Articles: anesthetics.
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Multicenter Study
Anesthesia-related cardiac arrest in children: the Thai Anesthesia Incidents Study (THAI Study).
The Thai Anesthesia Incidents study (THAI Study) is the first national study of anesthesia outcomes during anesthesia practice in Thailand. The authors extracted data of 25,098 pediatric cases from the THAI Study in order to examine the incidence, suspected causes, contributory factors, and suggested corrective strategies associated with anesthesia-related cardiac arrest. ⋯ The incidence of anesthesia-related cardiac arrest was 5.1:10,000 anesthetics. Major risk factors were children younger than 1 year of age and ASA 3-5. The identifications of airway management and medication-related problems as the main causes of anesthesia-related cardiac arrest have important implications for preventive strategies.
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Anesthesia and analgesia · Mar 2009
Multicenter StudyThe incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium.
We used a large database of prospectively collected data on pediatric sedation/anesthesia outside the operating room provided by a wide range of pediatric specialists to delineate the nature and frequency of adverse events associated with propofol-based sedation/anesthesia care. ⋯ We report the largest series of pediatric propofol sedation/anesthesia for procedures outside the operating room. The data indicate that propofol sedation/anesthesia is unlikely to yield serious adverse outcomes in a collection of institutions with highly motivated and organized sedation/anesthesia services. However, the safety of this practice is dependent on a system's ability to manage less serious events. We propose that our data suggest variables for training and credentialing providers of propofol sedation/anesthesia and the system characteristics that promote safe use of this drug.
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American heart journal · Mar 2009
Randomized Controlled Trial Multicenter StudyNitrous oxide and perioperative cardiac morbidity (ENIGMA-II) Trial: rationale and design.
Globally there are >200 million major surgical procedures undertaken annually, and about 20% of these involve patients who have coronary artery disease. Many receive nitrous oxide, which impairs methionine synthase, thus inhibiting folate synthesis and increasing postoperative homocysteine levels. Nitrous oxide anesthesia leads to postoperative endothelial dysfunction, and there is some evidence that it increases myocardial ischemia and, possibly, myocardial infarction. We have initiated the Nitrous oxide and perioperative cardiac morbidity (ENIGMA-II) Trial to test the hypothesis that in inpatients undergoing anesthesia for major noncardiac surgery, avoidance of nitrous oxide will reduce the incidence of death and major cardiovascular events. ⋯ The ENIGMA-II Trial will be the largest study yet conducted to ascertain the benefits and risks of removing nitrous oxide from the gas mixture in anesthesia. The results of this large international trial will guide the clinical care of the hundreds of millions of adults undergoing noncardiac surgery annually.
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Multicenter Study
The Thai Anesthesia Incident Monitoring study (Thai AIMS): perioperative arrhythmia.
The Royal College of Anesthesiologists of Thailand organized the first national sentinel incident reports of anesthesia related adverse events in 2007 on an anonymous and voluntary basis. The aims of the present study were to analyze incidence, risk factors, clinical course and outcome of perioperative arrhythmia and indicate the contributing factors and suggested corrective strategies in the database of the Thai Anesthesia Incidents Monitoring Study (Thai AIMS). ⋯ Arrhythmia accounted for 19.2% of 2,537 incidents of the Thai AIMS database. Bradycardia was the most common type of cardiac arrhythmia. Most arrhythmia was benign but might be fatal. Suggested corrective strategies such as guidelines practice, improvement of supervision and quality assurance activity.
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Multicenter Study
The Thai Anesthesia Incident Monitoring study (Thai AIMS): an analysis of 21 awareness events.
To demonstrate the characteristics, outcomes, and the circumstances associated with intraoperative recall of awareness. ⋯ Intra-operative recall of awareness in the Thai AIMS was 1.05% of all incident reports. Most of the events were considered as anesthesia related. The suggested corrective strategies were quality assurance activity, effective monitoring and equipment maintenance.