Incidence of Anesthesia-Associated Cardiac Arrest And Related Factors At Srinagarind Hospital

Objective:  To identify the incidence of anesthesia-related cardiac arrest complications and related factors.Design:  Prospective, descriptive study.Methods:  This was part of a multi-center study conducted by the Thai Royal College of Anesthesiologists for surveillance of anesthetic-related complications in Thailand in 2003.  We collected data from all of the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, to report the incidence of cardiac arrest and analyze the causes in order to improve the quality of service.  Events of cardiac arrest were reported by the attending anesthesia personnel and anesthesiologists.  All the forms were checked and verified by the principal author then included in the study.Results:  10,601 patients were included in this study.  The incidence of cardiac arrest was 47 (44.33 per 10,000 95%CI 32.59, 58.91).  The most common cause was hypotension (53.19%) while contributing factors included emergency situation (29.67%), poor patient preparation (16.48%), lack of experience (15.38%) and inappropriate decision-making (12.09%). The suggested corrective strategies were quality assurance activity and additional training.Conclusion:  The most common cause of cardiac arrest during anesthesia at Srinagarind Hospital was hypotension from massive blood loss.  Preventive and corrective strategies would include quality assurance activities that involve personnel development and the provision of sufficient equipment.

Survey the problems with daily anesthetic machine-checking at Srinagarind Hospital

Objective:  1) To study the process of daily checking the anesthetic machine in the Department of Anesthesiology at Srinagarind Hospital; and 2) to assess what might be interfering with the standard daily checking of the equipment including problems and opinions about guideline.Design:  Descriptive study.Methodology:  The Anesthesiology Department personnel included in the study were anesthetic residents, nurse anesthetists and training anesthetic nurses (working between October and December, 2004.) The questionnaire used asked for:  1) frequency of daily anesthetic machine-checking; 2) problems in checking and the causes of those problems; and, 3) suggestions.  The data were analyzed for percentages.Results:  Most (92.9%) of the personnel in the Department of Anesthesiology were concerned about the daily anesthetic machine checking before anesthetizing patients so most checked the equipment by themselves.  The most common check was the “leakage of circuit test” (85.7%) followed by the “O2, Air, N2O bobbin and APL valve” (83.9%).  The least checked aspect was the “O2 cylinder supply check” (37.5%).  The most common causes for not checking the equipment were: 1) forgetting, 2) busy, 3) thinking it unnecessary, 4) thinking it already done by other staff and 5) insufficient equipmentConclusion:  Personnel in the Anesthesiology Department were concerned about the daily checking of the anesthetic equipment and most checked it by themselves before using it on patients.  Some staff, however, did not check the equipment for a number of untenable reasons. The most common causes were: forgetting, busy, thinking it unnecessary and thinking it already done by other staff. In order to guarantee high quality service by the Department a more systematic approach to daily checking must be implemented.Keywords:   Anesthesia, anesthetic machine; daily checking