Canadian Journal of Anaesthesia

, Volume 48, Issue 4, pp 326–332 | Cite as

Fatal and non fatal cardiac arrests related to anesthesia

  • Philippe Biboulet
  • Pierre Aubas
  • Jacques Dubourdieu
  • Josh Rubenovitch
  • Xavier Capdevila
  • Françoise d’Athis
General Anesthesia

Abstract

Purpose: The aim of this study was to assess the incidence and causes of cardiac arrests related to anesthesia.

Methods: All patients undergoing anesthesia over a six year period were included in a prospective study. The cardiac arrests encountered during anesthesia and the first twelve postoperative hours in the PACU or ICU were analysed. For each arrest, partially or totally related to anesthesia, the sequence of events leading to the accident was evaluated.

Results: Eleven cardiac arrests related to anesthesia were identified among the 101,769 anesthetic procedures (frequency: 1.1/10,000 [0.44–1.72]). Mortality related to anesthesia was 0.6/10,000 [0.12–1.06]. Age over 84 yr and an ASA physical status >2 were found to be risk factors of cardiac arrest related to anesthesia. The main causes of anesthesia related cardiac arrest were anesthetic overdose (four cases), hypovolemia (two cases) and hypoxemia due to difficult tracheal intubation (two cases). No cardiac arrests due to alveolar hypoventilation were noted during the postoperative periods in either PACU or ICU. At least one human error was noted in ten of the eleven cardiac arrests cases, due to poor preoperative evaluation in seven. All cardiac arrests totally related to anesthesia were classified as avoidable.

Conclusion: Efforts must be directed towards improving preoperative patient evaluation. Anesthetic induction doses should be titrated in all ASA 3 and 4 patients. The prediction of difficult tracheal intubation, and if required, the use of awake tracheal intubation techniques, should remain a priority when performing general anesthesia.

Résumé

Objectif: Le but de cette étude était d’évaluer la fréquence et les causes des arrêts cardiaques liés à l’anesthésie (ACA).

Méthode: Toutes les anesthésies effectuées pendant six ans dans un département d’anesthésie ont été relevées de manière prospective. Les arrêts cardiaques notés en peropératoire et dans les 12 premières heures postopératoires en salle de réveil ou en réanimation ont été analysés. Pour chaque arrêt cardiaque lié partiellement ou totalement à l’anesthésie, l’étude des causes de l’accident était réalisée.

Résultats: Onze ACA ont étés relevés sur 101769 anesthésies éffectuées (fréquence de 1.1/10000 [0.44–1.72]). La mortalité liée â l’anesthésie était de 0.6/10000 [0.12–1.06]. Un âge de plus de 84 ans et un score ASA supérieur à 2 étaient des facteurs de risque de survenue d’ACA. Les principales causes d’ACA étaient le surdosage anesthésique (quatre cas), l’hypovolémie (deux cas) et l’hypoxie par difficulté d’intubation trachéale (deux cas). Aucun ACA hypoxique postopératoire n’était relevé en salle de réveil ou en réanimation. Dans dix des onze ACA au moins, une erreur humaine était relevée, le plus souvent (sept cas) il s’agissait d’une mauvaise évaluation préopératoire. Tous les arrêts cardiaques totalement liés à l’anesthésie étaient classés évitables.

Conclusion: Une meilleure évaluation préopératoire semble primordiale. Chez les patients âgés et/ou avec un score ASA supérieur à 2, un titrage de la dose d’induction est indispensable. La prédiction d’une intubation difficile et, si nécessaire, l’utilisation des techniques d’intubation trachéale vigiles, doivent rester une priorité au cours d’une anesthésie générale.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Philippe Biboulet
    • 1
  • Pierre Aubas
    • 2
  • Jacques Dubourdieu
    • 1
  • Josh Rubenovitch
    • 1
  • Xavier Capdevila
    • 1
  • Françoise d’Athis
    • 1
  1. 1.From the Department of Anesthesiology and Critical Care “A”Lapeyronie University HospitalMontpellierFrance
  2. 2.Department of Medical InformationLapeyronie University HospitalMontpellierFrance

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