Perioperative Cardiac Arrest: Analysis of anesthetics over a 16-year period

Abstract

Objective: Several studies surveyed perioperative cardiac arrests and their outcomes, whether patients were successfully resuscitated or died. No similar studies originated from the Kingdom of Saudi Arabia. This is a study of perioperative cardiac arrests and their outcome in a Saudi General Hospital over a 16-year period. Methods: Armed Forces Hospital, Wadi Al-Dawasir, Kingdom of Saudi Arabia is well equipped and covers most of the medical specialties with the exception of open heart surgery. The Hospital provides both primary and secondary medical care to military personnel and their dependants, and receives entitled patients from the civilian population. It acts as a referral centre for other hospitals in the region. Following approval of hospital Research and Ethics Committee, operating theater records were examined to collect details of patients who underwent a form of surgical procedure from the date of commission of the hospital on 12.07.1992 until 31.08.2008. Those surgical cases were traced in the Medical Records Department and the outcome of each case was observed. The numbers and causes of cardiac arrests and deaths occurred during the intraoperative and within 24hour postoperative period were noticed. Results: There were 13416 patients received anesthesia during the 16-year period. All ASA risk grades were represented. There were 6555 males (47.4%) and 7061 females (52.6%), a ratio of 0.9 M: 1.0 F. Age group ranged from one day to 104 years old (average 28.5 yr-old). General anesthesia was administered to 10654 (79.4%) cases, 2289 (17.1%) received regional (spinal, epidural or caudal), and 474 (3.5%) plexus, nerve or regional intravenous IV (Bier's) block. Four patients presented for emergency surgery died during this period, three of them died intraoperatively and the fourth died within the first 24 hour postoperatively. Conclusion: There were 4 deaths in the perioperative period during the 16-year period, an incidence of 0.0003%. This low incidence in such patient population is attributed to: 1) many patients are young without common chronic problems, and 2) the adoption of quality measures and applying strict, but updated and evidence-based, guidelines in the prevention of such catastrophes. However, a national multicentre survey is needed to find the incidence of perioperative cardiac arrests in all types of surgical operations.