Postoperative mortality in children after 101,885 anesthesia at a tertiary paediatric hospital

Error in deserializing body of reply message for operation 'Translate'. The maximum string content length quota (8192) has been exceeded while reading XML data. This quota may be increased by changing the MaxStringContentLength property on the XmlDictionaryReaderQuotas object used when creating the XML reader. Line 2, position 8043. Error in deserializing body of reply message for operation 'Translate'. The maximum string content length quota (8192) has been exceeded while reading XML data. This quota may be increased by changing the MaxStringContentLength property on the XmlDictionaryReaderQuotas object used when creating the XML reader. Line 1, position 8573. Postoperative Mortality in Children After 101,885 Anesthetics at a Tertiary Pediatric Hospital Skip to main page content

HOME CURRENT ISSUE PAST ISSUES CME SUBSCRIBE ONLINE HELP SUBMIT TO A&A ACTIVATE MY ACCOUNT Search GO Advanced Search ? User Name Password Sign In Postoperative Mortality in Children After 101,885 Anesthetics at a Tertiary Pediatric Hospital Benjamin F. van der Griend, MBBS, BMedSc, FANZCA*, Nichole A. Lister, BA, BSc(Hons), PhD?, Ian M. McKenzie, MBBS, DipRACOG, FANZCA?, Nick Martin, MBBS, FRCA, FANZCA?, Philip G. Ragg, MBBS, FFARACS, FANZCA?, Suzette J. Sheppard, BSc(Hons)? and Andrew J. Davidson, MBBS, MD, FANZCA?

From *Christchurch Hospital, Christchurch, New Zealand and ? Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia. Address correspondence to Benjamin F. van der Griend, MBBS, BMedSc, FANZCA, Christchurch Hospital, Riccarton Avenue, Private Bag 4710, New Zealand. Address e-mail to ben{at}vandergriend.com. Abstract BACKGROUND: Mortality is a basic measure for quality and safety in anesthesia. There are few anesthesia-related mortality data available for pediatric practice. Our objective for this study was to determine the incidence of 24-hour and 30-day mortality after anesthesia and to determine the incidence and nature of anesthesia-related mortality in pediatric practice at a large tertiary institution.

METHODS: Children ?18 years old who had an anesthetic between January 1, 2003, and August 30, 2008, at the Royal Children's Hospital, Melbourne, Australia, were included for this study. Data were analyzed by merging a database for every anesthetic performed with an accurate electronic record of mortality of children who had ever been a Royal Children's Hospital patient. Cases of children dying within 30 days and 24 hours of an anesthetic were identified and the patient history and anesthetic record examined. Anesthesia-related death was defined as those cases whereby a panel of 3 senior anesthesiologists all agreed that anesthesia or factors under the control of the anesthesiologist more likely than not influenced the timing of death.

RESULTS: During this 68-month period, 101,885 anesthetics were administered to 56,263 children. The overall 24-hour mortality from any cause after anesthesia was 13.4 per 10,000 anesthetics delivered and 30-day mortality was 34.5 per 10,000 anesthetics delivered. The incidence of death was highest in children ?30 days old. Patients undergoing cardiac surgery had a higher incidence of 24-hour and 30-day mortality than did those undergoing noncardiac surgery. From 101,885 anesthetics there were 10 anesthesia-related deaths. The incidence of anesthesia-related death was 1 in 10,188 or 0.98 cases per 10,000 anesthetics performed (95%confidence interval, 0.5 to 1.8). In all 10 cases, preexisting medical conditions were identified as being a significant factor in the patient's death. Five of these cases (50%) involved children with pulmonary hypertension.

CONCLUSIONS: Anesthesia-related mortality is higher in children with heart disease and in particular those with pulmonary hypertension. The lack of anesthetic-related deaths in children who did not have major comorbidities reinforces the safety of pediatric anesthesia in healthy children.

