Ten Deaths Out of 100,000 Anesthetics—All in Children with Serious Medical Conditions
Newswise — San Francisco, CA. (May 31, 2011) – A large study at an Australian children's hospital suggests that there's little or no risk of death related to anesthesia in healthy children, reports the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).
Although the study identified ten anesthesia-related deaths out of a series of nearly 102,000 anesthesia procedures in children, all of the children who died had heart disease or other serious medical conditions. The overall rate is actually higher than reported in some previous studies, raising questions about how "anesthesia-related deaths" should be defined. The lead author of the study was Dr. Benjamin F. van der Griend of Christchurch Hospital, New Zealand.
More Accurate Data on Anesthesia-Related Deaths in ChildrenThe researchers analyzed 101,885 anesthesia procedures in 56,000 children undergoing surgery at Children's Hospital, Melbourne, Australia, from 2003 to 2008. Deaths within 24 hours and 30 days after the anesthesia were identified. A panel of expert anesthesiologists judged whether each death was related to the anesthesia in any way.
The overall rate of death from any cause within 24 hours was 13.4 per 10,000 anesthesia procedures, while the rate of death within 30 days was 34.5 per 10,000 procedures. The risk of death was higher among infants aged 30 days or younger and among infants and children undergoing heart surgery.
Overall, 10 deaths were considered to be related to anesthesia, or to factors under the control of the anesthesiologist—a rate of just under 1 out of 10,000 anesthesia procedures. "In all 10 cases, preexisting medical conditions were identified as being a significant factor in the patient's death," according to the authors. Five of the ten deaths occurred in children with pulmonary hypertension, or abnormally high blood pressure in the arteries of the lungs.
Especially in children, anesthesia-related death is a rare event—so rare that it's difficult to get reliable estimates of the risk. The rates reported in the new study are higher than in most previous studies. However, they're also based on patients seen at a national children's hospital, many with serious illnesses.
All of the deaths occurred in children with "significant life-threatening medical problems." Before recent medical advances, many of these children would likely have been considered "unfit for anesthesia," Dr. van der Griend and colleagues note. They highlight the need for careful planning and clear communication with families to provide "realistic pictures of the risks and benefits" of anesthesia for children with such complex medical conditions.
The study also suggests that, for healthy children, the risk of anesthesia-related death should be very low. Dr. van der Griend and colleagues even question whether it's appropriate to list death as a potential risk of anesthesia for children without significant medical problems.
In an accompanying editorial, Dr. Jayant K. Deshpande of Arkansas Children's Hospital and University of Arkansas for Medical Sciences emphasizes that the study used a new and not generally accepted definition of anesthesia-related deaths—which likely helps to explain why the reported rate is higher than in previous studies. Dr. Deshpande believes that establishing a "uniform, clinically useful definition" of anesthesia-related death would help in standardizing studies of anesthesia risks, and thus in clarifying the true risks—for healthy children as well as those with serious medical conditions.
About the IARSThe International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through basic research. The IARS contributes nearly $1 million annually to fund anesthesia research; sponsors an annual forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of more 15,000 physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia-related practice; sponsors the SmartTots initiative in conjunction with the FDA; and publishes the journal Anesthesia & Analgesia. Additional information about the society and the journal may be found at the IARS website.
About Anesthesia & AnalgesiaAnesthesia & Analgesia was founded in 1922 and was issued bi-monthly until 1980, when it became a monthly publication. A&A is the leading journal for anesthesia clinicians and researchers and includes more than 500 articles annually in all areas related to anesthesia and analgesia, such as cardiovascular anesthesiology, patient safety, anesthetic pharmacology, and pain management. The journal is published on behalf of the IARS by Lippincott Williams & Wilkins (LWW), a division of Wolters Kluwer Health.