| Impact of anesthesia management characteristics on severe morbidity and mortality. | |
| | |
MedLine Citation:
|
PMID: 15681938 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Quantitative estimates of how anesthesia management impacts perioperative morbidity and mortality are limited. The authors performed a study to identify risk factors related to anesthesia management for 24-h postoperative severe morbidity and mortality. METHODS: A case-control study was performed of all patients undergoing anesthesia (1995-1997). Cases were patients who either remained comatose or died during or within 24 h of undergoing anesthesia. Controls were patients who neither remained comatose nor died during or within 24 hours of undergoing anesthesia. Data were collected by means of a questionnaire, the anesthesia and recovery form. Odds ratios were calculated for risk factors, adjusted for confounders. RESULTS: The cohort comprised 869,483 patients; 807 cases and 883 controls were analyzed. The incidence of 24-h postoperative death was 8.8 (95% confidence interval, 8.2-9.5) per 10,000 anesthetics. The incidence of coma was 0.5 (95% confidence interval, 0.3-0.6). Anesthesia management factors that were statistically significantly associated with a decreased risk were: equipment check with protocol and checklist (odds ratio, 0.64), documentation of the equipment check (odds ratio, 0.61), a directly available anesthesiologist (odds ratio, 0.46), no change of anesthesiologist during anesthesia (odds ratio, 0.44), presence of a full-time working anesthetic nurse (odds ratio, 0.41), two persons present at emergence (odds ratio, 0.69), reversal of anesthesia (for muscle relaxants and the combination of muscle relaxants and opiates; odds ratios, 0.10 and 0.29, respectively), and postoperative pain medication as opposed to no pain medication, particularly if administered epidurally or intramuscularly as opposed to intravenously. CONCLUSIONS: Mortality after surgery is substantial and an association was established between perioperative coma and death and anesthesia management factors like intraoperative presence of anesthesia personnel, administration of drugs intraoperatively and postoperatively, and characteristics of delivered intraoperative and postoperative anesthetic care. |
| | |
Authors:
|
M Sesmu Arbous; Anneke E E Meursing; Jack W van Kleef; Jaap J de Lange; Huub H A J M Spoormans; Paul Touw; Frans M Werner; Diederick E Grobbee |
Related Documents
:
|
3138628 - A comparison of alfentanil and fentanyl in short surgical procedures with special refer... 10561978 - Total intravenous anesthesia using propofol and ketamine for ambulatory gynecologic lap... 18162008 - Clinical uses of dexmedetomidine in pediatric patients. 23400788 - Laparoscopic versus open bilateral intrafascial nerve-sparing radical prostatectomy aft... 19483228 - The effect of the offset humeral head on the micromovement of pegged glenoid components... 8371128 - Treatment of intracranial abscesses: experience with sulbactam/ampicillin. |
Publication Detail:
|
Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: Anesthesiology Volume: 102 ISSN: 0003-3022 ISO Abbreviation: Anesthesiology Publication Date: 2005 Feb |
Date Detail:
|
Created Date: 2005-01-31 Completed Date: 2005-02-24 Revised Date: 2006-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
|
Languages: eng Pagination: 257-68; quiz 491-2 Citation Subset: AIM; IM |
Affiliation:
|
Julius Center for Patient Oriented Research, Dutch Association for Anesthesiology, Utrecht, The Netherlands. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Anesthesia / adverse effects, methods*, statistics & numerical data Case-Control Studies Chi-Square Distribution Cohort Studies Confidence Intervals Female Humans Intraoperative Complications / epidemiology, mortality* Male Middle Aged Monitoring, Intraoperative / methods, mortality* Odds Ratio Prospective Studies Risk Factors Statistics, Nonparametric |
| Comments/Corrections | |
Comment In:
|
Anesthesiology. 2005 Feb;102(2):251-2
[PMID:
15681936
]
Anesthesiology. 2006 Jan;104(1):202-3; author reply 204-5, 205-6 [PMID: 16394709 ] Anesthesiology. 2006 Jan;104(1):203; author reply 204-5, 205-6 [PMID: 16394711 ] Anesthesiology. 2006 Jan;104(1):203; author reply 204-5, 205-6 [PMID: 16394712 ] Anesthesiology. 2006 Jan;104(1):204; author reply 205-6 [PMID: 16394714 ] Anesthesiology. 2006 Jan;104(1):202; author reply 205-6 [PMID: 16394710 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Mycophenolate mofetil for the treatment of primary biliary cirrhosis in patients with an incomplete ...
Next Document: Recombinant coagulation factor VIIa in major liver resection: a randomized, placebo-controlled, doub...