Анестезиологическая летальность: основные причины и факторы риска. Обзор литературы

Abstract

INTRODUCTION: The lethal outcome associated with anesthesia or surgery is an indicator of both the safety of patients in the perioperative period and the level of healthcare. OBJECTIVE: We analyzed the causes and risk factors of anesthetic mortality according to the world literature in order to justify the necessity of confidential enquiry on perioperative critical events in the Russian Federation. MATERIALS AND METHODS: We analyzed the references published from 2000 to 2023 in the databases PubMed, Google Scholar, MEDLINE and eLibrary (for Russian authors). RESULTS: Of the 5,190 results, only 97 papers turned out to be relevant. After careful study, 29 full-text publications were selected as met all the selection criteria and were included into the analysis. In most of the reported observations, there is a global decrease in anesthesia-related mortality. The main dominant causes remains exactly the same (respiratory and hemodynamic disorders) with conventional risk factors (ASA grades 3–5, after-hours operations, etc.). Unfortunately, we were unable to collect data on the situation in the Russian Federation, since such studies have not yet been conducted here. CONCLUSIONS: Despite the decrease in anesthesia-related mortality, the main causes remain constant: respiratory disorders and violation of instructions for the use of drugs or their incorrect use. In the last decade, in research, the authors have been paying attention to risk factors for the occurrence of critical incidents, the main of which is, for example, operations at night. Since traditional causes of anesthesia-related death may constitute the basis of accusation, in order to effectively study the safety of anesthesia, develop protocols and recommendations, it seems to be necessary to create a regularly conducted confidential enquiry in Russia, similar to NCEPOD in the UK.