The Thai Anesthesia Incidents Study (THAI Study) of ambulatory anesthesia: Part I: Method, geographic distribution and population.

BACKGROUND: There is a continuing trend to have more elective surgical operations performed on an outpatient basis. OBJECTIVE: To determine the proportional distribution of anesthetic procedures performed in ambulatory elective surgery at different levels of hospitals across Thailand. MATERIAL AND METHOD: A prospective and descriptive study was conducted at 20 hospitals comprising seven universities, five regional, four general and four district hospitals across Thailand Consecutive outpatients who were undergoing elective surgical operation were included and their relevant data were selected and extracted for summary by using descriptive statistics. RESULTS: From the database of 118,027 anesthetics performed for elective surgical operation, 7,786 (6.6%) were outpatients. According to this, 7,016 (90.1%) were practiced in university hospitals, 656 (8.4%) in regional or tertiary hospitals, 71 (9%) in general or provincial hospitals, and 43 (0.6%) in district hospitals. The frequency of the ambulatory anesthesia was higher in hospitals in the central region, especially in university hospitals in Bangkok than in other regions. The majority of cases (86%) received their initial pre-anesthetic evaluation in the operating room while 12% were evaluated at the outpatient office. About 28% of the cases presented with pre-anesthetic abnormal conditions. The relatively common pre-anesthetic diseases were hypertension, diabetes mellitus, anemia, arrhythmia, and asthma. CONCLUSION: From the results of the present study, the authors have concluded that the rate of expansion of ambulatory anesthesia in Thailand is relatively slow, and varies according to the type of hospital and its geographic region. This indicates further studies should be formally conducted to determine factors affecting the practice of ambulatory surgery in Thailand. A large proportion of patients receive initial pre-anesthetic evaluation in the operating room on the day of surgery. This indicates that a system of pre-anesthetic evaluation should be set up for outpatients such as a pre-anesthetic care clinic should be set up for outpatients.

Postoperative reintubation after planned extubation in Thai Anesthesia Incidents Study (THAI Study).

OBJECTIVE: To analyze precipitating causes, outcomes and corrective strategies especially anesthetic related factors associated with reintubation after planned extubation in anesthetic technique of general anesthesia with endotracheal intubation. DESIGN: Prospective observational study. MATERIAL AND METHOD: Incidents of reintubation after planned extubation 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: The total of two hundred and thirty four patients of reintubation after planned extubation (RAP) at the end of general anesthesia was reviewed in this study. The incidence of RAP was 27:10,000 and the incidence in the university hospital was similar to the tertiary and secondary care hospital. The incidence was increased in extreme age group (age < 1 and > 70 year). One hundred and fifty eight cases of RAP (67.5%) occurred in operating theater and recovery room which included 83 cases occurring within 10 minutes after extubation. The two most common primary diagnoses were upper airway obstruction and hypoventilation. Three main precipitating factors were residual effect of neuromuscular blocking and anesthetic agents (53-57%), upper airway obstruction (31%) and unstable hemodynamics (26.3%). Nearly half of RAP incidents occurring in the operating theater and recovery room were successful reextubation within six hours and 58-72 % of these two subgroups were complete recovery. The chance for prevention was more than 80% by additional training and supervision. CONCLUSION: More than 90% of RAP occurred in operating theater and recovery room were completely or partially related to anesthetic process. Incidence of RAP could be decreased by quality assurance process of recording, reporting and modeling care process together with increase individual experience.