Abstract :

Background: A rising under-five perioperative death occurring especially in sub-Saharan Africa, despite global decline in child mortality over the last decade, necessitates a review of the contribution from anaesthesia-related causes.

Objective: To analyze the 5-year impact of Paediatric Anaesthesia Fellowship on anaesthesia-related child deaths in the University of Port Harcourt Teaching Hospital (UPTH).

Method: A five-year survey of all anaesthetic interventions and outcomes in children aged 0 to 5 years, in UPTH, was undertaken. Data including general or loco-regional anaesthesia for elective/emergency surgeries, sedation-analgesia for diagnostic radiology, the indications, perioperative critical events/child deaths up to 24 hours following anaesthesia, and their causes, were obtained from the registers and records of the relevant units in the UPTH, after ethical approval.

Results: Totally, 1596 anaesthetic interventions [987 (61.842%) electives; 609 (38.158%) emergencies] and outcomes were reviewed. General anaesthesia with endotracheal tube (GA + ETT) placement was the most frequent form of anaesthesia, administered to 1,075 (67.36%), and perioperative laryngospasm [49 (3.07%)] was the ranking critical event, followed by hypoxaemia, delayed recovery and difficult tracheal intubation respectively as the second, third and fourth, with the corresponding values of 34 (2.13%), 33 (2.07%) and 25 (1.57%); anaesthesia-related mortality was 1 (0.06%), occurring postoperatively from respiratory failure, following GA + ETT placement for elective abdominoplasty in a child with Prune-belly Syndrome.

Conclusion: Within the five-year period in this survey, anaesthesia-related child mortality was 1 (0.06%), occurring postoperatively from respiratory failure.

---

Keywords :

Anaesthesia, Child mortality, Paediatric anaesthesia training.

---

References :

1. Under-five mortality”. UNICEF December 2021. Archived from the original on 1 September 2022. Retrieved 2019-11-26.
2. Gonzalez LP, Pignaton W, Kusano PS, Modolo NS, Braz JR, Braz LG. Anesthesia-related mortality in pediatric patients: a systematic review. Clinics (Sao Paulo). 2012;67(4):381-387. Doi:10.6061/clinics/2012(04)12.
3. Paediatric Anaesthesia Training in Africa (PATA)-World Federation of Societies of Anaesthesilogists. Available at: https://wfsahq.org/OurWork/Education & Training. Accessed November 19, 2024
4. Morray JP, Geiduschek JM, Ramamoorthy C, Haberkern CM, Hackel A, Caplan RA, et al. Anaesthesia-relared cardiac arrest in children: initial findings of the Pediatric Perioperative Cardiac Arrest (POCA) Registry. Anesthesiology 2000;93(1):6 -14. doi: 10.1097/00000542-200007000-00007
5. United Nations. Transforming our world: The 2030 Agenda for Sustainable Development. 2015. General Assembly Resolution A/RES/70/1. Accessesd January16, 2026. Available from: https://sdgs.un.org/goals
6. Watters DA, Hollands MJ, Gruen RL, Maoate K, Perndt H, McDougall RJ, et al. Perioperative mortality rate (POMR): a global indicator of access to safe surfery and anaesthesia. World J Surg. 2015;39(4):856-864. doi: 10.1007/s00268-014-2638-4
7. Currie MA. A prospective survey of anaesthetic critical evnts in a teaching hospital. Anaesth Intensive care. 1989;17(4):403-411. doi: 10.1177/0310057X8901700402.
8. Bhanaker SM, Ramamoorthy C, Geiduschek JM, Posner KL, Domino KB, Haberkern CL, et al. Anaesthesia-related cardiac arrest in children: Update from the Pediatric Perioperative Cardiac Arrest Registry. Anesth Analg. 2007;105(2):344-350. doi: 10.1213/01.ane.0000268712.00756.dd
9. Sen I, Dave N, Bhardwaj N, Juwarkar C, Beegum S. Specialised training in paediatric anaesthesia training: Need of the hour. Indian J Anaesth. 2021;65(1):17-22. doi: 10.4103/ija.ija_1445_20.
10. Tudjegbe SO, Amadasun FE. What is anesthetic death? Ann Biomed Sci. 2010;9(1):25-28. doi: 10.4314/abs.v9i1.66579
11. Hasan MR, Sharmin T, Rickta D, Sharmin R, Gosh P. Complications of Anesthesia in Children: An Observational Study.EAS J Anesthesiol Crit Care.2025;7(4):60-66. doi: 10.36349/easjacc.2025.v07i04.001
12. Lee HH, Milgrom P, Starks H, Burke W. Trends in death associated with paediatric dental sedation and general anaesthesia. Paediatr Anaesth. 2013;23(8):741-746. doi: 10.1111/pan.12210
13. Hampson-Evans D, Morgan P, Farrar M. Pediatric Laryngospasm. Paediatr Anaesth. 2008;18:303-307. doi: 10.1111/j.1460-9592.2008.02446.x

