The Risk of Anesthesia
About: This article is published in Anesthesiology.The article was published on 1970-08-01. It has received 91 citations till now. The article focuses on the topics: Anesthesiology & MEDLINE.
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TL;DR: The results of this study indicate that catheter ablation of accessory AV connections with radiofrequency current can be performed safely and expeditiously in a majority of patients and confirm in a large series the feasibility of catheterablation at the time of an initial diagnostic electrophysiology test.
Abstract: BACKGROUNDThe purpose of this study was to report the results and complications of radiofrequency catheter ablation of accessory atrioventricular (AV) connections by using an abbreviated approach aimed at minimizing the duration of the procedure.METHODS AND RESULTSTwo hundred fifty consecutive patients with the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardia involving a concealed accessory AV connection underwent catheter ablation with the use of radiofrequency current. In 179 of the 250 patients, catheter ablation was performed at the time of an initial electrophysiology test. Two hundred thirty-five patients had one accessory AV connection and 15 patients had two or more. One hundred eighty-three accessory AV connections were manifest and 84 were concealed. One hundred sixty-one were were located in the free wall of the left ventricle, 47 were in the right free wall, 44 were posteroseptal, 10 were anteroseptal, and five were intermediate test, and the ablation procedure was rec...
391 citations
TL;DR: Radiofrequency catheter ablation of accessory AV connections may result in significant radiation exposure to the patient and to the physician, and somatic and genetic risks are estimated.
Abstract: BACKGROUNDCatheter ablation of accessory atrioventricular (AV) connections has been demonstrated to be effective in more than 85% of patients. One of the risks of this procedure is radiation exposure during the fluoroscopic imaging necessary to guide catheter manipulation. The objective of the present study was to measure the radiation received by patients and physicians during radiofrequency catheter ablation and to estimate the resultant somatic and genetic risks.METHODS AND RESULTSRadiation exposure to patients and physicians was measured during attempts at radiofrequency catheter ablation of accessory AV connections in 31 consecutive patients. Radiation exposure was measured using thermoluminescent sensors placed on the patient and on the physician. Somatic and genetic risks were estimated based on the radiation levels recorded using these sensors. The durations of fluoroscopy and of the catheter ablation procedure were recorded for each patient. Catheter ablation was successful in 28 of 31 patients (...
240 citations
TL;DR: A model for prediction of mortality risk was developed that included five significant preoperative predictive variables; age; patients with history of chronic heart disease, and renal disease; emergency surgery; and the type of operation.
Abstract: The aims of this study were to: 1) determine the incidences and causes of mortality associated with anaesthesia and surgery, 2) identify important factors associated with mortality in hospital, and 3) estimate the mortality risk associated with anaesthesia and surgery when a combination of risk factors are present. A total of 7306 anaesthetized patients undergoing abdominal, urological, gynaecological, or orthopaedic surgery were included in the study. Of these, 0.05% (1:1800) died during anaesthesia, 0.1% (1:730) during the recovery period, and the overall mortality rate in hospital was 1.2% (1:81). Most deaths occurred in the elderly (greater than or equal to 70 years of age) and were unavoidable due to progression of the presenting condition, such as advanced cancer, or co-existing diseases such as cardiopulmonary or renal failure. Of the patients who developed myocardial infarction (MI) following anaesthesia, 67% (8/12) died in the postoperative period. Half of the MI patients who died received regional anaesthesia, and in addition suffered from periods of cardiovascular dysfunction intraoperatively. By utilizing logistic regression analysis, a model for prediction of mortality risk was developed. The model included five significant preoperative predictive variables: age; patients with history of chronic heart disease, and renal disease; emergency surgery; and the type of operation. With this model it is possible to distinguish between patients with very different mortality risks.
211 citations
TL;DR: Six variables were found to be significant in predicting complications: high age, major abdominal surgery, emergency surgery, a history of chronic obstructive lung disease, long‐lasting general anaesthesia (≥ 180 min) involving pancuronium, and anaesthesia involving pancakes, in the order given.
Abstract: The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patient's age, the presence or absence of chronic obstructive lung disease (preoperative risk factors), the type of surgery and the duration of anaesthesia (perioperative risk factors). Seven thousand and twenty-nine patients undergoing abdominal, urological, gynaecological or orthopaedic surgery were included in the study. A total of 290 patients (4.1%) suffered from one or more postoperative pulmonary complications. Six thousand and sixty-two patients received general anaesthesia and 4.5% of these had postoperative pulmonary complications. Of the patients admitted to major surgery receiving pancuronium, 12.7% (135/1062) developed postoperative pulmonary complications, compared to only 5.1% (23/449) receiving atracurium (P < 0.05). When stratified for type of surgery and duration of anaesthesia, conventional statistics showed no difference between pancuronium and atracurium as regard postoperative pulmonary complications. However, a logistic regression analysis indicated that long-lasting procedures involving pancuronium entailed a higher risk of postoperative pulmonary complications than did other procedures. In patients having regional anaesthesia, only 1.9% (18/967) developed postoperative pulmonary complications (P < 0.05 compared to general anaesthesia). However, when stratified for type of surgery there was a significantly higher incidence of postoperative pulmonary complications only in patients undergoing major orthopaedic surgery under general anaesthesia, 11.5% compared to 3.6% in patients given a regional anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)
151 citations
TL;DR: The need to comprehensively examine the events of cardiac arrest as well as mortality prompted the first national study in Japan, which reported data of mortality and morbidity related to anesthesia since World War II.
Abstract: Background: Statistical data of mortality and morbidity related to anesthesia have not been reported in Japan since World War II. The need to comprehensively examine the events of cardiac arrest as well as mortality prompted the first national study in Japan.
Methods: Confidential questionnaires were sent to all Japan Society of Anesthesiologists Certified Training Hospitals every year from 1994 through 1998. Collected data were analyzed for incidence of cardiac arrest and other critical events during anesthesia and surgery, and their outcomes within 7 postoperative days. The principal causes of the critical incidents were also analyzed.
Results: With an average response rate of 39.9%, a total of 2,363,038 cases were documented over 5 years. The average incidence per year of cardiac arrest during surgery due to all etiologies and that totally attributable to anesthesia was 7.12 [95%CI: 6.30,7.94] and 1.00 [0.88, 1.12]) per 10,000 cases, respectively. The average mortality per year in the operating room or within 7 postoperative days due to all etiologies and that totally attributable to anesthesia was 7.18 [6.22, 8.13] and 0.21 [0.15, 0.27] per 10,000 cases, respectively. The two principal causes of cardiac arrest during anesthesia and surgery due to all etiologies were massive hemorrhage (31.9%) and surgery (30.2%), and those totally attributable to anesthesia were drug overdose or selection error (15.3%) and serious arrhythmia (13.9%). Preventable human errors caused 53.2% of cardiac arrest and 22.2% of deaths in the operating room totally attributable to anesthesia.
Conclusions: The rates in Japan of cardiac arrest and death during anesthesia and surgery due to all etiologies as well as those totally attributable to anesthesia are comparable to those of other developed countries.
147 citations
Cites background from "The Risk of Anesthesia"
...Anesthetic mortality and morbidity studies since 1980 have frequently been carried out on a national basis because of the large sample size required (4)....
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...8%), (4) inappropriate airway Table 3A...
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...incidents of death in the operating room (OR), death within 7 postoperative days, survival in a vegetative state, and recovery without any significant sequelae; and (4) the principal cause of each incident selected from a list of 44 items provided on the questionnaire....
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