title: Etiology of postanesthetic and postsedation events on the inpatient ward: data from a rapid response team at a tertiary care children's hospital.
abstract: BACKGROUND
  The goal of this study was to identify the etiology of events and demographics of patients that experience complications requiring activation of the Rapid Response Team (RRT) during the first 24 h following anesthetic care.
  
  
  METHODS
  We performed a retrospective review of the Quality Improvement database from the Department of Anesthesiology & Pain Medicine at Nationwide Children's Hospital. The database was searched to identify those patients who had a RRT evaluation activated within 24 h of receiving anesthesia or procedural sedation. These patients' charts were reviewed to obtain demographic information, etiology of the RRT call, and outcomes.
  
  
  RESULTS
  The study cohort included 106 RRT calls that were made over a 3-year period. Six patients were excluded from analysis due to incomplete datasets. One hundred patients remained for analysis including 60 males and 40 females. Patients ranged in age from 0.08 to 31.21 years (7.8 ± 7.7 years, median 5.3 years). Seventy-one patients were American Society of Anesthesiologists' (ASA) status 3 or 4 and 29 patients were ASA status 1 or 2. Five calls were made for patients who had undergone procedural sedation while the other 95 were on patients who received general anesthesia. The average time to the RRT call after the end of anesthetic care was 11.4 ± 6.6 h. Respiratory concern was the most common reason for RRT initiation, accounting for 71 of the 100 calls. Forty-nine patients had a recent respiratory illness, chronic respiratory-related disease, or history of preterm birth. Fifty patients (50%) were transferred to a higher level of care following the RRT consult. There was no significant difference between age, gender, ASA status, or etiology of the event for patients transferred vs. those who were not. A significant difference was noted in the Pediatric Early Warning Score of patients transferred to a higher level of care in comparison to patients who remained on the floor (4 ± 2 vs. 3 ± 2, P = 0.0097).
  
  
  CONCLUSIONS
  RRT calls were most common for respiratory concerns. High ASA status, general anesthesia administration, and the presence of acute or chronic conditions prior to anesthetic administration predispose a patient to perioperative complications resulting in the need for an RRT call.
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: N'Diris
authors.initials: N
authors.lastname: Barry
authors.affiliation: The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: M Miller
authors.affiliation: Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Ryshen
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Uffman
authors.affiliation: Department of Anesthesiology, Dayton Children's Hospital, Dayton, OH, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Taghon
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D016292:Procedural Sedation / Q000009:adverse effects* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: ASA status; Rapid Response Team; assessment and consultation team; perioperative complications; respiratory insufficiency