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Biomedical subjects

J C Warden

Publications and source records attributed to J C Warden.

At least 19 recordsLinked to original sources
PubMed1996

Deaths attributed to anaesthesia in New South Wales, 1984-1990.

The New South Wales Special Committee Investigating Deaths Under Anaesthesia classified 1503 deaths before full recovery from anaesthesia occurring between 1984 and 1990. 172 deaths were attributed to anaesthesia, including 11 in which the anaesthetic choice or management could not be criticized. In the remaining 161 an average of 1.8 errors per case were identified, the most frequent being inadequate preparation of the patient (in 72 cases), inadequate postoperative care (52 cases), the technique of anaesthesia chosen (44 cases) and overdose (43 cases). Death was most commonly attributed to anaesthesia in elderly patients (modal age group 70-79), in males (1.9:1) and was most commonly associated with abdominal and orthopaedic operations. Urgent non-emergency cases, 10% of the 1503 cases classified, constituted 26% of those deaths attributed to anaesthesia. One death attributable to anaesthesia occurred per 20,000 operations and the rate of such deaths was 0.44 per 100,000 population per annum.

Adolescent↗
PubMed1996

Urgent non-emergency surgery and death attributable to anaesthetic factors.

The Special Committee Investigating Deaths Under Anaesthesia in New South Wales classified 1503 deaths which occurred in the years 1984 to 1900 during, within 24 hours of, or as a result of anaesthesia. One hundred and seventy-two (11.4%) of these were attributed definitely, probably or jointly to factors under the anaesthetists' control. One hundred and forty-four (9.6%) of the 1503 deaths classified occurred in patients undergoing urgent non-emergency operations of which 45 (31.3%) were attributed to anaesthetic factors. A specialist anaesthetist either gave the anaesthetic or was present for part or all of it in 35 of these 45 cases. In 22 the hospital was a metropolitan teaching hospital. General anaesthesia was employed in 31 cases and major regional block (10 spinals and 4 epidurals) in the others. The commonest type of surgery was orthopaedic (26 cases), particularly for fractured neck of femur (20 cases). There were no deaths attributed to anaesthetic factors in cases of this degree of urgency in patients less than 16 years old. The factors under the anaesthetists' control most often identified as contributing to death were inadequate preparation for anaesthesia and surgery (18 cases, 12 of which were jointly attributed to the surgeon); inappropriate choice or application of technique (17); inadequate postoperative care (12 cases); and overdose (11 cases). If improved outcomes are to be achieved for patients having operations of this degree of urgency, greater attention must be paid to these aspects of their anaesthetic management.

Adolescent↗
PubMed1994

Mortality associated with anaesthesia in New South Wales, 1984-1990.

OBJECTIVE: To review deaths in New South Wales associated with anaesthesia from 1984 to 1990. DESIGN: The Special Committee Investigating DeathS Under Anaesthesia reviewed all deaths in NSW under anaesthesia or within 24 hours of anaesthesia in which complete recovery from anaesthesia did not occur. FINDINGS: The Committee reviewed 1503 deaths in some 3.5 million surgical procedures. In 60% the patient's death was considered to be inevitable and in 4% fortuitous. Factors under the control of the anaesthetist caused or significantly contributed to the fatal outcome in 172 cases (11%). Factors under the control of the surgeon caused or significantly contributed to the fatal outcome in 421 cases (28%). In 191 of the 421 deaths related to surgical factors and 11 of the 172 deaths related to anaesthetic factors, no better alternative procedure was considered possible and the procedures were properly performed. In only one death in a child under 10 years and in two obstetric fatalities was the anaesthetic management considered to have contributed to the outcome. Three quarters of the deaths were related to abdominal, cardiothoracic or vascular surgery, and 70% were related to emergency procedures. Male deaths outnumbered female 1.7:1. The mortality rate was 4.4 per 10,000 operations, with a male: female ratio of more than 2:1. Trauma in the 20-29 age group and vascular and cardiothoracic surgery in the 50-79 age group were mainly responsible for the sex difference in the number of deaths, but the difference was also seen in other surgical groups. CONCLUSIONS: From 1984 to 1990, deaths in which factors under the control of the anaesthetist caused or contributed to the fatal outcome occurred at a rate of 1 in 20,000 operations. This figure compares favourably with a rate of 1 in 5500 operations in NSW in 1960 and 1 in 10,250 operations in 1970.

Adolescent↗
PubMed1980

Atrax robustus envenomation.

Two patients who developed massive pulmonary oedema, profound vasoconstriction and hypertension followed by hypotension after Atrax Robustus envenomation are described. The pulmonary oedema is due to increased pulmonary capillary membrane permeability which may be due to neurogenic or toxic causes. Use of artificial ventilation with high level PEEP, isoprenaline and high dose steroids allowed support of the patients during volume replacement with albumin. When the circulation was stable and airway frothing ceased, conventional dehydration therapy further improved lung function. Both patients were discharged well.

Adult↗