Footnotes Funding: Hospital funded.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Accepted January 21, 2011. Copyright ? 2011 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print May 4, 2011, doi: 10.1213/?ANE.0b013e318213be52 A & A June 2011 vol. 112 no. 6 1440-1447 ? Abstract Full Text Full Text (PDF) CME Classifications Pediatric Anesthesiology Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal Similar articles in PubMed Download to citation manager Request Permissions Citing Articles Load citing article information Google Scholar Articles by van der Griend, B. F. Articles by Davidson, A. J. PubMed PubMed citation Articles by van der Griend, B. F. Articles by Davidson, A. J. Related Content Outcomes Patient Safety Pediatrics Load related web page information Current Issue August 2011, 113 (2) Alert me to new issues of A & A Join the IARS About A&A Mission Editorial Board For Authors For Reviewers Cover Art Sign up Sign up for eTOCs Sign up for RSS feeds Browse by Topic Permissions and Copyright Press Room OpenAnesthesia Advertise in A&A Career Center Most Read Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial Transmission Postoperative Sore Throat: More Answers Than Questions Nitrous Oxide and Long-Term Morbidity and Mortality in the ENIGMA Trial Surgical Site Infections and the Anesthesia Professionals' Microbiome: We've All Been Slimed! Now What Are We Going to Do About It? The Role of Interleukin-1 in Wound Biology. Part I: Murine In Silico and In Vitro Experimental Analysis ? View all Most Read articles Cited ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials Cerebral Autoregulation and Flow/Metabolism Coupling during Cardiopulmonary Bypass: The Influence of Paco2 Consensus Guidelines for Managing Postoperative Nausea and Vomiting A Postanesthetic Recovery Score ? View all Most Cited articles Copyright ? 2011 by the International Anesthesia Research Society

Print ISSN: 0003-2999 Online ISSN: 1526-7598

View the original article here

Nitrous oxide and long-term morbidity and mortality in the ENIGMA trial

Nitrous oxide and long-term morbidity and mortality in the ENIGMA trial Go to main page content home current query previous queries CME subscribe ONLINE using send to (A) and (A) activate my account search go advanced search? user name password characters in N2O emissions and long-term morbidity and mortality in the ENIGMA trial Kate Leslie, MBBS, MD, MEpi, FANZCA *, Paul s. Myles, MBBS, MD, MPH, FANZCA, FCARSCI, FRCA ?, Matthew t. v. Chan, MBBSFANZCA ?, Andrew Forbes, MSc, PhD, Michael j. Paech, MBBS, DM, DRCOG, FRCA, FANZCA, FFPMANZCA, FRANZCOG (She) ?, Philip Peyton, MBBS, MD, FANZCA, Brendan p. Silbert, MBBS, FANZCA # and Elizabeth Williamson, PhD **

