Bille Christophe, Auvigne Vincent, Bomassi Eric, Durieux Philippe, Libermann Stéphane, Rattez Elise
Centre Hospitalier Vétérinaire des Cordeliers, Meaux, France.
Vet Anaesth Analg. 2014 May;41(3):249-58. doi: 10.1111/vaa.12116. Epub 2013 Dec 18.
To evaluate anaesthetic death after implementation of recommendations and its risk factors in a small animal practice.
Observational cohort study.
All cats and dogs anaesthetized at the Centre Hospitalier Vétérinaire des Cordeliers during two periods, from April 15th, 2008 to April 15th, 2010 (period 1) and from June 15th, 2010 to August 24th, 2011 (period 2).
Death occurring during or before full recovery from anaesthesia was recorded. At the end of period 1, a logistic regression model was generated to describe anaesthetic death and identify risk factors. Potential risk factors in our practice setting were identified, and three recommendations, relating to improving physical status and anaesthetic/analgesic regimen implemented for period 2. The relationship between anaesthetic death and recorded variables were analyzed, and where relevant, compared between periods.
Six thousand two hundred and thirty-one animals underwent general anaesthesia. The overall death rate during period 1 was 1.35% (48 in 3546, 95% CI [1.0-1.7%]) and during period 2 was 0.8% (21 in 2685, 95% CI [0.6-1.2%]). For sick animals (ASA status 3 and over), the overall death rate was 4.8% (45 of 944 95% [CI 3.5-6.4%]) during period 1 and 2.2% (18 of 834 95% CI [1.3-3.5%]) during period 2; this represented a significant decrease in death rate in period 2 (p = 0.002). In period 2, the main factors associated with an increased odds ratio of anaesthetic death were poor health status (ASA physical status classification) and old age. Species, gender, anaesthetic regimen, the nature and urgency of the procedure were not associated with risk.
Following evidence based recommendations, the death rate related to anaesthesia was significantly decreased during period 2 compared to period 1. Application of evidence-based medicine may contribute to an effective approach to decrease death rates. Other factors, not monitored in this study, may also have had an impact.
评估在一家小动物诊疗机构实施相关建议后麻醉死亡情况及其风险因素。
观察性队列研究。
所有于两个时间段内在科德利埃兽医中心接受麻醉的猫和狗，即从2008年4月15日至2010年4月15日（第1阶段）以及从2010年6月15日至2011年8月24日（第2阶段）。
记录麻醉完全恢复前或期间发生的死亡情况。在第1阶段结束时，建立逻辑回归模型以描述麻醉死亡情况并识别风险因素。确定了我们诊疗机构中的潜在风险因素，并针对第2阶段实施了三项与改善身体状况及麻醉/镇痛方案相关的建议。分析了麻醉死亡与记录变量之间的关系，并在相关情况下对两个阶段进行了比较。
6231只动物接受了全身麻醉。第1阶段的总体死亡率为1.35%（3546只中有48只，95%可信区间[1.0 - 1.7%]），第2阶段为0.8%（2685只中有21只，95%可信区间[0.6 - 1.2%]）。对于患病动物（ASA状态为3及以上），第1阶段的总体死亡率为4.8%（944只中有45只，95%[可信区间3.5 - 6.4%]），第2阶段为2.2%（834只中有18只，95%可信区间[1.3 - 3.5%]）；这表明第2阶段死亡率显著降低（p = 0.002）。在第2阶段，与麻醉死亡比值比增加相关的主要因素是健康状况差（ASA身体状况分类）和年龄较大。物种、性别、麻醉方案、手术性质及紧迫性与风险无关。
遵循循证建议后，与第1阶段相比，第2阶段与麻醉相关的死亡率显著降低。应用循证医学可能有助于采取有效方法降低死亡率。本研究未监测的其他因素可能也有影响。
