The Thai Anesthesia Incident Monitoring Study (Thai AIMS) of oxygen desaturation in the post-anesthetic care unit.

OBJECTIVE: As part of the Thai Anesthesia Incident Monitoring Study (Thai AIMS), the present study was aimed to analyze the problems of oxygen desaturation in the post-anesthetic care unit in Thailand including clinical course, outcomes, contributing factors, and preventive strategies. MATERIAL AND METHOD: The authors prospectively collected incident reports of oxygen desaturation in the post-anesthetic care unit between January and June 2007 from 51 studied hospitals across Thailand Clinical characteristics, outcomes, and contributing factors were recorded. All data were analyzed to identify contributing factors and preventive strategies. RESULTS: Eighty-six of post-anesthetic oxygen desaturation incidents were reported Forty-six cases (53.5%) were diagnosed by pulse oximetry. Forty-eight cases (55.8%) were immediately detected within a minute upon arrival at the PACU. Thirty-one cases (36%) were caused by inadequate awakening. Eighty-two cases (95.3%) were anesthesia-related and preventable. The major clinical outcomes were re-intubation (51 cases; 59.3%), prolonged artificial ventilation (23 cases; 26.7%), unplanned ICU admission (16 cases; 18.6%), and prolonged hospital stay (3 cases; 3.5%). Sixty-three patients (73.3%) recovered completely within 24 hours but one died. Judgment error and lack of adequate patient evaluation were the two most common contributing factors that were minimized by high awareness and prior experience. Main strategies suggested to prevent the incidents included the development of specific guideline and quality assurance. These incidents did not effectively decrease when labor was increased. CONCLUSION: Post-anesthetic oxygen desaturation was frequently found during the transport period. It can cause morbidity and mortality. Anesthesia providers should be aware of these potential incidents and strictly follow guidelines.

The Thai anesthesia incidents study (THAI Study) of perioperative death in geriatric patients.

BACKGROUND: The study was part of the Thai Anesthesia Incidents Study (THAI Study), a multi-centered study conducted by the Royal College of Anesthesiologists of Thailand, aiming to survey anesthetic related complications in Thailand. OBJECTIVE: Identify the incidence and factors related to perioperative death in geriatric patients. Material and Method: During a 12 months period (March 1, 2003 - February 28, 2004), a prospective multicenter descriptive study conducted in 20 hospitals comprising of seven university, five tertiary, four general and four district hospitals across Thailand. Anesthesia personnel filled up patient-related data, surgical-related, and anesthesia related variables and adverse outcomes of geriatric patients (age > or =65 yr) on a structured data entry form. The data were collected during pre-anesthetic, intra-operative, and 24 hr post operative periods. RESULTS: The overall mortality was 39.3 per 10,000 anesthetics from the registry of 23,899 geriatric patients receiving anesthesia. Multiple regression analysis showed that higher American Society of Anesthesiologists (ASA) physical status grading (p < 0.001), emergency operation (p = 0.031) and current medications (p = 0.043) were factors related to 24 hr perioperative death in geriatric patients. Patient's underlying diseases and duration of operations were not significantly related to death. CONCLUSION: The present study showed an incidence of 24-hr perioperative death of 1:254 in geriatric patients receiving anesthesia, which is comparable to other countries. Mortality in elderly patients operated under anesthesia can be predicted by ASA physical status, current medications, and emergency condition.