Fatal and non fatal cardiac arrests related to anesthesia

Purpose: The aim of this study was to assess the incidence and causes of ca rdiac arrests related to anesthesia. Methods: All patients undergoing anesthesia over a six year period were inc luded in a prospective study. The cardiac arrests encountered during anesth esia and the first twelve postoperative hours in the PACU or ICU were analy sed. For each arrest, partially or totally related to anesthesia. the seque nce 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 [0.44-1.721). Mo rtality related to anesthesia was 0.6/10,000 [0.12-1.06], Age over 84 yr an d an ASA physical status > 2 were found to be risk factors of cardiac arres t related to anesthesia. The main causes of anesthesia related cardiac arre st were anesthetic overdose (four cases). hypovolemia (two cases) and hypox emia due to difficult tracheal intubation (two cases). No cardiac arrests d ue 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 ele ven cardiac arrests cases, due to poor preoperative evaluation in seven. Al l cardiac arrests totally related to anesthesia were classified as avoidabl e. 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 requir ed, the use of awake tracheal intubation techniques. should remain a priori ty when performing general anesthesia.