Authors' affiliations are listed at the end of the article. Address correspondence to Kate Leslie, MBBS, MD, MEpi, FANZCA, Parkville, Victoria, 3050, Australia. Address e-mail to kate.leslie{at}mh.org.au. Abstract BACKGROUND: There is a plausible pathophysiologic rationale for increased long-term cardiovascular morbidity and mortality in patients receiving significant exposure to nitrous oxide. However, this relationship has not been established clinically. The ENIGMA trial randomized 2050 patients having noncardiac surgery lasting more than 2 hours to nitrous oxide–based or nitrous oxide–free anesthesia. We conducted a follow-up study of the ENIGMA patients to evaluate the risk of cardiovascular events in the longer term. METHODS: The trial case report forms and medical records of all study patients were reviewed. The date and cause of death and occurrence of myocardial infarction or stroke were recorded. A telephone interview was then conducted with all surviving patients. The primary endpoint of the study was survival. RESULTS: The median follow-up time was 3.5 (range: 0 to 5.7) years. Three hundred eighty patients (19%) had died since the index surgery, 91 (4.5%) were recorded as having myocardial infarction, and 44 (2.2%) had a stroke during the entire follow-up period. Nitrous oxide did not significantly increase the risk of death [hazard ratio = 0.98 (95% confidence interval, CI: 0.80 to 1.20; P = 0.82)]. The adjusted odds ratio for myocardial infarction in patients administered nitrous oxide was 1.59 (95% CI: 1.01 to 2.51; P = 0.04) and for stroke was 1.01 (95% CI: 0.55 to 1.87; P = 0.97). CONCLUSIONS: The administration of nitrous oxide was associated with increased long-term risk of myocardial infarction, but not of death or stroke in patients enrolled in the ENIGMA trial. The exact relationship between nitrous oxide administration and serious long-term adverse outcomes will require confirmation by an appropriately designed large randomized controlled trial. Footnotes This study was supported by a project grant from the Australian and New Zealand College of Anaesthetists and a direct grant for research from the Chinese University of Hong Kong (project #2041315). The ENIGMA Trial was funded by the National Health and Medical Research Council of Australia (236956). Accepted August 5, 2010. Copyright ? 2011 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print September 22, 2010, doi: 10.1213/?ANE.0b013e3181f7e2c4 A & A February 2011 vol. 112 no. 2 387-393 ? Abstract Full Text Full Text (PDF) Classifications Patient Safety Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal Similar articles in PubMed Download to citation manager Request Permissions Citing Articles Load citing article information Google Scholar Articles by Leslie, K. Articles by Williamson, E. Search for related content PubMed PubMed citation Articles by Leslie, K. Articles by Williamson, E. Related Content Cardiovascular Complications Outcomes Patient Safety Pharmacology Load related web page information Current Issue July 2011, 113 (1) Alert me to new issues of A & A Join the IARS About A&A Mission Editorial Board For Authors For Reviewers Cover Art Sign up Sign up for eTOCs Sign up for RSS feeds Browse by Topic Permissions and Copyright Press Room OpenAnesthesia Advertise in A&A Career Center Most Read Special Article: 2010 Anesthesia & Analgesia Guide for Authors: 2009-2010 Editorial Board, Anesthesia & Analgesia Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial Transmission Postoperative Sore Throat: More Answers Than Questions Nitrous Oxide and Long-Term Morbidity and Mortality in the ENIGMA Trial Surgical Site Infections and the Anesthesia Professionals' Microbiome: We've All Been Slimed! Now What Are We Going to Do About It? ? View all Most Read articles Cited ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials Consensus Guidelines for Managing Postoperative Nausea and Vomiting Cerebral Autoregulation and Flow/Metabolism Coupling during Cardiopulmonary Bypass: The Influence of Paco2 A Postanesthetic Recovery Score ? View all Most Cited articles Copyright ? 2011 by the International Anesthesia Research Society Print ISSN: 0003-2999 Online ISSN: 1526-7598

View the original article here

Nitrous oxide and long-term morbidity and mortality in the ENIGMA trial

Nitrous oxide and long-term morbidity and mortality in the ENIGMA trial Go to main page content current issue past issues home CME subscribe ONLINE using the send to (A) and (A) activate my account search go advanced search? user name password characters in N2O emissions and long-term morbidity and mortality in the ENIGMA trial Kate Leslie, MBBS, MD, MEpi, FANZCA *, Paul s. Myles, MBBS, MD, MPH, FANZCA, FCARSCI, FRCA ?, Matthew t. v. Chan, MBBSFANZCA ?, Andrew Forbes, MSc, PhD, Michael j. Paech, MBBS, DM, DRCOG, FRCA, FANZCA, FFPMANZCA, FRANZCOG (She) ?, Philip Peyton, MBBS, MD, FANZCA, Brendan p. Silbert, MBBS, FANZCA # and Elizabeth Williamson, PhD **

