Perioperative myocardial ischemia/infarction: study of incidents from Thai Anesthesia Incidence Study (THAI Study) of 163,403 cases.

OBJECTIVES: To analyze incidence, risk factors, clinical course, outcomes of PMI. Degree of anesthesia related to PMI, management, precipitating factors and corrective strategies. MATERIAL AND METHOD: PMI cases were extracted from the Thai Anesthesia Incidents Study (THAI Study) database conducted between February 1, 2003 and January 31, 2004, and analyzed using descriptive statistics. RESULTS: Forty-five cases were recorded as PMI (Suspected myocardial ischemia/infarction) from 20 hospital study centers. The incidence was 2.7:10,000 of all anesthetic services (163,403 cases). PMI occurred more frequently in male, underlying disease of hypertension, diabetes mellitus, ischemic heart disease, ASA class >2, under general anesthesia and during operation. EKG change and hypotension were primary clinical symptoms. PMI caused high mortality (5 cases), high morbidity (6 cases of brain death), high medical cost and change of management plan. CONCLUSION: PMI was strongly impact to both anesthetic and surgical outcomes. Improve quality of anesthetic care for patient at risk and surgical risk reflected the whole anesthetic quality of care.

The Thai Anesthesia Incidents Study (THAI Study) of pulmonary aspiration: a qualitative analysis.

OBJECTIVES: To examine the risk factors, outcomes, and contributing factors associated with perioperative pulmonary aspiration. MATERIAL AND METHOD: Pulmonary aspiration incidents were extracted from the Thai Anesthesia Incidents Study (THAI Study) database conducted between March 1, 2003, and February 28, 2004, and analyzed using descriptive statistics. RESULTS: Thirty-two incidents of aspiration were reported. Passive regurgitation occurred more frequently than active vomiting. Aspiration occurred more commonly in elective rather than emergency surgery, with 59% of incidents taking place during the induction of anesthesia and intubation period. While a major immediate physiological disturbance was common, long term morbidity was not. Death ensued in 5 cases, most of which had significant co-morbidities. Most cases (62.5%) were appropriately treated. The majority of incidents occurred in ASA class 2 (56.3%), age group 15-64 years (59.4%), non obese (92.9%) and non-difficult intubation (71.9%). Most cases were incomplete fasted or had prolonged gastric emptying time. Nasogastric aspiration and rapid sequence induction with cricoid pressure were infrequently used (12.5, 25%). Factors reported as contributing to the incidents included failure of technique and error of judgement. Additional training, continuing medical education and quality assurance tended to minimize the incidents. CONCLUSION: Aspiration occurred commonly in patients with incomplete fasted or had prolonged gastric emptying time and underwent elective surgery. Additional training, continuing medical education and quality assurance tended to minimize the incidents.