The Thai Anesthesia Incident Monitoring Study (Thai AIMS) of postoperative central neurological complications.

OBJECTIVE: To analyze the incidents of central neurological complication in the Thai Anesthesia Incident Monitoring Study (Thai AIMS). MATERIAL AND METHOD: A prospective descriptive multi-centered study of incident reports was conducted in 51 hospitals across Thailand from January to June 2007. Voluntary and anonymous reports of any adverse events during the first 24 hrs of anesthesia were sent to the Thai AIMS data management unit. Three anesthesiologists reviewed the possible central neurological complication reports. Descriptive statistics was used RESULTS: There were 16 relevant incident reports of central neurological complications (7 cases of convulsion, 5 cases of cerebro-vascular accident and 4 cases of coma). Majority of patients appeared to be old with underlying co-morbidities undergoing major surgical procedures under general anesthesia and required more intensive intra-operative monitoring. These complications occurred commonly with patients of orthopedics, cardiac, urologic and neurosurgical surgery. The majority of cerebro-vascular accident (80%) and coma (75%) were considered preventable. CONCLUSION: Inappropriate decision making and inexperienced anesthesiologists were common contributing factors while suggested corrective strategies were quality assurance activity, clinical practice guidelines and improvement of supervision.

The Thai anesthesia incident monitoring study (Thai AIMS): an analysis of perioperative myocardial ischemia/infarction.

OBJECTIVES: To analyze the clinical course, outcome, contributing factors and factors minimizing the incidents of perioperative myocardial ischemia or infarction (PMI) from Thai AIMS study. MATERIAL AND METHOD: The present study was a prospective multicenter study. Data was collected from 51 hospitals in Thailand during a six-month period. The participating anesthesia provider completed the standardized incident report form of the Thai AIMS as soon as they found the PMI incident. Each incident was reviewed by three peer reviewers for clinical courses, contributing factors, outcome and minimizing factors of PMI. RESULTS: From the Thai AIMS incident report, the authors found 25 suspected PMI cases which was 0.9% of the 2,669 incidents reported in the present study. Most of the PMI occurred in elective cases (84%) and orthopedic procedures (56%). The majority of PMI was reported from the patients undergoing general anesthesia (72%). Suspected PMI occurred mostly during operations (56%). New ST-T segment change was detected in 92% of these patients. The most common immediate outcome of PMI was major physiological change (88%). The most common management effect of PMI was unplanned ICU admission (64%); the others were prolonged ventilatory support (12%) and prolonged hospital stay (16%). Four patients (16%) died after the suspected PMI. Most of the events occurred spontaneously and were unpreventable (80%). Patient factors (100%), anesthesia factors (72%), surgical factors (32%) and system factors (8%) were all judged as a precipitating factor for PMI. Human factors were the most common contributing factors which included poor preoperative evaluation, inexperience and improper decision. The three most common factors minimizing the adverse incidents included prior experienced, high awareness and experienced assistance. The recommended corrective strategies were guideline practice, quality assurance activity, improvement of supervision and additional training. CONCLUSION: Perioperative myocardial ischemia/infarction was infrequent but may be lethal. Patient factors were the most common precipitating cause. The morbidity and mortality could be reduced by high quality preoperative evaluation and preparation, early detection and appropriate treatment. Guideline practice, quality assurance activity, improvement of supervision and additional training were suggested corrective strategies.

The Thai anesthesia incident monitoring study of perioperative allergic reactions: an analysis of 1996 incidents reports.

OBJECTIVES: Analyze the clinical course, management, outcome, and contributing factors of perioperative allergic reactions in the Thai Anesthesia Incident Monitoring Study (Thai AIMS). MATERIAL AND METHOD: A prospective descriptive multicenter study was conducted in 51 hospitals across Thailand Voluntary, anonymous reports of any adverse or undesirable events during the first 24 hours of anesthesia were sent to the Thai AIMS data management unit. Possible perioperative allergic reactions were extracted and examined independently by three peer reviewers. RESULTS: Forty-three reports of possible perioperative allergic reactions from the 2,537 incidents reported to the Thai AIMS (1.6%) were reviewed. There was a female predominance (1.9:1). The most common features were cutaneous manifestations (93%), arterial hypotension (20.1%), and bronchospasm (11.6%) respectively. The severity grades were 69.8% in grade I, 4.7% in grade II, and 25.6% in grade III. The three most suspected causative agents were neuromuscular blocking agents (39.5%, 30.2%-succinylcholine), antibiotics (27.9%), and opioids (18.6%) respectively. All but one responded well to treatment with complete recovery. One patient suffered acute myocardial infarction and had to stay at the hospital for longer than one week. None had further allergic reaction. CONCLUSION: Perioperative allergic reactions accounted for 1.6% of anesthetic adverse events. The most common features were cutaneous manifestations. A quarter of these were life-threatening but responded well to treatment. The most common suspected causative agent was succinylcholine.