Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000600009
Brazilian Journal of Anesthesiology
Clinical Information

Estudo retrospectivo da incidência de óbitos anestésico-cirúrgicos nas primeiras 24 horas: revisão de 82.641 anestesias

Retrospective study of anesthetic deaths in the first 24 hours: review of 82,641 anesthesias

Raquel Pei Chen Chan; José Otávio Costa Auler Junior

http://dx.doi.org/10.1590/S0034-70942002000600009 Braz J Anesthesiol, vol.52, n6, p.719-727, 2002
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JUSTIFICATIVA E OBJETIVOS: Desde o primeiro relato de óbito por anestesia, muitas tentativas têm sido feitas para estudar a incidência de fatores de risco, complicações e mortalidades associadas à anestesia e cirurgia. O risco estimado peri-operatório de mortalidade varia de 0,05 a 10 casos para 10.000 anestesias. O objetivo deste estudo foi reportar a incidência de óbitos anestésicos-cirúrgicos nas primeiras 24 horas, ocorridos no Hospital das Clínicas da FMUSP. MÉTODO: Foram revisados os prontuários de pacientes anestesiados nos anos 1998 e 1999, num total de 82.641 cirurgias. Os óbitos foram classificados quanto à causa de óbito pela classificação de Edwards, faixa etária, sexo, estado físico (ASA), especialidade e tipo de anestesia. RESULTADOS: A causa de óbito pela classificação de Edwards demonstrou que 91,04% eram da categoria V; 3,77% da categoria VI; 2,13% da VII; 2,84% da IV e 0,23% da I. A faixa etária acima de 65 anos teve incidência de óbito de 1,48%; a dos adultos de 0,48%; crianças de 1 a 12 anos de 0,11%; crianças de 31 dias a 1 ano de 1,29% e neonatos até 30 dias de 2,88%. A proporção de óbitos em relação ao total é de 59,2% de adultos; 30,2% acima de 65 anos; 2,8% de 1 a 12 anos; 4% de 31 dias a 1 ano e 3,8% de neonatos. Os homens representam 66,3% e as mulheres 33,7% dos óbitos. A distribuição por ASA foi a seguinte: ASA I -11,1%, ASA II- 5,2%, ASA III- 30,9%, ASA IV- 34,4% e ASA V- 18,4%. Cirurgias de emergência contabilizaram 67,2% dos óbitos e as eletivas 32,8%. A incidência geral de óbitos foi de 0,51% (sendo 1,88%, a mais elevada, em cirurgia cardíaca, e 1,87% em vascular). CONCLUSÕES: Os óbitos anestésico-cirúrgicos nos anos 1998 e1999 foram considerados inevitáveis, considerando-se a classificação de Edwards. A incidência mais alta de óbitos ocorreu em neonatos, O predomínio dos óbitos foi do sexo masculino, de pacientes ASA III ou mais, em cirurgias de emergência, cardíacas ou vasculares.

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Abstract

BACKGROUND AND OBJECTIVES: Since the first reported anesthetic death, many attempts have been made to study the incidence of risk factors, complications and mortality associated to anesthesia and surgery. The estimated perioperative mortality risk varies from 0.05 to 10 cases per 10,000 anesthesias. This study aimed at reporting the incidence of anesthetic-surgical death in the first 24 hours, at our hospital. METHODS: Charts had been reviewed from 82,641 surgeries performed in 1998 and 1999. Deaths were analyzed according to EdwardsÂ’ classification, and by age, gender, physical status, (ASA), type of surgery and anesthesia. RESULTS: Cause of the deaths according to Edwards classification has shown that 91.04% were class V, 3.77% class VI, 2.13% class VII, 2.84% class IV and 0.23% were class I. Age above 65 years accounted for 1.48% of deaths; adults incidence was 0.48%; the incidence in children aged 1 to 12 years was 0.11%; in children aged 31 days to 1 year it was 1.29% and in neonates up to 30 days of life the incidence was 2.88%. Death ratio as compared to total deaths was 59.2% in adults, 30.2% in patients above 65 years of age, 2.8% at the age 1 to 12, 4% in patients with 31 days of life to 1 year and 3.8% in newborn babies. Males represented 66.3% of deaths and females 33.7%. The distribution by ASA physical status was: ASA I - 11.1%, ASA II - 5.2%, ASA III - 30.9%, ASA IV - 34.4% and ASA V - 18.4%. Emergency surgeries accounted for 67.2% of deaths and elective surgeries for 32.8%. General incidence of the deaths was 0.51% being the highest in cardiac (1.88%) and vascular (1.87%) surgeries. CONCLUSIONS: Anesthetic-surgical deaths in the years 1998 and 1999 were considered inevitable according to EdwardÂ’s classification. The highest incidence of deaths was in neonates. Most deaths occurred in males, ASA III or above patients, and emergency vascular or cardiac surgeries.

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