Cardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.

Hdl Handle:
http://hdl.handle.net/10147/207401
Title:
Cardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.
Authors:
Lynch, Johanne; Pehora, Carolyne; Holtby, Helen; Schwarz, Steven M; Taylor, Katherine
Affiliation:
Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
Citation:
Paediatr Anaesth. 2011 Sep;21(9):951-7. doi: 10.1111/j.1460-9592.2011.03645.x., Epub 2011 Jul 8.
Journal:
Paediatric anaesthesia
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207401
DOI:
10.1111/j.1460-9592.2011.03645.x
PubMed ID:
21736663
Abstract:
INTRODUCTION: It is thought that patients with cardiomyopathy have an increased risk of cardiac arrest on induction of anesthesia, but there is little available data. The purpose of this study was to identify the incidence and potential risk factors for cardiac arrest upon induction of anesthesia in children with cardiomyopathy in our institution. METHODS: A retrospective chart review was performed. Eligible patients included patients admitted between 1998 and 2008 with the International Statistical Classification of Disease code for cardiomyopathy (ICD-9 code 425) who underwent airway intervention for sedation or general anesthesia in the operating room, cardiac diagnostic and interventional unit (CDIU) or intensive care unit. Patients undergoing emergency airway intervention following cardiovascular collapse were excluded. For each patient, we recorded patient demographics, disease severity, anesthesia location, and anesthetic technique. RESULTS: One hundred and twenty-nine patients with cardiomyopathy underwent a total of 236 anesthetic events, and four cardiac arrests were identified. One was related to bradycardia (HR<60), two were attributed to bradycardia in association with severe hypotension (systolic blood pressure<45), and the fourth arrest was related to isolated severe hypotension. Two occurred in the operating suite and two in the CDIU. There was no resulting mortality. One patient progressed to heart transplantation. Multiple combinations of anesthetic drugs were used for induction of anesthesia. CONCLUSION: We performed a review of the last 10 years of anesthesia events in children with cardiomyopathy. We report four cardiac arrests in two patients and 236 anesthetic events (1.7%). To the best of our knowledge, this is the largest review of these patients to date but is limited by its retrospective nature. The low cardiac arrest incidence prevents the identification of risk factors and the development of a cardiac arrest risk predictive clinical tool.
Language:
eng
MeSH:
Adolescent; Airway Management; Anesthesia/*adverse effects; Anesthetics/adverse effects; Cardiomyopathies/*complications/epidemiology; Cardiomyopathy, Dilated/complications/epidemiology; Cardiomyopathy, Hypertrophic/complications/epidemiology; Child; Child, Preschool; Echocardiography; Electrocardiography/drug effects; Female; Heart Arrest/epidemiology/*etiology; Humans; Infant; Infant, Newborn; International Classification of Diseases; Male; Muscle Relaxants, Central/adverse effects; Ontario/epidemiology; Respiratory Insufficiency/etiology; Risk Factors; Stroke Volume/physiology
ISSN:
1460-9592 (Electronic); 1155-5645 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorLynch, Johanneen_GB
dc.contributor.authorPehora, Carolyneen_GB
dc.contributor.authorHoltby, Helenen_GB
dc.contributor.authorSchwarz, Steven Men_GB
dc.contributor.authorTaylor, Katherineen_GB
dc.date.accessioned2012-02-01T10:24:04Z-
dc.date.available2012-02-01T10:24:04Z-
dc.date.issued2012-02-01T10:24:04Z-
dc.identifier.citationPaediatr Anaesth. 2011 Sep;21(9):951-7. doi: 10.1111/j.1460-9592.2011.03645.x., Epub 2011 Jul 8.en_GB
dc.identifier.issn1460-9592 (Electronic)en_GB
dc.identifier.issn1155-5645 (Linking)en_GB
dc.identifier.pmid21736663en_GB
dc.identifier.doi10.1111/j.1460-9592.2011.03645.xen_GB
dc.identifier.urihttp://hdl.handle.net/10147/207401-
dc.description.abstractINTRODUCTION: It is thought that patients with cardiomyopathy have an increased risk of cardiac arrest on induction of anesthesia, but there is little available data. The purpose of this study was to identify the incidence and potential risk factors for cardiac arrest upon induction of anesthesia in children with cardiomyopathy in our institution. METHODS: A retrospective chart review was performed. Eligible patients included patients admitted between 1998 and 2008 with the International Statistical Classification of Disease code for cardiomyopathy (ICD-9 code 425) who underwent airway intervention for sedation or general anesthesia in the operating room, cardiac diagnostic and interventional unit (CDIU) or intensive care unit. Patients undergoing emergency airway intervention following cardiovascular collapse were excluded. For each patient, we recorded patient demographics, disease severity, anesthesia location, and anesthetic technique. RESULTS: One hundred and twenty-nine patients with cardiomyopathy underwent a total of 236 anesthetic events, and four cardiac arrests were identified. One was related to bradycardia (HR<60), two were attributed to bradycardia in association with severe hypotension (systolic blood pressure<45), and the fourth arrest was related to isolated severe hypotension. Two occurred in the operating suite and two in the CDIU. There was no resulting mortality. One patient progressed to heart transplantation. Multiple combinations of anesthetic drugs were used for induction of anesthesia. CONCLUSION: We performed a review of the last 10 years of anesthesia events in children with cardiomyopathy. We report four cardiac arrests in two patients and 236 anesthetic events (1.7%). To the best of our knowledge, this is the largest review of these patients to date but is limited by its retrospective nature. The low cardiac arrest incidence prevents the identification of risk factors and the development of a cardiac arrest risk predictive clinical tool.en_GB
dc.language.isoengen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAirway Managementen_GB
dc.subject.meshAnesthesia/*adverse effectsen_GB
dc.subject.meshAnesthetics/adverse effectsen_GB
dc.subject.meshCardiomyopathies/*complications/epidemiologyen_GB
dc.subject.meshCardiomyopathy, Dilated/complications/epidemiologyen_GB
dc.subject.meshCardiomyopathy, Hypertrophic/complications/epidemiologyen_GB
dc.subject.meshChilden_GB
dc.subject.meshChild, Preschoolen_GB
dc.subject.meshEchocardiographyen_GB
dc.subject.meshElectrocardiography/drug effectsen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHeart Arrest/epidemiology/*etiologyen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInfanten_GB
dc.subject.meshInfant, Newbornen_GB
dc.subject.meshInternational Classification of Diseasesen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMuscle Relaxants, Central/adverse effectsen_GB
dc.subject.meshOntario/epidemiologyen_GB
dc.subject.meshRespiratory Insufficiency/etiologyen_GB
dc.subject.meshRisk Factorsen_GB
dc.subject.meshStroke Volume/physiologyen_GB
dc.titleCardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.en_GB
dc.contributor.departmentOur Lady's Children's Hospital, Crumlin, Dublin, Ireland.en_GB
dc.identifier.journalPaediatric anaesthesiaen_GB
dc.description.provinceLeinster-

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