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Scientific Articles • Rev. Bras. Anestesiol. 69 (5) • Sep-Oct 2019 • https://doi.org/10.1016/j.bjane.2019.06.006 linkcopy

Adverse events in anesthesiology: analysis based on the Logbook tool used by specializing physicians in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Logbook is a digital tool launched by the Brazilian Society of Anesthesiology in 2014 and has since been used. This tool allows physicians specializing in anesthesiology to record and store activities performed during the training period. This enabled a descriptive analysis of an extensive database of anesthetic procedures, as well as complications that occurred and were reported by these doctors. The present study includes the review of these data over a period of 2 years (2014–2015).

KEYWORDS Anesthesiology; Complications; Adverse events; Logbook; Physicians in specialization training; Brazilian Society of Anesthesiology

Variable	n	%
Sex
Female	899,631	55.49
Male	721,545	44.51
Total	1,621,176	100.00
Age group
Newborn (up to 30 days)	6,537	0.40
Infant (30 days-2 years)	33,416	2.06
Child (2-12 years)	139,203	8.59
Adolescent (12-18 years)	75,938	4.68
Adult (18-65 years)	1,125,580	69.43
Elderly (65-85 years)	225,395	13.90
Fragile (over 85 years)	15,112	0.93
Total	1,621,181	100.00
Anesthetic technique
General and regional combined anesthesia	171,570	10.58
General anesthesia/sedation	876,957	54.10
Regional Anesthesia	572,576	35.32
Total	1,621,103	100.00
ASA physical status
I	732,972	45.21
II	647,283	39.93
III	202,776	12.51
IV	34,778	2.15
V	2,607	0.16
VI	707	0.04
Total	1,621,123	100.00
Have the following morbidity
Kidney disease	34,514	2.13
Heart disease	304,888	18.81
Gastrointestinal Disease	48,380	2.98
Liver disease	14,416	0.89
Lung disease	64,267	3.96
Central nervous system disease	45,188	2.79
Multisystem disease	294,144	18.14
Other diseases	194,485	12.00
Patient care regimen
Elective	1,236,533	76.28
Urgency or emergency	384,596	23.72
Total	1,621,129	100.00
Inpatient regimen
Outpatient	309,640	19.10
Inpatient	1,311,483	80.90
Total	1,621,123	100.00
Pre-anesthetic visit
Yes	1,200,497	74.05
No	420,644	25.95
Total	1,621,141	100.00
Care setting
Pain	9,638	0.59
Remote	107,341	6.62
Operating room	1,310,498	80.83
Obstetrics	193,657	11.94
Uninformed	107	0.01
Total	1,621,241	100.00

Variable	n	%	95% CI
Care setting
Operating room	1.120	79,21	(77,09-81,32)
Induction room	77	5,45	(4,26-6,63)
PACU	88	6,22	(4,96-7,48)
Outside the operating room	129	9,12	(7,62-10,62)
Total	1.414	100,00
Time of occurrence
After preanesthetic medication	15	1,06	1,06
Before anesthetic induction	78	5,52	(4,33-6,71)
During anesthetic induction	304	21,50	(19,36-23,64)
Within 12 hours after anesthetic induction	251	17,75	(15,76-19,74)
12-24 hours after anesthesia induction	79	5,59	(4,39-6,78)
24-48 hours after anesthetic induction	26	1,84	(1,14-2,54)
Over 48 hours after anesthetic induction	10	0,71	(0,27-1,14)
During maintenance of anesthesia	489	34,58	(32,1-37,06)
During emergence	162	11,46	(9,8-13,12)
Total	1.414	100,00
Detection time
<1 minute	939	66,41	(63,95-68,87)
1-5 minutes	241	17,04	(15,08-19)
5 minute-1 hour	120	8,49	(7,03-9,94)
1-12 hours	68	4,81	(3,69-5,92)
12-24 hours	27	1,91	(1,2-2,62)
24-48 hours	12	0,85	(0,37-1,33)
Over 48 hours	7	0,50	(0,13-0,86)
Total	1.414	100,00
Detection method
Checking	707	50,00	(47,39-52,61)
Monitors	662	46,82	(44,22-49,42)
Casual detection	45	3,18	(2,27-4,1)
Total	1.414	100,00

