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Pediatric anesthesia morbidity and mortality in the perioperative period
M M Cohen1, C B Cameron, P G Duncan
1Department of Anesthesia, University of Manitoba, Winnipeg, Canada.
Insights
Pediatric anesthesia poses risks, with infants under 1 month experiencing the most adverse events, primarily respiratory and cardiovascular issues. Older children frequently experience postoperative nausea and vomiting, with overall pediatric adverse event rates higher than adults.
Area of Science:
- Pediatric Anesthesiology
- Perioperative Medicine
- Patient Safety
Background:
- General anesthesia risks in children are not well-studied.
- Pediatric anesthesiologists frequently address parental concerns about anesthesia risks.
- Few studies have comprehensively examined adverse events following pediatric anesthesia.
Purpose of the Study:
- To determine the rates of perioperative adverse events in children across different age groups.
- To identify specific risks associated with general anesthesia in pediatric patients.
- To compare adverse event rates in pediatric patients versus adults.
Main Methods:
- Utilized data from a large pediatric anesthesia follow-up program (1982-1987).
- Collected data from 29,220 cases using anesthesiologist check-off forms and chart reviews.
- Analyzed adverse effects in five age groups: <1 mo, 1-12 mo, 1-5 yr, 6-10 yr, and 11-16 yr.
Main Results:
- Infants under 1 month had the highest intraoperative and recovery room adverse event rates, mainly respiratory and cardiovascular.
- Children over 5 years frequently experienced postoperative nausea and vomiting (approx. one-third).
- Overall adverse event risk was 35% in pediatric cases, compared to 17% in adults.
Conclusions:
- Infants <1 month old represent a high-risk group for perioperative adverse events.
- Postoperative nausea and vomiting is a significant issue in older pediatric patients.
- This morbidity survey highlights critical areas for intervention and further research in pediatric anesthesia safety.
Abstract:
One of the most frequent questions asked of a pediatric anesthesiologist is "What are the risks of anesthesia for my child?" Unfortunately, few studies have examined the consequences of general anesthesia in children. We used data from a large pediatric anesthesia follow-up program at Winnipeg Children's Hospital (1982-1987) to determine rates of perioperative adverse events among children of different ages. A check-off form was completed by a pediatric anesthesiologist for each case (n = 29,220) and a designated follow-up reviewer examined all anesthesia forms and hospital charts to ascertain adverse effects for children less than 1 mo, 1-12 mo, 1-5 yr, 6-10 yr, and 11-16 yr of age in the intraoperative, recovery room, and postoperative periods. The majority of the children were healthy, and 70% had no preoperative medical conditions. Infants less than 1 mo old were more likely to be undergoing major cardiac or vascular procedures, whereas the older children had mainly orthopedic or otolaryngologic procedures. Infants less than 1 mo old had the highest rate of adverse events both intraoperatively and in the recovery room. The main problem in this age group was related to the respiratory and cardiovascular systems. In children over 5 yr of age, postoperative nausea and vomiting was very frequent, with about one-third of the children experiencing this problem. When all events were considered (both major and minor), there was a risk of an adverse event in 35% of the pediatric cases. This contrasts with 17% for adults. This morbidity survey helps to focus on areas of intervention and for further study.