Chapter 127

2092 PART 6 ■ Specific Considerations
TABLE 127-1. Perioperative Mortality and Anesthesia-Related Mortality in the Adult General Population in the
Published Surveys
Study Duration Number of Deaths per Anesthesia Mortality
Author Country Years of Survey Anesthesias 10,000 Anesthesia per 10,000
Holland 2
Holland 2
Tiret 7
Lunn
Hovi-Viander 3
Holland 2
Buck 1
Tikkanen 6
Lienhart 8
Kawashima 4
Australia
Australia
France
United
Kingdom
Finland
Australia
United
Kingdom
Finland
France
Japan
1960–1985
1960–1985
1978–1982
1978–1979
1975
1960–1985
1985–1986
1986
1999
1994–1998
–
–
24 h
6 d
72 h
–
30 d
72 h
>3d
7d
1960s
1970s
1980s
1990s
–
–
198,103
1,447,362
338,934
–
485,850
325,585
7,756,121
(estimated)
2,363,038
60–69
70–80
19
32
18
83–85
70
17
–
7.18
1.8
0.97
0.76
1.0
2.0
0.38
0.06
0.15
0.07
0.21
old compared to those older than 10. A Japanese survey of
preoperative morbidity and mortality during 2000 reported an
incidence of anesthesia-related cardiac arrest of 28.3 per 10,000
anesthetics in infants of less than 1 month of age and 8.5 in those
aged 1–12 months. 18
The etiology of anesthesia-related cardiac arrests has changed
over the past 20 years as practice has evolved in the care of patients.
In the 1980s–1990s, two major causes of cardiac arrests have been
identified in infants: respiratory problems and halothane overdose.
Both causes were at least partially avoidable. In 1985, Keenan 17
reported a survey of 27 cardiac arrests due to anesthesia. Six out of
27 were observed in children and all were considered avoidable.
One was related to ventilation failure and the other five to an
“absolute” halothane overdose. In the large database of Olsson
and Hallen, 20 the incidence of cardiac arrests was very high in
children less than 1 year of age (17/10.000 anesthesia). Ventilation
failure and halothane overdose were responsible for 66% of the
cases (33% and 33%, respectively), followed by vagal reflex (16%)
and hypovolemia (8%).
Keenan 23 addressed the question of incidence of cardiac arrests
and training in pediatric anesthesia. In infants less than 1 year of
age, the incidence of cardiac arrest was 19/10,000 anesthetics,
when anesthesia was provided by a nonpediatric anesthetist and
was zero when a pediatric anesthetist was in charge of the case. It
was concluded “that the use of pediatric anesthesiologists for
all infants 1 year of age or younger might decrease anesthetic
morbidity in this age group.”
The Pediatric Perioperative Cardiac Arrest registry (POCA)
started in 1994 and data are based on voluntary report from
63 university-affiliated or children’s hospitals in North America. The
first POCA (POCA 1) results found an incidence of 150 anesthesiarelated
cardiac arrests out of 1,089,200 anesthetics (1.4/10000). 24
By contrast with the pediatric component of the American
Society of Anesthesiologists (ASA) Closed Claims Project, 25
TABLE 127-2. Incidence of Cardiac Arrest During Anesthesia in Children
Cardiac Arrests
Author Country Years Number of Anesthesias Age, y per 10,000 Anesthesias
Olsson 20
Tiret 7
Cohen 15
Braz 16
Murat 19
Sweden
France
United States
Brazil
France
1967–1984
1978–1982
1982–1987
1996–2004
2000–2002
250,543
2,103
28,137
2,905
26,285
3,065
8,856
3,332
3,681
12,495
6,867