an audit of paediatric perioperative incidents in the first 10000 anaesthetics administered in KK Women's and Children's Hospital in Singapore between May 1997 and April 1999. The spectrum of surgery performed ranged from simple ambulatory surgery to open heart surgery for complicated congenital heart diseases.
An audit form is completed for every anaesthetic delivered and critical incidents are reported on the reverse blank page of the audit form. An anaesthetic incident was defined as 'any incident which affected, or could have affected, the safety of the patient under anaesthetic care'.
Two hundred and ninety-seven critical incidents were reported. The majority of them happened in healthy patients (80.1% ASA I and II) scheduled for elective surgery (73.3%). Critical incidents in infants less than 1 year of age were four times as common as in older children (8.6% versus 2.1%). Incidents occurred mainly during maintenance (80.6%). There was no anaesthetic mortality. Respiratory events were the most common (77.4%) with laryngospasm accounting for 35.7%. Cardiovascular incidents (10.8%) included hypotension from haemorrhage and sepsis, and dysrhythmias. The incidence of equipment and pharmacologically related problems was low.
Future reviews of a larger patient population may be helpful to determine trends of perioperative events and whether quality assurance programs have made a difference.
我们对1997年5月至1999年4月期间新加坡KK妇女儿童医院实施的前10000例儿科麻醉中的围手术期事件进行了审计。所进行的手术范围从简单的门诊手术到复杂先天性心脏病的心脏直视手术。
为每例麻醉填写一份审计表格，并在审计表格的反面空白页报告严重事件。麻醉事件被定义为“任何影响或可能影响接受麻醉护理患者安全的事件”。
共报告了297起严重事件。其中大多数发生在计划进行择期手术的健康患者中（80.1%为ASA I和II级）（73.3%）。1岁以下婴儿的严重事件发生率是大龄儿童的四倍（8.6%对2.1%）。事件主要发生在维持麻醉期间（80.6%）。无麻醉死亡病例。呼吸事件最为常见（77.4%），其中喉痉挛占35.7%。心血管事件（10.8%）包括出血和脓毒症引起的低血压以及心律失常。设备和药物相关问题的发生率较低。
未来对更多患者群体的审查可能有助于确定围手术期事件的趋势以及质量保证计划是否产生了影响。
