From the Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan.
Anesth Analg. 2021 Jan;132(1):217-222. doi: 10.1213/ANE.0000000000005162.
The analysis of adverse events, including morbidity and mortality (M&M), helps to identify subgroups of children at risk and to modify clinical practice. There are scant data available from low- and middle-income countries. Our aim was to estimate the proportion of pediatric patients with various severe adverse events in the perioperative period extending to 48 hours and to describe the clinical situations and causes of those events.
We reviewed the M&M database of the Department of Anesthesiology between 1992 and 2016. A data collection tool was developed, and the outcomes were standardized. Each case was reviewed independently and subsequently discussed between 2 reviewers to identify a major primary causative factor.
The total number of pediatric cases during this period was 48,828. Seventy-six significant adverse events were identified in 39 patients (8 patients [95% confidence interval {CI}, 5.7-10.9] per 10,000). Thirteen patients had multisystem involvement, and hence the total number of events exceeded the number of patients. Respiratory events were the most common (33.5%). Thirteen patients had perioperative cardiac arrest within 48 hours of surgery (2.6 [95% CI, 1.3-4.3] per 10,000), 7 of these were infants (54%), 5 of whom had congenital heart disease (CHD). Eleven of these 39 patients died within 48 hours (2.0 [95% CI, 1.1-4.0] per 10,000).In 13 cases, anesthesia was assessed to be the predominant cause of morbidity (2.6 per 10,000), whereas in 26 cases, it contributed partially (5.32 per 10,000). There was only 1 death solely related to anesthesia (0.2 per 10,000), and this death occurred before the start of surgery.
Adverse events were uncommon. Respiratory complications were the most frequent (33%). Infants, especially those with CHD, were identified as at a higher risk for perioperative cardiac arrest, but this association was not tested statistically. Twenty-eight percent of the patients who suffered events died within 48 hours. Increased access to anesthesia drugs and practice improvements resulted in a decline in perioperative cardiac arrests.
分析不良事件（包括发病率和死亡率）有助于确定围手术期存在风险的儿童亚组，并改进临床实践。来自中低收入国家的数据非常有限。我们的目的是评估在 48 小时内发生的各种严重围手术期不良事件患儿的比例，并描述这些事件的临床情况和原因。
我们回顾了 1992 年至 2016 年期间麻醉科的发病率和死亡率数据库。开发了一个数据收集工具，并对结果进行了标准化。对每个病例进行独立评估，然后由 2 名评审员进行讨论，以确定主要的原发性致病因素。
在此期间，共有 48828 例儿科病例。在 39 例患儿中发现 76 例严重不良事件（8 例[95%置信区间（CI）：5.7-10.9]例/10000 例）。13 例患儿多系统受累，因此事件总数超过患儿人数。呼吸事件最常见（33.5%）。术后 48 小时内有 13 例患儿发生心脏骤停（2.6[95%CI：1.3-4.3]例/10000 例），其中 7 例为婴儿（54%），5 例为先天性心脏病（CHD）患儿。在这 39 例患儿中，有 11 例在术后 48 小时内死亡（2.0[95%CI：1.1-4.0]例/10000 例）。在 13 例中，麻醉被评估为主要的发病率原因（2.6 例/10000 例），而在 26 例中，麻醉为部分原因（5.32 例/10000 例）。仅有 1 例死亡完全与麻醉相关（0.2 例/10000 例），且发生在手术开始之前。
不良事件并不常见。呼吸并发症最常见（33%）。婴儿，尤其是患有 CHD 的婴儿，被认为是围手术期心脏骤停的高危人群，但这一关联未进行统计学检验。28%的不良事件患儿在术后 48 小时内死亡。麻醉药物的使用增加和实践改进导致围手术期心脏骤停减少。