14. Gavel G, Walker RWM. Laryngospasm in anaesthesia. 2014;14(2):47-51. doi: 10.1093/bjaceaccp/mkt031
15. Olsson GL, Hallen B. Laryngospasm during anaesthesia: a computer-aided incidence study in 136,929 patients. Acta Anaesthesiol. Scand. 1984;28(5):567-575. doi: 10.1111/j.1399-6576.1984.tb02121.x
16. Gulhas N, Durmus M, Demirbilek S, Togal T, Ozturk E, Ersoy MO. The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: a preliminary study. Paediatr Anaesth. 2003;13(1):43-47.doi: 10.1046/j.1460-9592.2003,00927.x
17. Harteveld LM, Nederend I, Ten Harkel ADJ, Schutte NM, de Rooij SR, Vrijkotte TGM. et al. Maturation of the Cardiac Autonomic Nervous System Activity in Children and Adol escents. J Am Heart Assoc. 2021;10(4):e017405. doi: 10.1161/JAHA.120.017405.

18. Marciniak B. growth and development. In: Cote CJ, Lerman J, Todres ID, editors. A Practice of Anaesthesia for Infants and Children. 4th ed. Philadelphia, PA: Saunders Elsevier;2009. p7-21
19. Bhammar DM, Wilhite DP, Olojo T, Alagappan K, Jones K, Liu Y-L, et al. Effects of Obesity and Sex on Supine Functional Residual Capacity and ExpiratoryFlow Limitation in Children. Pediatr Pulmonol. 2025;60(4):e71061. doi: 101002/ppul.71061

20. Edfast PJ, Frykholm P. Can the Introduction of a Preoxygenation Routine Reduce the Incidence of Desaturation During Induction In Children? Ann Pediatr. 2021;4(1):1052
21. Furlong-Dillard JM, Nguyen A, Facciolo MD, Feygin YB, Napolitano N, Emeriaud G, et al. Associations with Severe Desaturation Events Among Children Receiving Noninvasive Respiratory Support At Time of Intubation. Respir Care. 2023;68(12):1646-1656. doi: 10.4187/respcare.10765
22. Pokrajac N, Sbiroli E, Hollenbach KA, Kohn MA, Contreras E, Murray M. Risk Factors for Peri-intubation Cardiac Arrest in Pediatric Emergency Department. Pediatr Emerg Care. 2022;38(1):e126-e131. doi: 10.1097/PEC.0000000000002171
23. Abiodun MT, Oziegbe G, Mbarie IA, Osarogiagbon WO, Etin-Osa CE, Oluwafemi RO, et al. Incidence, severity and outcomes of hypoxaemia in paediatric emergencies seen at a tertiary hospital in Southern Nigeria. Int J Cont Paediatr. 2025;12(8):1289-1298. doi: 10.18203/2349-3291.ijcp20252209
24. Amaha E, Haddis L, Aweke S, Fenta E. The prevalence of difficult airway and its associated factors in pediatric patients who underwent surgery under general anesthesia.: An observational study. SAGE Open Med. 2021;20(9):20503121211052436. doi: 10.1177/20503121211052436
25. Li H, Jia X, Ye H, Liang J-W, Zhao W-L, Cui P, et al. Impact of lateral positioning on upper airway morphology in sedated children under five. World J Pediatr. 2025;21:587-596. doi: 10.1007/s12519-025-00910-w
26. Di Cicco M, Kantar A, Masini B, Nuzzi G, Ragazzo V, Peroni D. Structural and functional development in childhood: children are not small adults. Pediatr Pulmonol. 2021;56:240-251
27. Gharavi-Fard M, Taghavi-Gilani M, Kazemi S, Razavi M. Apneas in Infants with Postconceptional Age below 60 Weeks Undergoing Herniorrhaphy. Iran J Pediatr. 2014;24(2):178-183
28. Watterson LM, Morris RW, Westhorpe RN, Williamson JA. Crisis management during anaesthesia: bradycardia.Qual Saf Health Care.2005;14(3):7-14. doi: 10.1136/qshc.2002.004457
29. Wojtowitcz-Marzec M.The Foramen ovale from the fetal to neonatal life span. Pediatr Pol 2021;96(1):60-67   doi: 10.5114/POLP.2021.104830

30. Feriante J, Torrrico TJ, Bernstein B.Separation Anxiety Disorder. [Updated 2023 Feb26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing: 2025 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560793/
31. Abate SM, Nega S, Basu B, Tamrat K. Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regressionAnn Med Surg. 2022;74:103285. doi: 10.1016/j.amsu.2022.103285
32. Arbous MS, Meursing AE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, et al. Impact of anaesthesia management characteristics on severe morbidity and mortality. Anaesthesiology. 2005;102(2):257-268. doi: 10.1097/00000542-200502000-00005.