Authors' affiliations are listed at the end of the article. Address correspondence to Kate Leslie, MBBS, MD, MEpi, FANZCA, Parkville, Victoria, 3050, Australia. Address e-mail to kate.leslie{at}mh.org.au. Abstract BACKGROUND: There is a plausible pathophysiologic rationale for increased long-term cardiovascular morbidity and mortality in patients receiving significant exposure to nitrous oxide. However, this relationship has not been established clinically. The ENIGMA trial randomized 2050 patients having noncardiac surgery lasting more than 2 hours to nitrous oxide–based or nitrous oxide–free anesthesia. We conducted a follow-up study of the ENIGMA patients to evaluate the risk of cardiovascular events in the longer term. METHODS: The trial case report forms and medical records of all study patients were reviewed. The date and cause of death and occurrence of myocardial infarction or stroke were recorded. A telephone interview was then conducted with all surviving patients. The primary endpoint of the study was survival. RESULTS: The median follow-up time was 3.5 (range: 0 to 5.7) years. Three hundred eighty patients (19%) had died since the index surgery, 91 (4.5%) were recorded as having myocardial infarction, and 44 (2.2%) had a stroke during the entire follow-up period. Nitrous oxide did not significantly increase the risk of death [hazard ratio = 0.98 (95% confidence interval, CI: 0.80 to 1.20; P = 0.82)]. The adjusted odds ratio for myocardial infarction in patients administered nitrous oxide was 1.59 (95% CI: 1.01 to 2.51; P = 0.04) and for stroke was 1.01 (95% CI: 0.55 to 1.87; P = 0.97). CONCLUSIONS: The administration of nitrous oxide was associated with increased long-term risk of myocardial infarction, but not of death or stroke in patients enrolled in the ENIGMA trial. The exact relationship between nitrous oxide administration and serious long-term adverse outcomes will require confirmation by an appropriately designed large randomized controlled trial. Footnotes This study was supported by a project grant from the Australian and New Zealand College of Anaesthetists and a direct grant for research from the Chinese University of Hong Kong (project #2041315). The ENIGMA Trial was funded by the National Health and Medical Research Council of Australia (236956). Accepted August 5, 2010. Copyright ? 2011 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print September 22, 2010, doi: 10.1213/?ANE.0b013e3181f7e2c4 A & A February 2011 vol. 112 no. 2 387-393 ? Abstract Full Text Full Text (PDF) Classifications Patient Safety Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal Similar articles in PubMed Download to citation manager Request Permissions Citing Articles Load citing article information Google Scholar Articles by Leslie, K. Articles by Williamson, E. Search for related content PubMed PubMed citation Articles by Leslie, K. Articles by Williamson, E. Related Content Cardiovascular Complications Outcomes Patient Safety Pharmacology Load related web page information Current Issue June 2011, 112 (6) Alert me to new issues of A & A Join the IARS About A&A Mission Editorial Board For Authors For Reviewers Cover Art Sign up Sign up for eTOCs Sign up for RSS feeds Browse by Topic Permissions and Copyright Press Room OpenAnesthesia Advertise in A&A Career Center Most Read Special Article: 2010 Anesthesia & Analgesia Guide for Authors: 2009-2010 Editorial Board, Anesthesia & Analgesia Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial Transmission Postoperative Sore Throat: More Answers Than Questions Nitrous Oxide and Long-Term Morbidity and Mortality in the ENIGMA Trial Surgical Site Infections and the Anesthesia Professionals' Microbiome: We've All Been Slimed! Now What Are We Going to Do About It? ? View all Most Read articles Cited ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials Consensus Guidelines for Managing Postoperative Nausea and Vomiting Cerebral Autoregulation and Flow/Metabolism Coupling during Cardiopulmonary Bypass: The Influence of Paco2 A Postanesthetic Recovery Score ? View all Most Cited articles Copyright ? 2011 by the International Anesthesia Research Society Print ISSN: 0003-2999 Online ISSN: 1526-7598

View the original article here

Preoperative Glucose Levels Predict 1-Year Mortality After Surgery

In order to use Medscape, your browser must be set to accept cookies delivered by the Medscape site. To find out how to adjust your browser settings to accept cookies, please click here.

Medscape uses cookies to customize the site based on the information we collect at registration. The cookies contain no personally identifiable information and have no effect once you leave the Medscape site. You can read more about our use of cookies in our privacy policy.

View the original article here

Preoperative Statin Use Reduces Mortality in Coronary Bypass Patients

In order to use Medscape, your browser must be set to accept cookies delivered by the Medscape site. To find out how to adjust your browser settings to accept cookies, please click here.

Medscape uses cookies to customize the site based on the information we collect at registration. The cookies contain no personally identifiable information and have no effect once you leave the Medscape site. You can read more about our use of cookies in our privacy policy.

View the original article here