Search

Background and Objective: The analysis of perioperative cardiac arrest and mortality remains a potentially valuable method to improve clinical outcome. This survey evaluated the incidence and causes of perioperative cardiac arrests and mortality in a paediatric surgical population over 5 years., Methods: All cardiac arrests that occurred between April 2003 and March 2008, during administration of anaesthesia at the paediatric centre of our institute, were recorded from an anaesthesia database and postsurgical ICU census register. All surgery performed under anaesthesia was included whether emergency or elective. All surgical procedures were covered except eye surgery, cardiac surgery and the procedures performed at remote locations. Data collected included patient characteristics, surgical procedures, preoperative physical status and anaesthesia-provider information, immediate cause of cardiac arrest, antecedent events, management and outcome. All cardiac arrests were grouped according to the cause of arrest into one of four groups: totally anaesthesia related, partially anaesthesia related, surgery related or child condition related., Results: There were a total of 27 cardiac arrests out of 12 158 procedures. Major risk factors for cardiac arrests were children under 1 year of age (P < 0.05), ASA physical status (ASA-PS) III or more (P < 0.001) and emergency surgery (P < 0.01). There were nine cardiac arrests attributed to anaesthesia, three totally and six partially related to anaesthesia. The main causes of anaesthesia-related cardiac arrest were respiratory events (56%), followed by cardiac events (33%). Anaesthesia-related mortality was 1.2/10 000 anaesthetics in patients with ASA-PS I-II and 7.7/10 000 anaesthetics in patients with ASA-PS III-V with a survival rate of 56%., Conclusion: Major risk factors for cardiac arrests were age under 1 year, poor physical status and emergency surgery. Respiratory and cardiovascular-related events accounted for most of all anaesthesia-related cardiac arrests. High ASA-PS was the leading cause of perioperative mortality.

Background: Intrathecal ketamine produces a short period of analgesia with stable haemodynamics. Midazolam with bupivacaine prolongs the duration of analgesia when administered intrathecally but does not prevent hypotension. The objective of this study was to assess the effect of a combination of intrathecal bupivacaine, ketamine and midazolam on the duration of analgesia and haemodynamic parameters., Methods: A prospective, randomized, double-blind study was carried out in 60 ASA I and II patients undergoing lower limb surgery under spinal anaesthesia. Patients were divided into three groups of 20 each. Patients in all the three groups received 3 mL of hyperbaric bupivacaine (0.5%) intrathecally. In addition, patients in Groups II and III received intrathecal ketamine (0.1 mg kg-1) and the same dose of ketamine along with midazolam (0.02 mg kg-1), respectively. All patients were evaluated for block characteristics, duration of pain-free period, total rescue analgesic requirement in the 24-h postoperative period, total dose of mephenteramine to treat hypotension and any central or neurological complication., Results: No patients in Group II required mephenteramine while 40% of patients in Group I and 10% in Group III required mephenteramine to maintain blood pressure after spinal anaesthesia. The mean +/- standard deviation duration of pain-free period was 331.5 +/- 89.9, 369.7 +/- 124.2 and 730.5 +/- 81.5 min in Group I, II and III, respectively. The pain-free interval was significantly greater in Group III compared to Groups I and II (P < 0.001). No patient had any complications., Conclusion: A low dose of midazolam and ketamine with bupivacaine intrathecally results in prolonged analgesia and less haemodynamic fluctuations. However, the safety of this combination needs to be proved before its use in clinical practice.