	Remote care setting		Operating room		Obstetrics		Total
Complications	n	%	n	%	n	%	n	%
Others^a a Anaphylaxis; Wrong anesthesia (site/technical); Accidental high spinal block; Post-dural puncture headache; Wrong surgery (site/procedure); Complication due to vascular access; Intraoperative awareness; Perioperative peripheral neurological deficit; Inadequate pain control; Accidental extubation; Accidental hypothermia; Nausea/vomiting difficult to control; Medication-related complication (dispensing/administration error); Visual deficit/loss after anesthesia; Technical Complaint (medications/materials/equipment); Perioperative transfusion reaction; Unplanned reintubation; Local anesthetic toxicity; Dental Trauma; Difficult intubation; Perioperative death.	16	23.2%	481	37.3%	31	67.4%	528	37.6%
Perioperative cardiac arrest	38	55.1%	361	28.0%	8	17.4%	407	29.0%
Unexpected difficult airway/Accidental extubation/Unplanned reintubation	10	14.5%	270	21.0%	4	8.7%	284	20.2%
Perioperative pulmonary aspiration	2	2.9%	55	4.3%	0	0.0%	57	4.1%
Perioperative acute myocardial infarction	2	2.9%	55	4.3%	0	0.0%	57	4.1%
Unplanned Semi-intensive/ICU admission (anesthetic cause)	1	1.40%	48	3.7%	3	6.50%	52	3.7%
Perioperative central nervous system complication (Stroke/Coma)	0	0.0%	14	1.1%	0	0.0%	14	1.0%
Malignant hyperthermia	0	0.0%	4	0.3%	0	0.0%	4	0.3%
Total	69	100.0%	1,288	100.0%	46	100.0%	1,403	100%

	Avoidable event?
	Yes		No		Total
Complications	n	%	n	%	n	%
Others^a a Anaphylaxis; Wrong anesthesia (site/technical); Accidental high spinal block; Post-dural puncture headache; Wrong surgery (site/procedure); Complication due to vascular access; Intraoperative awareness; Perioperative peripheral neurological deficit; Inadequate pain control; Accidental extubation; Accidental hypothermia; Nausea/vomiting difficult to control; Medication-related complication (dispensing/administration error); Visual deficit/loss after anesthesia; Technical Complaint (medications/materials/equipment); Perioperative transfusion reaction; Unplanned reintubation; Local anesthetic toxicity; Dental Trauma; Difficult intubation; Perioperative death.	114	40.0%	415	37.1%	529	37.6%
Perioperative cardiac arrest	25	8.8%	382	34.1%	407	29.0%
Unexpected difficult airway/Accidental extubation/Unplanned reintubation	109	38.1%	175	15.6%	284	20.2%
Perioperative pulmonary aspiration	18	6.3%	39	3.5%	57	4.1%
Perioperative acute myocardial infarction	9	3.2%	48	4.3%	57	4.1%
Unplanned Semi-intensive/ICU admission (anesthetic cause)	7	2.5%	45	4.0%	52	3.7%
Perioperative central nervous system complication (Stroke/Coma)	2	0.7%	12	1.1%	14	1.0%
Malignant hyperthermia	1	0.4%	3	0.3%	4	0.3%
Total	285	100.0%	1,119	100.0%	1,404	100.0%

	Avoidable event?
	Yes		No		Total
Complications	n	%	n	%	n	%
Unplanned Semi-intensive/ICU admission (anesthetic cause)	0	0.0%	6	1.4%	6	1.3%
Perioperative pulmonary aspiration	1	7.7%	9	2.1%	10	2.2%
Perioperative central nervous system complication (Stroke/Coma)	1	7.7%	2	0.5%	3	0.7%
Perioperative acute myocardial infarction	0	0.0%	13	3.0%	13	2.9%
Perioperative cardiac arrest	4	30.8%	155	35.3%	159	35.2%
Unexpected difficult airway/Accidental extubation/Unplanned reintubation	0	0.0%	7	1.6%	7	1.5%
Others^a a Anaphylaxis; Wrong anesthesia (site/technical); Accidental high spinal block; Post-dural puncture headache; Wrong surgery (site/procedure); Complication due to vascular access; Intraoperative awareness; Perioperative peripheral neurological deficit; Inadequate pain control; Accidental extubation; Accidental hypothermia; Nausea/vomiting difficult to control; Medication-related complication (dispensing/administration error); Visual deficit/loss after anesthesia; Technical Complaint (medications/materials/equipment); Perioperative transfusion reaction; Unplanned reintubation; Local anesthetic toxicity; Dental Trauma; Difficult intubation; Perioperative death.	7	53.8%	247	56.1%	254	56.2%
Total	13	100.0%	439	100.0%	452	100.0%

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Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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