Authors Keywords: paediatric, critical events, adverse events, anaesthesia, perioperative outcomes Abstract

Background: Critical events in anaesthesia are defined as events requiring immediate intervention to prevent major disability or death. South African research on risk factors predisposing our vulnerable paediatric patients to critical events is limited.

Methods: A prospective, observational, cross-sectional study was conducted at Rahima Moosa Mother and Child Hospital (RMMCH) in Johannesburg. The study included 206 paediatric patients up to the age of 12 years undergoing anaesthesia for elective and emergency procedures. The study aimed to describe the incidence and management of perioperative critical events, determine risk factors, and describe the immediate postoperative outcomes.

Results: The median age of patients with a critical event was four years with a weight of 13 kg. The cumulative incidence of critical events was 34% (95% confidence interval [CI] 27 to 40), with hypoglycaemia having the highest incidence of 21% (95% CI 16 to 27). The incidence of respiratory critical events was 11% (95% CI 7 to 16), emergence delirium 2.4% (95% CI 0.90 to 5.9), cardiovascular events 1.9% (95% CI 0.62 to 5.2), and temperature abnormalities 0.5% (95% CI 0.03 to 3.1). Risk factors associated with respiratory events included younger age and using endotracheal tubes (ETT). The management of the events varied according to physician preference. Of the patients included, 87% were discharged to the ward.

Conclusion: The cumulative incidence of critical events was more than double the number previously reported in a large South African multicentre study. Hypoglycaemia continues to be the biggest contributor. To improve patient outcomes, attention should be given to improving in-service training and continuous medical education (CME).

Author Biographies A Viljoen, University of the Witwatersrand

Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

S Mayet, University of the Witwatersrand

Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa

J Wagner, aunceston General Hospital

Department of Anaesthesiology, Launceston General Hospital, Tasmania

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